[Aortic stenosis with low preoperative ejection fraction. Long-term postoperative hemodynamic and angiographic...

Twenty-two patients underwent aortic valve replacement for aortic stenosis with a preoperative ejection fraction less than 45%. Three patients died peroperatively and a fourth patient died 18 months later before the haemodynamic control. The other 18 patients were systematically reinvestigated, on average 16 months after surgery. Sixteen had a remarkable functional improvement and a significant increase in ejection fraction at haemodynamic control: 32 +/- 6% to 61 +/- 8%, p less than 0.001. They were surgical successes (Group I). In this group, the 7 patients with the most severe alteration of ventricular function and an average ejection fraction of: 26 +/- 3%, also improved to near normal function with a postoperative fraction of 62 +/- 11%. There was no significant improvement of the ejection fraction in 2 patients, and they were classified with the fatalities as surgical failures (Group II). The clinical, electrocardiographic, radiological, haemodynamic and angiographic data of these two populations were compared to try and identify preoperative indices of prognostic value. Only the angiographic left ventricular myocardial mass index (LVMI) was significantly higher in Group II (253 +/- 98 g/m2) than in Group I (156 +/- 56 g/m2, p less than 0.05). A discriminating analysis showed that the most important parameters to separate the 2 groups of patients were the LVMI and the thickness of the left ventricular wall. The marked increase of the postoperative ejection fraction in 3/4 of our patients confirmed the clinical value of valvular replacement justifying the indication for surgery in patients with severe aortic stenosis in spite of a severe alteration of left ventricular function.