Healio
Healio
March 13, 2015
1 min read
Save

AVR operative risk higher for patients with low ejection fraction, paradoxical low flow

In a study of patients with severe aortic stenosis who underwent aortic valve replacement, those with low ejection fraction and paradoxical low flow had increased 30-day mortality compared with normal flow.

Researchers compared outcomes after AVR with or without CABG (n = 1,154). Eighteen percent of patients had left ventricular ejection fraction less than 50%; 28% had paradoxical low flow, defined as LVEF of at least 50%, but stroke volume indexed to body surface area of 35 mL/m-2 or less; and 54% had normal flow, defined as LVEF of at least 50% and stroke volume index greater than 35 mL/m-2.

The 30-day mortality rate was 6.3% for patients with low EF vs. 6.3% for patients with paradoxical low flow vs. 1.8% for patients with normal flow (P < .001). At 5 years, overall surgical was 72 ± 4% for patients with low EF vs. 81 ± 2% for patients with paradoxical low flow vs. 85 ± 2% for patients with normal flow (P < .0001).

Independent predictors of any mortality included older age (P < .0001), NYHA class III or IV HF (P = .005) and chronic kidney failure (P = .002). Independent predictors of operative mortality included stroke volume index (OR = 1.18; P < .05) and paradoxical low flow (OR = 2.97; P = .004); however, stroke volume index or paradoxical low flow were not association with midterm mortality in a multivariable analysis.

Mean aortic valve area of 0.71 ± 0.2 cm2 for patients with low EF vs. 0.65 ± 0.23 cm2 for patients with paradoxical low flow vs. 0.77 ± 0.18 cm2 for patients with normal flow (P < .001).

Other results indicated that low EF and normal flow were associated with increased rates of low output syndrome and use of intra-aortic balloon pumps.

“Consideration of [stroke volume index] may be useful to enhance operative risk stratification prior to [AVR] and improve decision making between surgical and transcatheter [AVR],” the researchers concluded. “Further studies are needed to determine whether outcomes of patients with [paradoxical low flow] are better with transcatheter [aortic valve replacement] or surgical [aortic valve replacement].” – by Rob Volansky

Disclosure: The researchers report no relevant financial disclosures.

Sources/Disclosures

Collapse
Source: Clavel MA, et al. J Am Coll Cardiol Intv. 2015;doi:10.1016/j.jacc.2014.11.047.