PMID- 24200400 OWN - NLM STAT- MEDLINE DCOM- 20140428 LR - 20140303 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 97 IP - 3 DP - 2014 Mar TI - Impact of preoperative symptoms on postoperative survival in severe aortic stenosis: implications for the timing of surgery. PG - 803-9 LID - S0003-4975(13)01995-4 [pii] LID - 10.1016/j.athoracsur.2013.08.059 [doi] AB - BACKGROUND: The impact of symptoms on the natural history of patients with severe aortic stenosis (SAS) has been well documented. By contrast, the implications of preoperative symptoms on postoperative outcomes remain poorly defined. METHODS: The long-term survival of 812 patients greater than 65 years old with SAS undergoing bioprosthetic aortic valve replacement (AVR) was analyzed according to their preoperative symptoms. RESULTS: Operative mortality was larger in New York Heart Association (NYHA) III-IV than in NYHA I-II patients (10% vs 6%, p = 0.036). Abrupt symptomatic deterioration from NYHA I to NYHA III-IV within the month preceding surgery was observed in 18% of NYHA III-IV patients and resulted in an increased operative mortality (17% vs 5% in NYHA I, p = 0.035). Long-term survival was also significantly worse in NYHA III-IV than in NYHA I-II patients (56% vs 72%, p = 0.002). Reduced long-term survival of NYHA III/IV patients was observed in subgroups with a left ventricular ejection fraction (LVEF) 0.50 or greater (58 vs. 74%, p = 0.008) and in those with a systolic pulmonary artery pressure (SPAP) less than 40 mm Hg (60% vs 74%, p = 0.014). By contrast, the presence of class III-IV symptoms did not influence outcome in patients with a LVEF less than 0.50 (51 vs. 55%, p = 0.34) or with a SPAP 40 mm Hg or greater (43% vs 48%, p = 0.78). CONCLUSIONS: In patients with SAS, preoperative NYHA III-IV symptoms, particularly of recent onset, are independently associated with excess short- and long-term postoperative mortality. This was particularly evident in patients with normal LV function or pulmonary artery pressures. These findings plead in favor of an earlier surgical correction of SAS, before the onset of severe symptoms, especially in low-risk patients. CI - Copyright (c) 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Pierard, Sophie AU - Pierard S AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - de Meester, Christophe AU - de Meester C AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Seldrum, Stephanie AU - Seldrum S AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Pasquet, Agnes AU - Pasquet A AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Gerber, Bernhard AU - Gerber B AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Vancraeynest, David AU - Vancraeynest D AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Robert, Annie AU - Robert A AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - El Khoury, Gebrine AU - El Khoury G AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Noirhomme, Philippe AU - Noirhomme P AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. FAU - Vanoverschelde, Jean-Louis AU - Vanoverschelde JL AD - Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain; and Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address: jean-louis.vanoverschelde@uclouvain.be. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20131105 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM CIN - Ann Thorac Surg. 2014 Mar;97(3):809-10. PMID: 24580902 MH - Aged MH - Aortic Valve Stenosis/*mortality/*surgery MH - Female MH - *Heart Valve Prosthesis Implantation MH - Humans MH - Male MH - Postoperative Period MH - Preoperative Care MH - Prospective Studies MH - Severity of Illness Index MH - Survival Rate MH - Time Factors EDAT- 2013/11/10 06:00 MHDA- 2014/04/29 06:00 CRDT- 2013/11/09 06:00 PHST- 2013/05/28 00:00 [received] PHST- 2013/08/21 00:00 [revised] PHST- 2013/08/27 00:00 [accepted] PHST- 2013/11/09 06:00 [entrez] PHST- 2013/11/10 06:00 [pubmed] PHST- 2014/04/29 06:00 [medline] AID - S0003-4975(13)01995-4 [pii] AID - 10.1016/j.athoracsur.2013.08.059 [doi] PST - ppublish SO - Ann Thorac Surg. 2014 Mar;97(3):803-9. doi: 10.1016/j.athoracsur.2013.08.059. Epub 2013 Nov 5.