Abstract 13161: Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic/minimally Symptomatic Patients With Severe Bioprosthetic Aortic Stenosis Undergoing Redo Aortic Valve Replacement

Abstract

Introduction: With improved survival of patients undergoing primary bioprosthetic aortic valve replacement (AVR), reoperation to relieve severe prosthetic aortic stenosis (PAS) is increasing. Timing of redo surgery in asymptomatic/minimally symptomatic patients remains controversial. Left ventricular global longitudinal strain (LV-GLS) is a marker of subclinical LV dysfunction. In asymptomatic/minimally symptomatic patients with severe PAS undergoing redo AVR, we sought to determine if LV-GLS provides incremental prognostic utility. Methods: We studied 191 patients with severe bioprosthetic PAS (63±16 years, 58% men) who underwent redo-AVR between 2000-12 (excluding mechanical PAS, severe other valve disease transcatheter AVR, LV ejection fraction <50%). Society of Thoracic Surgeons (STS) score was calculated. Standard echocardiography data was obtained. LV-GLS was measured on 2, 3 and 4-chamber views using Velocity Vector Imaging. Severe PAS was defined as AV area <0.8 cm 2 , mean AV gradient ≥40 mm Hg and/or dimensionless index <0.25. A composite outcome of death and congestive heart failure (CHF) admission was recorded. Results: At baseline, mean STS score, LV ejection fraction, mean AV gradients, right ventricular systolic pressure (RVSP) were 7±6, 58±6%, 54±10 mm Hg and 40±14 mm Hg, while 50% had >II+ aortic regurgitation (AR). Median LV-GLS was -14.2% [-11.4, -17.1%]. At 4.2±3 years, 41 (22%) patients met the composite endpoint. The results of the multivariable Cox analysis are shown in Table 1. Kaplan-Meier survival curves separated based on median LV-GLS are shown in Figure 1. Incremental prognostic utility of LV-GLS over established predictors is shown in Figure 2. Conclusions: In asymptomatic/minimally symptomatic patients with severe bioprosthetic PAS undergoing redo AVR, baseline LV-GLS provides incremental prognostic utility over established predictors; and could potentially aid in surgical timing and risk stratification.