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Cited by 208Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesCongenital Heart Disease Studies

Survival after valve replacement for aortic stenosis: Implications for decision making

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Mihaljevic, Tomislav, Nowicki, Edward R., Rajeswaran, Jeevanantham, Blackstone, Eugene H., Lagazzi, Luigi, Thomas, James, Lytle, Bruce W., Cosgrove, Delos M.·2008·The Journal of Thoracic and Cardiovascular Surgery
DOI 10.1016/j.jtcvs.2007.12.042
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Abstract

Objective Recommendations for aortic valve replacement in severe aortic stenosis are based primarily on the presence of symptoms. However, the onset of symptoms is often insidious, potentially leading to delayed intervention and suboptimal results. Identifying factors that reduce the survival of patients undergoing aortic valve replacement could lead to revised treatment guidelines and improved outcomes.Methods We conducted a single-center observational clinical study of 3049 patients with aortic stenosis who underwent native aortic valve replacement with a single type of bioprosthesis. The primary end point was all-cause mortality from the date of operation. Multivariable analysis of risk factors for death was performed in the multiphase hazard function domain.Results The presence of severe left ventricular hypertrophy at operation, which preceded symptoms in 17% of patients, was associated with decreased survival. This effect was magnified by the severity of aortic stenosis (P = .02) and use of small prostheses (P = .01). The presence of left ventricular dysfunction reduced survival (P = .0003). Although older age was a risk factor for death (P < .0001), elderly patients had survival comparable to their age, race, and sex-matched cohorts, whereas younger patients had worse than expected survival that was further diminished with insertion of a small prosthesis (P = .01).Conclusion To optimize survival, earlier aortic valve replacement should be considered even in asymptomatic patients before severe left ventricular hypertrophy or dysfunction develops. In younger patients, the largest possible prosthesis should be implanted to minimize residual gradient; in elderly patients, complex operations just to insert larger prostheses should be avoided.

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  • The LV response to chronic pressure overload from aortic stenosis is characterized by hypertrophic remodelling with myocyte hypertrophy and fibrosis, and by diastolic and systolic dysfunction.

    “The LV response to chronic pressure overload from AS is characterized by hypertrophic remodelling (myocyte hypertrophy and fibrosis) and diastolic and systolic dysfunction.”

    From Calcific aortic stenosis (2016) · cites this paper as [257]

    The “Severity of Aortic Stenosis” section (page unavailable) says chronic pressure overload causes concentric LV hypertrophy and associates severe hypertrophy with fibrosis and possible systolic or diastolic dysfunction. It does not specifically identify myocyte hypertrophy, and it presents dysfunction as a possible consequence of severe hypertrophy rather than a general feature of the LV response. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • This LV response considerably influences the morbidity and mortality of aortic stenosis.

    “In many ways, this LV response considerably influences the morbidity and mortality of the disease199;257–260.”

    From Calcific aortic stenosis (2016) · cites this paper as [257]

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Research works printed but not linked: 1

  1. [14]14. Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL. De- creased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med. 1982;307:1362-6.

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Authors
Mihaljevic, T., Nowicki, E. R., Rajeswaran, J., Blackstone, E. H., Lagazzi, L., Thomas, J., Lytle, B. W., & Cosgrove, D. M.
Affiliations
Cleveland Clinic (US)
ORCID
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
2008-06
Volume
135
Issue
6
Pages
1270-1279.e12
ISSN
0022-5223 (ISSN-L)
DOI
10.1016/j.jtcvs.2007.12.042
OpenAlex
W2165651395
Cited by
208
References
35
Citations by year
2026: 5 · 2025: 4 · 2024: 9 · 2023: 11 · 2022: 7 · 2021: 12 · 2020: 12 · 2019: 11 · 2018: 12 · 2017: 16 · 2016: 8 · 2015: 15 · 2014: 5 · 2013: 13 · 2012: 18
FWCI
12.13
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
Keywords
aortic stenosis, aortic valve replacement, bioprosthetic heart valves, survival, left ventricular hypertrophy, left ventricular dysfunction, asymptomatic patients, prosthesis sizing, all-cause mortality, risk factors, treatment decision-making, elderly patients
MeSH terms
Adult, Aged, Aortic Valve Stenosis, Bioprosthesis, Cardiopulmonary Bypass, Cause of Death, Decision Making, Female, Heart Valve Prosthesis, Humans, Male, Middle Aged, Ohio, Postoperative Complications, Probability, Prosthesis Failure, Retrospective Studies, Severity of Illness Index, Echocardiography, Doppler, Cohort Studies, Multivariate Analysis, Proportional Hazards Models, Survival Analysis, Risk Assessment, Heart Valve Prosthesis Implantation

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