Abstract 17470: Comparison of Outcomes for Adult Patients With Subaortic Stenosis by Surgical or Medical Management: Single-Center Cohort Study

Abstract

Introduction: Surgery is recommended subaortic stenosis (SAS) patients with severe left ventricular outflow tract obstruction and symptoms, left ventricular dysfunction and sometimes aortic regurgitation, although how surgery modifies patient prognosis is not well understood. We compared the outcomes of SAS based on past and follow-up treatment disposition. Methods: This is a retrospective observation study of adult patients (≥ 18 years) evaluated for SAS on transthoracic echocardiography at our institution during 1/1/2001 to 6/30/2022. Patients were divided into three groups: 1. Patients with prior SAS surgery at index visit; 2. Patients who underwent surgery during follow-up without prior SAS surgery; and 3. Patients managed medically. Primary follow-up endpoint all-cause mortality and secondary endpoint heart failure (HF) hospitalization were compared between groups. Results: There were a total of 115, 106, and 263 patients in group 1, 2, and 3 respectively. The mean age was 45.7±20 years and 67.1% were females. Over median follow-up of 5.5 years, there were 8, 6 and 42 deaths, 3, 9 and 21 heart failure hospitalization, and 20, 15, and 25 SAS recurrences in groups 1, 2, and 3, respectively. Multivariate analysis showed that patients with shortness of breath (odds ratio 3.64, 95% confidence interval 1.20-11.05, P=0.02) and those who are treated medically (1.77 (1.03-3.05), P=0.03) are associated with higher rates of composite death and HF hospitalization. The figure illustrates the Kaplan-Meier survival curves for the primary and secondary endpoint. Group 3 had significantly worse all-cause mortality (P=0.04) and heart failure hospitalization (P=0.03) rates during follow-up. Conclusions: The cohort of adult SAS patients that were managed medically were associated with worse prognosis.