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DOI: 10.1055/s-0037-1598963
One Year Clinical Outcome and Biomarker Levels after Randomized Comparison of Two Supraannular Pericardial Aortic Xenografts
Publication History
Publication Date:
03 February 2017 (online)
Objectives: In the era of transcatheter techniques there is increasing interest in longer term outcomes and functional parameters after conventional aortic valve replacement (AVR). Clinical outcome, quality of life (QoL) using EQ-5D-3L questionnaire and biochemical markers after conventional AVR including combined AVR and concomitant surgical procedures was assessed at up to one-year follow-up.
Methods: 100 patients with aortic stenosis undergoing AVR and randomized for two different supraannular pericardial valves, with or without concomitant procedures were included. Baseline and up to one year follow-up QoL, B-Type Natriuretic Peptide (BNP) plasma levels, and routine clinical, operative and echocardiographic data were assessed.
Results: Mean age was 69 ± 4 years and 36% of the patients were female. Isolated AVR was performed in 56% of patients, 26% underwent concomitant coronary artery bypass grafting (CABG), 14% epicardial ablation and in 4% replacement of the ascending aorta was performed. Overall mortality at 10 months was 1% and there was no stroke. QoL improved significantly from 85 ± 17 to 95 ± 15 points (p < 0.001) at follow-up. Median BNP plasma level decreased significantly from 659 (interquartile range: 260–1,535) to 296 (187–442) pg/mL (p < 0.001) at follow-up, and cardiac mass index decreased from 136 ± 26 to 100 ± 25 g/m2. All endpoint improvements were independent from the procedure. There was a significant correlation between decrease in BNP plasma levels and cardiac mass index regression, but both parameters had no significant influence on QoL. NYHA functional class and QoL showed a significant correlation of 0.5 (p < 0.001).
Conclusion: Conventional aortic valve replacement with or without concomitant surgical procedures leads to excellent clinical outcomes with significant improvement in QoL, cardiac mass regression and decrease in plasma BNP levels. These improvements were independent from the procedure and should be considered when treatment strategies for younger patients with aortic stenosis are discussed.