Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate?
OBJECTIVE
The effects of post-operative left ventricular mass regression (LVMR) on clinical outcome after aortic valve surgery remains to be established. This study was intended to establish the impact of patient characteristics on post-operative survival in patients referred for aortic valve replacement (AVR), with particular regard to LVMR.


RESULTS
Two hundred and sixty consecutive cases submitted to aortic valve replacement for valvular stenosis were prospectively followed for a mean of 28+/-9 months. Baseline, characteristics and extent of LVMR were tested for association with survival by uni- and multivariable analysis. Ten deaths occurred during hospital stay and 52 during out-of-hospital follow-up. Mean left ventricular mass decreased from 190+/-43 to 158+/-70 g/m2 (P<0.001). Older age, advanced functional class, hypertension, reduced left ventricle ejection fraction, and high pre-operative left ventricular mass index were associated with reduced survival. Overall the extent of LVMR did not influence the clinical results, while only early (<6 months) LVMR was weakly associated with mid-term outcome.


CONCLUSIONS
Survival after aortic valve surgery is mainly determined by the pre-operative functional cardiac and systemic status. The extent of LVMR does not correlate with clinical outcome, whereas aggressive treatment of hypertension may improve post-operative survival.
Gaudino
Mario
M
Department of Cardiac Surgery, Catholic University, Largo A Gemelli 8, 00168 Rome, Italy. mgaudino@tiscali.it
Alessandrini
Francesco
F
Glieca
Franco
F
Luciani
Nicola
N
Cellini
Carlo
C
Pragliola
Claudio
C
Morelli
Mauro
M
Canosa
Carlo
C
Nasso
Giuseppe
G
Possati
Gianfederico
G
D000368:Aged; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality; D017379:Hypertrophy, Left Ventricular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D016019:Survival Analysis