Valvular & structural heart disease
Quantifying the Survival Loss Linked to Late Therapeutic Indication in High-Gradient Severe Aortic Stenosis
Authors' conclusion
Guideline-based Class I triggers for AVR in HGSAS have profound consequences on long-term postoperative survival, suggesting that HGSAS patients should undergo AVR before trigger onset.
Study context
- Population
- Patients operated (aortic valve replacement (AVR)) for high-gradient severe AS
- Participants
- 2,030 patients
- Exposure
- AVR with Class I triggers vs without Class I triggers
- No Class I triggersn = 853reference
- Symptomsn = 965
- Left ventricular ejection fraction (LVEF) <50%n = 212
- Outcome
- Long-term postoperative survival
- Follow-up
- 10 years
Methodological detailsinverse probability weighting
- Inverse probability weighting
Main finding
As reported in the abstract
Ten-year survival
Each group vs no Class I triggersHazard ratio (95% CI)
Symptoms
1.45(1.15–1.82)
LVEF <50%
1.47(1.05–2.06)
Observational data: associations, not effects.
Further findings
Survival vs general population, by LVEF · 10 years
- AVR with LVEF >60%: outcomes similar to general population; LVEF <60%: 10-year postoperative survival penalty
Restricted mean survival time loss vs asymptomatic patients with LVEF >60% · 10 years
- Symptomatic patients: survival loss
- 8.3-month
- LVEF <60%: survival loss
- 11.4-month
Original publication
Quantifying the Survival Loss Linked to Late Therapeutic Indication in High-Gradient Severe Aortic Stenosis. JACC Adv. Published 8 February 2024. doi:10.
Summarised from the published abstract; every number is checked against it