Abstract 16541: Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score-Matched Retrospective Cohort Study

Introduction: Aortic valve replacement (AVR) is a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence of the benefit of early AVR in symptomatic patients with normal-flow, low-gradient (NFLG) severe AS.

Hypothesis: Early AVR has benefit in patients with NFLG severe AS

Methods: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥ 35 mL/m ² , mean transaortic pressure gradient < 40 mmHg, peak transaortic velocity < 4 m/s, and aortic valve area < 1.0 cm ² ) between January 2010 and December 2020 were retrospectively reviewed. After 1:1 propensity score matching, 121 patients aged 75.1 ± 9.8 years (including 63 women) who underwent early AVR within three months after index echocardiography were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure hospitalization.

Results: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group presented a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29-0.93; P = 0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23-1.16; P = 0.110), although the early AVR group showed a significantly lower incidence of hospitalization for heart failure (HR, 0.43; 95% CI, 0.19-0.95, P = 0.037). Subgroup analyses supported the main findings.

Conclusions: An early AVR strategy may benefit guard against a composite outcome of death or hospitalization for heart failure in symptomatic patients with NFLG severe AS. Future randomized studies must confirm our findings.