Key result
SAVR links to better survival in octogenarian women with adaptive LV remodeling but worse in men.
Why the study?
To analyze the evolution of left ventricular remodeling and hypertrophy geometry after SAVR in octogenarians, and determine sex-related differences and long-term outcome implications.
How do left ventricular remodeling and long-term survival differ by sex after surgical aortic valve replacement in octogenarian patients with aortic stenosis?
Cohort (n=170)
How do left ventricular remodeling and long-term survival differ by sex after surgical aortic valve replacement in octogenarian patients with aortic stenosis?
p-value: p=0.039
Following SAVR in octogenarians, men with adaptive remodeling and concentric hypertrophy face a higher risk of cardiac death compared to women, highlighting significant sex-related differences in post-operative LV remodeling and survival.
Sex-specific survival differences after SAVR in octogenarians with adaptive LV remodeling should not change practice; leaves open need for prospective validation.
OBJECTIVES: To analyze how left ventricular (LV) remodeling and hypertrophy geometry evolve after surgical aortic valve replacement (SAVR) in octogenarian patients, and identify potential sex-related differences and implications for long-term outcomes. METHODS: In 170 patients with aortic stenosis ([AS], age 80 ± 4 years, 59% women), hypertrophy geometry and remodeling (LV index) were reanalyzed one year post-SAVR. The six-year outcomes were evaluated. RESULTS: Pre-SAVR, 65% of the women and 38.6% of the men (P < .001) showed adaptive remodeling. Concentric hypertrophy was prevalent in adaptive remodeling, and mixed and dilated hypertrophy were more prevalent in maladaptive remodeling. At one year, the remodeling patterns and sex distribution were similar to those observed pre-SAVR, but the LV index decreased in women and increased in men (P < .0001). Women with adaptive remodeling had a higher incidence of persistent concentric hypertrophy with higher LV filling pressures. Long-term survival was better in women and worse in men with adaptive remodeling (P = .039). Men with adaptive remodeling and men with concentric hypertrophy had the highest risk of cardiac death. This risk was similar between sexes for patients with maladaptive remodeling and dilated hypertrophy. Women with LV ejection fraction >55% had a lower risk of cardiac death than men. CONCLUSIONS: The long-term outcomes of SAVR differ between sexes in older patients with AS and adaptive LV remodeling. The LV index facilitates studying the pathways of adaptation to AS. The follow-up shifts help explain the sex differences in long-term outcomes post-SAVR. Concentric hypertrophy is associated with the highest risk of cardiac death in men.
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Barletta et al. (2021) conducted a cohort in aortic stenosis (n=170). Surgical aortic valve replacement (SAVR) was evaluated on Long-term survival (p=0.039). Surgical aortic valve replacement in octogenarians with adaptive left ventricular remodeling resulted in better long-term survival for women and worse survival for men (P=0.039).
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