Aortic Valve Replacement in the Failing Left Ventricle: Worthwhile?

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.