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Indexed left ventricular dimensions best predict survival after aortic valve replacement in patients with aortic

Morgan L Brown1, Hartzell V Schaff, Rakesh M Suri

  • 1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.

The Annals of Thoracic Surgery
|March 28, 2009
PubMed

Insights

Aortic valve replacement for aortic regurgitation does not predict late mortality based on ejection fraction or ventricular dimensions. However, indexed dimensions predict survival, and higher preoperative ejection fraction is key for preserving late systolic function.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Aortic regurgitation often necessitates valve replacement.
  • Indications include diminished ejection fraction and enlarged left ventricular dimensions.
  • Preoperative cardiac function impacts post-operative outcomes.

Purpose of the Study:

  • To evaluate the impact of preoperative ejection fraction and left ventricular dimensions on survival.
  • To assess the predictors of normal systolic function recovery after aortic valve replacement.

Main Methods:

  • Retrospective review of 301 patients undergoing aortic valve replacement (1996-2006).
  • Analysis of clinical, echocardiographic data, and vital status.
  • Assessment of preoperative and late echocardiographic findings.

Main Results:

  • Operative mortality was 1.7%; 10-year survival was 77%.
  • Preoperative ejection fraction and absolute ventricular dimensions did not predict late survival.
  • Indexed left ventricular dimensions predicted late survival (p < 0.01).
  • Higher preoperative ejection fraction predicted recovery of normal late ejection fraction (OR, 2.85; p < 0.001).

Conclusions:

  • Decreased ejection fraction and enlarged ventricular dimensions are not linked to late mortality post-aortic valve replacement.
  • Indexed left ventricular dimensions are associated with late mortality.
  • Optimal recovery of late ejection fraction is achieved with near-normal preoperative systolic function.
Abstract

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