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Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators

H M Connolly1, J K Oh, T A Orszulak

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Circulation
|May 20, 1997
PubMed

Insights

Aortic valve replacement for aortic stenosis is feasible in patients with left ventricular systolic dysfunction. Outcomes are acceptable, with most patients experiencing symptom and ejection fraction improvement, though survival is linked to coronary artery disease.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Aortic stenosis (AS) with left ventricular (LV) systolic dysfunction poses increased risks for valve replacement.
  • Limited data exist on outcomes for AS patients with LV systolic dysfunction.

Purpose of the Study:

  • To evaluate the outcomes of aortic valve replacement in patients with AS and LV systolic dysfunction.

Main Methods:

  • 154 patients with LV systolic dysfunction (ejection fraction ≤35%) underwent aortic valve replacement for AS between 1985-1992.
  • Coronary artery bypass grafting was performed in 51% of patients.
  • Follow-up data were analyzed for mortality, survival rates, and changes in ejection fraction.

Main Results:

  • Perioperative mortality was 9%.
  • Coronary artery disease and reduced preoperative cardiac output were significant predictors of reduced survival.
  • 88% of patients improved symptomatically (NYHA class III/IV pre-op to 7% post-op).
  • 76% of survivors showed improved ejection fraction post-surgery.

Conclusions:

  • Aortic valve replacement for AS is acceptable in patients with LV dysfunction.
  • Outcomes are influenced by coronary artery disease and mean aortic gradient.
  • Long-term survival is associated with coronary artery disease and cardiac output.
  • Most patients experience significant improvement in symptoms and ejection fraction.
Abstract

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