Aortic valve replacement in patients with severely reduced left ventricular function.
Aortic valve replacement (AVR) can be done safely in patients with severe aortic stenosis (AS) and depressed ventricular function (ejection fraction < or =35%). Dobutamine echocardiography is useful to identify AS patients with contractile reserve who will benefit from AVR and can be used for risk stratification of these patients. AVR can also be undertaken in patients with severe aortic regurgitation and depressed ventricular function with an acceptable operative mortality. AVR in both groups results in a 5-year survival of approximately 70%, which is similar to that of orthotopic heart transplantation. Due to the comorbidities of immunosuppression and limited donor organ supply, AVR should be attempted prior to transplantation in both these high-risk groups.
Paul
Subroto
S
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
Mihaljevic
Tomislav
T
Rawn
James D
JD
Cohn
Lawrence H
LH
Byrne
John G
JG
D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002303:Cardiac Output, Low / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D009200:Myocardial Contraction; D011183:Postoperative Complications / Q000401:mortality; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000601:surgery*