Abstract 12749: Aortic Valve Replacement in Mixed Aortic Valve Disease-Beyond Ejection Fraction

Abstract

Introduction: There are limited data about outcomes after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) population Hypothesis/objectives: To determine the risk factors for cardiovascular adverse event (CAE) after AVR in patients wit moderate-severe MAVD Methods: Review of patients with moderate-severe MAVD (combination of ≥moderate aortic stenosis and ≥moderate aortic regurgitation) who underwent AVR at Mayo Clinic, 1994-2014. CAE was defined as stroke, heart failure hospitalization, severe left ventricular (LV) dysfunction or cardiac death. Results: AVR was performed in 283 patients, age 67±5 years, follow-up 9±3 years, men 206 (73%). A bioprosthetic valve was implanted in 151 (57%), aorta replacement in 75 (27%) and coronary artery bypass grafting in 89 (31%). There were 5 perioperative deaths (2%). CAE occurred in 69 (24%) (stroke 22, heart failure hospitalization 28, severe LV dysfunction 46, and cardiac death 26). Only one event was counted per patient. The multivariable predictors of CAE were relative wall thickness >0.46 (hazard ratio [HR] 3.24, 95% confidence interval [CI] 1.25-5.33, P =.001), LV mass index >180 g/m 2 (HR 1.79, 95% CI 1.32-2.63, P =.02), and LV ejection fraction <50% (HR 1.48, 95% CI 1.11-2.59, P =.04). The presence of RWT > 0.46 reliably predicted postoperative CAE with sensitivity of 78% and specificity of 88%. Conclusions: Preoperative LV hypertrophy was the strongest predictor of CAE after AVR in patients with MAVD. Perhaps it should be taken into consideration when determining the timing of AVR. Legends Kaplan-Meier curves showing cardiovascular adverse event (CAE) occurrence (A) CAE rates in the entire cohort; (B) CAE rates in patients with RWT >0.46 (blue) vs RWT ≤0.46 (red); (C) CAE rates in patients with LVMI >180 g/m 2 (green) vs RWT ≤180 g/m 2 (yellow); (D) CAE rates in patients with LVEF < 50% (purple) vs RWT ≥50% (light blue).