Key result
Poor preoperative sympathetic compensation is linked to ~4.8-fold higher complication or death risk after AVR.
Why the study?
Although severe calcific aortic stenosis patients have decreased sympathetic compensation to active standing, its association with postoperative complications or death after aortic valve replacement had not been studied.
Does poor sympathetic compensation during active standing predict morbidity and mortality in patients with severe calcific aortic stenosis undergoing aortic valve replacement?
Observational (n=49)
Does poor sympathetic compensation during active standing predict morbidity and mortality in patients with severe calcific aortic stenosis undergoing aortic valve replacement?
Odds Ratio: 4.8 (95% CI 1.06–21.8)
p-value: p=<0.041
Poor sympathetic compensation during a preoperative orthostatic challenge and greater left ventricular mass independently predict an increased risk of complications or death within 30 days after aortic valve replacement.
(1) Background: Although all severe calcific aortic stenosis (SCAS) patients have decreased sympathetic compensation to active standing, it has not been studied in patients who underwent aortic valve replacement (AVR). The objective was to assess the association of the heart rate variability (HRV) response to an active orthostatic challenge before AVR with the risk of complications or death during the AVR postoperative period in patients with SCAS. (2) Methods: This observational study included 49 patients. The cardiac autonomic activity was assessed by HRV analysis during supine position and active standing (five minutes each). (3) Results: Twenty-four patients (48.9%) who presented outcomes (complication or death) had a greater left ventricular (LV) mass and a smaller magnitude of change during active standing in both the mean cardiac period and sympathetic predominance. Poor sympathetic compensation to active standing and LV mass were independently associated with the outcome odds ratio (OR) = 4.8 [(1.06, 21.8), p < 0.041] and 1.03 [(1.007, 1.062), p < 0.013], respectively. (4) Conclusions: In SCAS patients, poor sympathetic compensation in the face of orthostatic challenge and greater LV mass are associated with complications or death after AVR surgery. This approach offers an opportunity to find new criteria to reduce the surgical risk of these patients.
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Ávila‐Vanzzini et al. (2025) conducted an observational in Severe calcific aortic stenosis (SCAS) (n=49). Poor sympathetic compensation during active standing vs. Adequate sympathetic compensation was evaluated on Incidence of complications or death from the start of surgery to the first 30 days of hospitalization or hospital discharge (OR 4.8, 95% CI 1.06-21.8, p=<0.041). Poor sympathetic compensation during an active orthostatic challenge pre-surgery was independently associated with a 4.8-fold increased risk of complications or death following aortic valve replacement.
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