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Aortic Valve Replacement in the Failing Left Ventricle: Worthwhile?

Asanish Kalyanasundaram1, Thais Faggion Vinholo1, Mohammad A Zafar1

  • 1Aortic Institute at Yale-New Haven Hospital, New Haven, CT 06510, USA.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed

Insights

Surgical aortic valve replacement (SAVR) is safe for patients with severe aortic stenosis or regurgitation and a low ejection fraction (EF) of 35% or less. SAVR significantly improves EF over time, with survival comparable to the general population.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Repair and Replacement
  • Echocardiography

Background:

  • Current guidelines recommend aortic valve replacement (AVR) for severe aortic stenosis or regurgitation, irrespective of left ventricular ejection fraction (LVEF).
  • However, surgeons may hesitate to perform SAVR in patients with very low LVEF (<55%) due to perceived high operative risks.
  • This study investigates the outcomes of SAVR in patients with severely impaired LVEF (≤35%).

Purpose of the Study:

  • To evaluate the safety and efficacy of surgical aortic valve replacement (SAVR) in patients with severely reduced left ventricular ejection fraction (LVEF ≤ 35%).
  • To assess changes in LVEF and mid-term survival following SAVR in this high-risk patient group.

Main Methods:

  • A retrospective analysis of 895 patients undergoing SAVR between 2004 and 2019 identified 40 patients with LVEF ≤ 35%.
  • Preoperative and postoperative echocardiograms were used to assess changes in LVEF.
  • Intra-aortic balloon pump (IABP) was used prophylactically in 18 patients; mid-term survival was analyzed.

Main Results:

  • Hospital survival was high at 97.5%.
  • The average LVEF improved significantly from 26% preoperatively to 46% at mid-term follow-up (mean 43 months).
  • Five-year survival was comparable to age- and gender-matched general population, with significant reductions in left ventricular dimensions observed.

Conclusions:

  • SAVR can be performed safely in patients with a compromised left ventricle (LVEF ≤ 35%) and severe aortic valve disease.
  • Patients experience significant improvements in LVEF post-SAVR, leading to normalized long-term survival.
  • Prophylactic use of IABP may be beneficial in this cohort, and surgeons should not avoid SAVR in these patients.
Abstract

Keywords:
aortic regurgitationaortic stenosisaortic valve replacementejection fractionheart failureintra-aortic balloon pump

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