Optimal timing of aortic valve replacement for aortic stenosis--are we operating late?
OBJECTIVE
To evaluate the adherence to current guidelines for surgery in patients with aortic valve stenosis.


METHODS
From 1 January 1997 to 31 May 1999, 99 patients were accepted for aortic valve surgery with preserved left ventricular function and normal coronary angiogram. On admission for operation, 20 patients were evaluated regarding symptoms, exercise capacity, and left ventricular morphology and function.


RESULTS
There were 14 men and 6 women, mean age 64.3 years. Years from symptom onset varied from 2.1 to 3.2. Dyspnoea was the most common limiting symptom. Thirty per cent of the patients were classified as NYHA IIIB. Physical capacity was reduced to 79% of the expected. Left ventricular hypertrophy was present in 14/20 patients. Left ventricular systolic function was reduced with mean ejection fraction of 0.46. Diastolic dysfunction (E/A ratio <1) was present in 12 patients.


CONCLUSIONS
Many patients accepted for aortic valve replacement due to aortic stenosis show advanced disease and are referred for surgery later in the disease process than is recommended in the current guidelines.
Hellgren
Laila
L
Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden. laila.hellgren@thorax.uas.lul.se
Kvidal
P
P
Landelius
J
J
Hansson
H E
HE
Ståhle
E
E
D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005080:Exercise Test; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications