Aortic valve replacement in asymptomatic and symptomatic patients with preserved left ventricular ejection fraction

Patients with moderate-severe aortic stenosis (AS) who maintain that they have no symptoms pose a decision-making dilemma. In order to determine whether or not preoperative symptoms were related to outcomes in these patients, results were compared after aortic valve replacement (AVR) in asymptomatic and symptomatic AS patients with a preserved left ventricular ejection fraction (LVEF).

Twenty asymptomatic and 18 symptomatic AS patients were investigated retrospectively, with clinical and echocardiographic studies being performed before and at 610 +/- 409 days after AVR. The patients' cardiopulmonary function was monitored using spiroergometry.

Symptomatic AS patients improved their exercise tolerance after surgery more than asymptomatic patients, although exercise tolerance and LVEF remained lower in symptomatic patients. On comparing all postoperative objective changes between the groups, a difference was observed only for aortic valve area index. Improvements in left ventricular structure, diastolic function, and filling pressures after AVR were similar in both groups. Systolic function, as assessed by tissue Doppler, was improved only in the symptomatic group. Regression analyses identified preoperative exercise tolerance as the strongest independent determinant of postoperative functional outcome. The postoperative LVEF was independently predicted by the preoperative LVEF and exercise tolerance.

Asymptomatic patients with moderate-severe AS and preserved systolic function exhibited similar improvements in cardiac remodeling, diastolic function, and filling pressures following AVR, compared to symptomatic patients. Differences in exercise tolerance and systolic function observed preoperatively between these groups were decreased after AVR.