title: Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators.
abstract: BACKGROUND
  Aortic valve replacement for aortic stenosis (AS) carries an increased risk in the presence of left ventricular (LV) systolic dysfunction. Few data are available on the outcome of such patients.
  
  
  RESULTS
  Between 1985 and 1992, 154 consecutive patients (107 men and 47 women) with LV systolic dysfunction (ejection fraction [EF] < or = 35%) underwent aortic valve replacement for AS. The mean preoperative characteristics included EF, 27 +/- 6%; aortic valve mean gradient, 44 +/- 18 mm Hg; aortic valve area, 0.6 +/- 0.2 cm2; and cardiac output, 4.1 +/- 1.5 L/min. Simultaneous coronary artery bypass graft surgery was performed in 78 patients (51%). Perioperative (30-day) mortality was 9% (14 of 154 patients). Fifty patients died during follow-up. Coronary artery disease (P = .002) and a reduced preoperative cardiac output (P = .03) were significantly related to reduced overall survival rate by multivariate analysis. Postoperative improvement occurred in most patients; 88% were New York Heart Association class III or IV before surgery versus 7% after surgery. Postoperative EF was assessed in 76% of survivors; 76% of these demonstrated improvement. By multivariate analysis, change in EF was inversely related to coronary disease (P = .002) and preoperative aortic valve area (P = .03).
  
  
  CONCLUSIONS
  Despite LV dysfunction, the risk of aortic valve replacement for AS was acceptable and related to coronary artery disease and mean aortic gradient, and long-term survival was related to coronary disease and cardiac output. Improvement in symptoms and EF occurred in most patients.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Connolly
authors.forename: J K
authors.initials: JK
authors.lastname: Oh
authors.forename: T A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: S L
authors.initials: SL
authors.lastname: Osborn
authors.forename: V L
authors.initials: VL
authors.lastname: Roger
authors.forename: D O
authors.initials: DO
authors.lastname: Hodge
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
authors.forename: A J
authors.initials: AJ
authors.lastname: Tajik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology