New article published: Vancraeynest et al, 2024

Congratulations to Prof. Vancraeynest and colleagues on the publication of their paper on survival loss in patients with severe high-gradient aortic stenosis (SHGAS) in the journal JACC: Advances. We are happy to have contributed to the success of this article!

𝐀𝐨𝐫𝐭𝐢𝐜 𝐯𝐚𝐥𝐯𝐞 𝐬𝐭𝐞𝐧𝐨𝐬𝐢𝐬 (AVS) affects 5% of adults aged >65 and is associated with a 𝐡𝐢𝐠𝐡 𝐦𝐨𝐫𝐭𝐚𝐥𝐢𝐭𝐲 𝐫𝐚𝐭𝐞 in the absence of adequate treatment. The treatments are pharmacological and surgical, and a growing more and more patients undergo 𝐚𝐨𝐫𝐭𝐢𝐜 𝐯𝐚𝐥𝐯𝐞 𝐫𝐞𝐩𝐥𝐚𝐜𝐞𝐦𝐞𝐧𝐭 (AVR). Learning societies recommend AVR for patients with SHGAS who are symptomatic or have a left ventricular ejection fraction (LVEF) <50%. However, the association between waiting for the onset of these two 𝐂𝐥𝐚𝐬𝐬 𝐈 𝐭𝐫𝐢𝐠𝐠𝐞𝐫𝐬 and the impact on 𝐩𝐨𝐬𝐭-𝐨𝐩𝐞𝐫𝐚𝐭𝐢𝐯𝐞 𝐬𝐮𝐫𝐯𝐢𝐯𝐚𝐥 is poorly understood.

The authors studied a cohort of 2,030 operated patients with SHGAS. They were divided into 𝐭𝐡𝐫𝐞𝐞 𝐠𝐫𝐨𝐮𝐩𝐬: those with neither Class I triggers, those with symptoms and an LVEF >50% and those with an LVEF <50%, regardless of the presence of symptoms. Survival at 10 years was 𝐛𝐞𝐭𝐭𝐞𝐫 in patients who underwent surgery 𝐰𝐢𝐭𝐡𝐨𝐮𝐭 𝐰𝐚𝐢𝐭𝐢𝐧𝐠 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐨𝐧𝐬𝐞𝐭 𝐨𝐟 𝐂𝐥𝐚𝐬𝐬 𝐈 𝐭𝐫𝐢𝐠𝐠𝐞𝐫𝐬. The risk of 𝐦𝐨𝐫𝐭𝐚𝐥𝐢𝐭𝐲 𝐰𝐚𝐬 𝐡𝐢𝐠𝐡𝐞𝐫 in patients in the group with symptoms than in those without a Class I trigger. AVR in symptomatic patients or patients with LVEF <60% led to a 𝐥𝐨𝐬𝐬 𝐨𝐟 𝐬𝐮𝐫𝐯𝐢𝐯𝐚𝐥 𝐨𝐟 𝟖.𝟑 𝐚𝐧𝐝 𝟏𝟏.𝟒 𝐦𝐨𝐧𝐭𝐡𝐬, respectively, after 10 years and compared with symptomatic patients operated on with LVEF >60%.

These results suggest that patients with SHGAS should 𝐛𝐞𝐧𝐞𝐟𝐢𝐭 𝐟𝐫𝐨𝐦 𝐀𝐕𝐑 𝐰𝐢𝐭𝐡𝐨𝐮𝐭 𝐰𝐚𝐢𝐭𝐢𝐧𝐠 𝐟𝐨𝐫 𝐂𝐥𝐚𝐬𝐬 𝐈 𝐭𝐫𝐢𝐠𝐠𝐞𝐫 𝐨𝐧𝐬𝐞𝐭, as this would improve their post-operative survival at 10 years. The article is now available on the journal's website! 𝐃𝐎𝐈: 𝟏𝟎.𝟏𝟎𝟏𝟔/𝐣.𝐣𝐚𝐜𝐚𝐝𝐯.𝟐𝟎𝟐𝟒.𝟏𝟎𝟎𝟖𝟑𝟎