Survival Benefit of Aortic Valve Replacement in Patients With Severe Aortic Stenosis With Low Ejection Fraction And Low Gradient With Normal Ejection.

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Survival Benefit of Aortic Valve Replacement in Patients With Severe Aortic Stenosis With Low Ejection Fraction And Low Gradient With Normal Ejection Fraction Ramdas G. Pai, MD, Padmini Varadarajan, MD, Anees Razzouk, MD The Annals of Thoracic Surgery Volume 86, Issue 6, Pages 1781-1789 (December 2008) DOI: 10.1016/j.athoracsur.2008.08.008 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The Kaplan-Meier survival curves of low ejection fraction (EF ≤ 0.35) patients with and without aortic valve replacement. (n = 194; AVR = aortic valve replacement.) The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Results of sensitivity analysis in low ejection fraction group. (A) ≤ 30 days eliminated; (B) ≤ 365 days eliminated. (AVR = aortic valve replacement.) The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Effect of aortic valve replacement (AVR) on survival in patients with an ejection fraction ≤ 0.20 (n = 72). The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Effect of aortic valve replacement (AVR) on survival as a function of mean transaortic gradient in low EF patients. (A) EF ≤ 0.35, MG ≤ 30 mm Hg; (B) EF ≤ 0.35, MG > 30 mm Hg. (EF = ejection fraction; MG = mean gradient.) The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Kaplan-Meier survival curves of patients with without aortic valve replacement (AVR) in severe aortic stenosis patients with transvalvular gradients of ≤ 30 mm Hg. The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Sensitivity analysis with persistent aortic valve replacement (AVR) benefit with patients with events until 2 years eliminated in the low gradient group. (A) Patients events in ≤ 30 days eliminated; (B) Patients events in ≤ 90 days eliminated; (C) Patients events in ≤ 1 year eliminated; (D) Patients events in ≤ 2 years eliminated. The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Effect of aortic valve replacement (AVR) on survival as a function of left ventricular ejection fraction (EF) in the low gradient group. (A) Severe aortic stenosis (AS), low gradient, EF < 0.35; (B) severe AS, low gradient, EF 0.35 to 0.54; (C) Severe AS, low gradient, EF ≥ 0.55. (AS = aortic stenosis.) The Annals of Thoracic Surgery 2008 86, 1781-1789DOI: (10.1016/j.athoracsur.2008.08.008) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions