Clinical value of the flow-adjusted pressure gradient in patients undergoing surgical aortic valve replacement.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41985624.
- Also identified by DOI 10.1016/j.jtcvs.2026.04.003.
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Abstract
Accurate assessment of prosthetic valve function after surgical aortic valve replacement is still challenging. This study aims to evaluate the clinical utility of the flow-adjusted pressure gradient after surgical aortic valve replacement. A total of 734 patients underwent isolated surgical aortic valve replacement at 7 Japanese institutions between January 2016 and December 2021. After excluding 4 emergency cases and 215 cases with missing postoperative echocardiographic data, 515 patients were analyzed. The flow-adjusted pressure gradient was defined as mean pressure gradient divided by stroke volume. The primary end point was a composite of 3-year cardiovascular death and heart failure rehospitalization. The median age was 76 years (interquartile range, 70-80), and 240 patients (46.6%) were male. The median flow-adjusted pressure gradient was 0.20 mm Hg/mL (interquartile range, 0.15-0.25). In univariable analysis, mean pressure gradient, stroke volume, and prosthesis-patient mismatch were not significantly associated with the primary end point (P = .14, .98, and .73, respectively). In multivariable analysis, flow-adjusted pressure gradient remained an independent predictor of the primary end point (adjusted hazard ratio, 1.76; 95% CI, 1.11-2.67; P = .012). Patients were categorized into high (≥0.30 mm Hg/mL; n = 62 [12.0%]) and low (<0.30 mm Hg/mL; n = 453 [88.0%]) flow-adjusted pressure gradient groups for exploratory analysis, and the incidence of the primary end point was significantly higher in the high flow-adjusted pressure gradient group than in the low flow-adjusted pressure gradient group (14.8% vs 5.3%; P = .004). Flow-adjusted pressure gradient was associated with an increased risk of 3-year adverse cardiac events after isolated surgical aortic valve replacement. Integrating flow-adjusted pressure gradient into conventional parameters may improve the assessment of prosthetic valve function.