title: Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function.
abstract: BACKGROUND
  Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known.
  
  
  RESULTS
  The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35%, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35% to 50%, MedEF, n=134) and those with normal left ventricular function (EF > or =50%, Nl EF, n=273). The operative mortality rate was higher with LoEF (14%) than with MedEF and Nl EF (6.7% and 3.7%, respectively, P=0.02). At 10 years, 41%+/-9% of LoEF patients had survived compared with 56%+/-5% and 70%+/-3% of MedEF and Nl EF patients, respectively (P<0.0001). Congestive heart failure occurred at 10 years in 25%+/-9% with LoEF compared with 17%+/-4% and 9%+/-2% with MedEF and NL EF, respectively (P<0.003). Postoperative EF improved by 4.9%+/-13.8% in the LoEF group and by 4%+/-11.9% in the MedEF group compared with -2.3%+/-10.9% in the Nl EF group (P<0.002 and P<0.0001, respectively).
  
  
  CONCLUSIONS
  Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
authors.forename: Hari P
authors.initials: HP
authors.lastname: Chaliki
authors.forename: Dania
authors.initials: D
authors.lastname: Mohty
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Avierinos
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: A Jamil
authors.initials: AJ
authors.lastname: Tajik
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
mesh_terms: D000792:Angiography; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000075202:Contraindications; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000601:surgery*