부산대학교 도서관

Background: Patients with moderate aortic stenosis (AS) exhibit high morbidity and mortality. Very limited evidence exists on the role of aortic valve replacement (AVR) in this patient population.Objectives: To investigate the benefit of AVR in patients with moderate AS compared to clinical surveillance on long-term survival.Methods: In a retrospective cohort study, patients aged ≥ 60 years with native tricuspid moderate AS between 2008-2016 were selected from the Cleveland Clinic echocardiographic database. Patients were classified as receiving AVR or managed with clinical surveillance. Clinical outcomes included all-cause and cardiovascular mortality, assessed by survival analyses and multivariable-adjusted Cox and competing risks regression, respectively.Results: We included 1,421 patients (mean age, 75.3 ± 5.4 years and 39.9% females) followed over a median duration of 6 years. Patients in the AVR group had lower risk of all-cause (adjusted HR = 0.51, 95% CI: [0.34, 0.77]; p = 0.001) and cardiovascular mortality (aHR = 0.50, 95% CI: [0.31, 0.80]; p = 0.004) compared to those in the clinical surveillance group irrespective of sex, receipt of other open-heart surgeries, and underlying malignancy.Conclusions: In patients with moderate AS, AVR was associated with favorable clinical outcomes and left ventricular remodeling patients.Figure 1 Incidence of all-cause mortality and cardiovascular mortality in patients with moderate AS in those who underwent AVR and clinical surveillance.Hazards ratios (HR) represent relative incidence of AVR versus clinical surveillance. HRs for all-cause mortality were calculated using Cox regression and for cardiovascular mortality using competing risks regression, with non-cardiac mortality as competing event. HRs were adjusted for age, sex, body-mass index, comorbidities, medications, and baseline echocardiographic data (AVA, MG, Vmax, and LVEF)