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[Low ejection fraction as risk factor after aortic valve replacement].

Mariola Cieśla-Dul1, Roman Pfitzner, Rafał Drwiła

  • 1Klinika Chirurgii Serca, Naczyń i Transplantologii Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. mardul@poczta.fm

Przeglad Lekarski
|February 24, 2005
PubMed
Summary
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Aortic valve replacement for severe aortic valve stenosis in patients with low ejection fraction has a higher operative risk. However, surgery offers significant survival and quality of life improvements, making it a vital treatment option.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Medicine

Background:

  • Severe aortic valve stenosis (AS) poses significant risks, especially in patients with impaired left ventricular function.
  • Left ventricular ejection fraction (LVEF) below 40% represents a distinct risk factor for cardiac surgery.
  • Understanding operative outcomes in this high-risk group is crucial for clinical decision-making.

Purpose of the Study:

  • To estimate the operative risk of aortic valve replacement (AVR) in patients with severe AS and significantly reduced LVEF (<40%).
  • To evaluate the outcomes and benefits of AVR in this specific high-risk patient cohort.

Main Methods:

  • Retrospective analysis of 2512 patients undergoing AVR between 1990-1999.
  • Selection of 108 patients (4.3%) with LVEF <40% and severe AS.

Related Experiment Videos

  • Standardized extracorporeal circulation and cardioplegia protocols were used.

    • Main Results:

    • The selected group consisted of 108 patients (85.2% male, average age 53.4 years) in NYHA functional class III/IV.
    • Average LVEF was 28.2%, with severe AS (valvular area 0.91 cm², gradient 71 mmHg) and left ventricular hypertrophy.
    • Hospital mortality was 8.6%, significantly higher than the overall AVR population; low output syndrome occurred in ~40% of patients.
    • Survivors (91.4%) showed early clinical improvement.

    Conclusions:

    • Low ejection fraction is a significant risk factor for AVR in severe AS.
    • Despite elevated operative mortality, AVR is the only effective treatment, offering substantial long-term benefits in function, longevity, and quality of life.
    • Heart transplantation (HTX) may be considered in extreme cases.