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Assessment of Stroke Volume Index of Sutureless, Transcatheter and Stented Pericardial Valves in the Early Postoperative Period - a Propensity Matched Analysis
Alessia Gambaro, Michael O. Murphy, Davorin Sef, Alison Duncan, John Pepper, Cesare Quarto, Ulrich Rosendahl, George Asimakopoulos.
Royal Brompton and Harefield NHS Trust, London, United Kingdom.

OBJECTIVE: Persistent or new onset low flow (LF), described as a stroke volume index (SVi) less than 35ml/m2/beat, is a predictor of poor outcomes after aortic valve intervention (AVI) in patients (pts) with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF). We compared the rate of new onset or persistent LF in the in a cohort of propensity-matched pts undergoing aortic valve intervention by sutureless valve (SLV), stented pericardial valves (SPV) or transcatheter valves (TAVI).METHODS: Among 423 pts with severe aortic stenosis (AS) and preserved left ventricular function (LVEF) who underwent AVI between 2014 and 2017, a cohort of 30 consecutive pts with SLV were matched with 30 with SPV and 30 patients who had TAVI. Preoperative and perioperative characteristics with echocardiographic results including SVi were assembled and analysed.
RESULTS:
LF AS was present in 50% of SPV, 72% of TAVI and 40% of SLV pts pre-operatively, with a median preoperative SVi of 35.02 (28.7-38.94), 30.65 (29.51-38.51) and 37.76 (31.28-42.62) 35ml/m2/beat, respectively. Predischarge LVEF was similar amongst the groups. Postoperative mean transvalvar gradients in SLV, SPV and TAVI were 16.00 (11.08-19.90), 11.79 (8.71-13.00) and 9.00 (6.12-11.20) mmHg respectively while median SVi 30.96 (28.29-41.23), 38.2 (27.57-43.16) and 37.18 (29.55-44.42) 35ml/m2/beat. Postoperative persistent or new-onset LF was significantly more prevalent in the SLV (57%) as compared with SPV (41%) or TAVI group (38%).CONCLUSIONS:
In pts with severe AS and preserved LVEF, AVI with TAVI and SPV was associated with improved SVi, and lower rates of persistent or new onset LF when compared with SLV. Further follow-up is required to evaluate long-term outcomes of both valve types.


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