Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score-Matched Retrospective Cohort Study

  • Kyu Kim (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Iksung Cho (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Kyu-Yong Ko (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Seung-Hyun Lee (Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Sak Lee (Department of Cardiothoracic Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Geu-Ru Hong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Jong-Won Ha (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Chi Young Shim (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2023.01.23
  • Accepted : 2023.06.18
  • Published : 2023.11.01
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Abstract

Background and Objectives: Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. Methods: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m2, mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm2) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. Results: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29-0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23-1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19-0.95, p=0.037). Subgroup analyses supported the main findings. Conclusions: An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS. Future randomized studies are required to validate and confirm our findings.

Keywords

Acknowledgement

The authors would like to thank Medical Illustration & Design, part of the Medical Research Support Services of Yonsei University College of Medicine, for all artistic support related to this work.

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