Article Text

Download PDFPDF
86 Long-term outcome of critical aortic valve stenosis
  1. Bea Bonello1,
  2. Michelle Carr1,
  3. Richard Issitt1,
  4. Marina Hugues2,
  5. Alessandro Giardini1,
  6. Xavier Iriart3,
  7. Victor Tsang1,
  8. Martin Kostolny1,
  9. Sachin Khambadkone1,
  10. Jan Marek4
  1. 1GOSH
  2. 2Papworth University
  3. 3CHU Bordeaux


Background Survival with critical aortic valve stenosis (CAS) can be successfully achieved in the short term. Long-term outcome however remains uncertain. We sought to study the long-term survival and reinterventions; exercise capacity and myocardial performance in a subgroup of long-term survivors.

Methods Retrospective over 40 years of all patients (n=96) requiring intervention for CAS. A subgroup (n=25) of long-term survivors underwent cardiopulmonary exercise test, echocardiography and magnetic resonance imaging.

Results Mean age at first intervention was 9±7.5 days. Early death occurred in 19 (19.8%) and overall reported death was 29 (32.9%). At 20 years, survival rate was 65.8% and freedom from reintervention was 24% (figure 1A and 1B).

Abstract 86 Figure 1

A) Kaplan Meyer curve of survival. B) Kaplan Meyer of freedom from reintervention

Median age of our long-term survivors, median age was 15.7±6.4 years, 16(64%) had a Ross procedure and 3(12%) had a mechanical aortic valve. Sixteen patients were in NYHA I, 3 NYHA II, 6 NYHA III. Overall peak VO2 was mildly depressed (84.6±24% predicted; 32.1±8.2 ml/kg/min), normal in 9(45%), severely depressed in 6 (30%). Mean left ventricle (LV) ejection fraction was 65.5±11.22% and mean LV end-diastolic volume Z score was 0.02±1.4. Mean LV outflow tract Vmax was 2.27±1.17 m/s. Four patients (16%) had moderate aortic regurgitation. Mean right ventricular outflow gradient was 19.23±23.57 mmHg. Five patients (20%) had severe LV diastolic dysfunction on echocardiography and confirmed by invasive measurement. Severe diastolic dysfunction was not associated with an older age (p=0.15), small ventricular dimension (p=0.2) or residual obstruction (p=0.39) but was associated with the presence of endocardial fibroelastosis (p=0.00014).

Conclusions After an early mortality, long-term survival of patients with critical aortic stenosis is good at the expense of a high rate of reinterventions. Despite a good clinical status, myocardial assessment revealed a high rate of LV diastolic dysfunction that could be a marker of irreversible intrinsic myocardial damage.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.