Key result
Adapted scale predicts need for concomitant septal myectomy during AVR with ~84% specificity.
Why the study?
A predictive scale for necessary septal myectomy in aortic valve replacement for severe aortic stenosis was lacking.
Does a new predictive scale using echocardiographic parameters accurately determine the necessity of concomitant septal myectomy during aortic valve replacement in patients with severe aortic stenosis?
Observational (n=180)
Does a new predictive scale using echocardiographic parameters accurately determine the necessity of concomitant septal myectomy during aortic valve replacement in patients with severe aortic stenosis?
A novel predictive score incorporating LV myocardial mass, IVST/PWT, and aortic annulus diameter can help identify which patients with severe aortic stenosis require concomitant septal myectomy during aortic valve replacement.
OBJECTIVE: To develop the adapted scale for analysis of necessary septal myectomy (SME) in aortic valve replacement (AVR) for severe aortic stenosis. MATERIAL AND METHODS: A retrospective and prospective analysis included 180 patients with severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm who underwent surgery between 2012 and 2024. Age of patients was 64 (61; 67.3) years. There were 96 (53.3%) men and 84 (46.7%) women. Heart failure NYHA class III was observed in 98 patients (54.4%), class II in 54 (30.0%) patients. The AVR+SME group included 100 patients, and the AVR group included 80 patients. Both groups did not differ in preoperative clinical and echocardiography characteristics. Sensitivity was 77.0%, specificity - 83.8%. IVST/ PWT and indexed LV myocardial mass increase the probability of concomitant SME, while aortic annulus diameter has inverse relationship. The cut-off point for indexed LV myocardial mass is 167.5 g, for IVST/ PWT - 1.15, for aortic annulus diameter - 23.5 mm. Further analysis was performed by assigning a score to each predictor. The total score in two groups was determined. Thus, total score > 83.5 indicates advisability of SME in aortic valve replacement. CONCLUSION: The new scale for predicting the need for SME in AVR will improve postoperative results.
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Fomin et al. (2024) conducted an observational in Severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm (n=180). Concomitant septal myectomy (SME) during aortic valve replacement vs. Aortic valve replacement alone was evaluated on Prediction of necessary septal myectomy using the adapted scale. An adapted scale (score > 83.5) predicted the need for concomitant septal myectomy during aortic valve replacement for severe aortic stenosis with 77.0% sensitivity and 83.8% specificity.
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