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Original research
Clinical outcomes after aortic valve replacement with severe stenosis of trileaflet aortic valve and low valve calcium score
  1. Yeonwoo Choi1,
  2. Jung-Min Ahn1,
  3. Dong Hyun Yang2,
  4. Hyun Jung Koo2,
  5. Seung-Ah Lee1,
  6. Do-Yoon Kang1,
  7. Joon Bum Kim3,
  8. Duk–Woo Park1,
  9. Dae-Hee Kim1,
  10. Suk Jung Choo3,
  11. Seung-Jung Park1
  1. 1 Division of Cardiology, Asan Medical Center, Seoul, South Korea
  2. 2 Department of Radiology, Asan Medical Center, Seoul, South Korea
  3. 3 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea
  1. Correspondence to Dr Jung-Min Ahn, Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, Korea; drjmahn{at}; Dr Dong Hyun Yang, Department of Radiology, Asan Medical Center, Songpa-gu, Seoul, Korea; donghyun.yang{at}


Background Some patients have severe aortic valve stenosis (AS) despite a lower degree of aortic valve calcification (AVC). This study compared the clinical features and prognosis of patients undergoing aortic valve replacement (AVR) for severe AS with a low AVC score compared with those with higher AVC scores.

Methods This study included 1002 Korean patients with symptomatic severe degenerative AS who underwent AVR. We measured AVC score before AVR and defined low AVC as AVC score of <2000 units for male patients and <1300 units for female patients. Patients with bicuspid or rheumatic aortic valve disease were excluded.

Results The mean age was 75.6±7.9 years and 487 patients (48.6%) were female. Mean left ventricular ejection fraction was 59.4%±10.4%, and concomitant coronary revascularisation was performed in 96 patients (9.6%). The median aortic valve calcium score was 3122 units (IQR 2249–4289 units) among male patients and 1756 units (IQR 1192–2572) among female patients. A total of 242 patients (24.2%) had low AVC; they were significantly younger (73.5±8.7 years vs 76.3±7.5 years, p<0.001) and were more likely to be female (59.5% vs 45.1%, p<0.001) and on haemodialysis (5.4% vs 1.8%, p=0.006) than those with high AVC. During a follow-up (median: 3.8 years), the patients with low AVC had significantly higher risk of death from any cause (adjusted HR 1.60, 95% CI 1.02 to 2.52, p=0.04), mostly non-cardiac cause.

Conclusions Patients with low AVC exhibit distinct clinical characteristics and a higher risk of long-term mortality compared with those with high AVC.

  • Aortic Valve Stenosis
  • Transcatheter Aortic Valve Replacement
  • Heart Valve Prosthesis Implantation
  • Diagnostic Imaging

Data availability statement

No data are available.

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  • Contributors YC, J-MA and DHY conceived and designed the study. YC, J-MA, D-HY, HJK, S-AL, D-YK, JBK, D-WP, D-HK, SJC and S-JP acquired the data and participated in the data interpretation. YC and J-MA performed the analysis and interpreted the results in collaboration with the other authors and wrote the first draft of the report. All authors critically revised the report and approved the final version of the manuscript. J-MA and D-HY were responsible for the overall content of the study as guarantor.

  • Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant number HC19C0022).

  • Competing interests DHY, the corresponding author of this paper, is an editorial board member for BMJ Heart.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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