title: Outcome after valve replacement for severe aortic stenosis associated with reduced left ventricular ejection fraction.
abstract: OBJECTIVE
  Because valve replacement for aortic stenosis (AS) remains a difficult surgical challenge in the presence of left ventricular dysfunction, the immediate and long-term outcomes, and evolution of left ventricular ejection fraction (LVEF) in this setting, were analyzed.
  
  
  METHODS
  Forty-three consecutive patients with severe AS (valve area < or =1 cm2) and reduced LVEF (< or =40%) who underwent valve replacement surgery at the authors' institution between April 1998 and December 2003 and were studied retrospectively.
  
  
  RESULTS
  Preoperative characteristics included: LVEF 33 +/- 6%, mean transaortic pressure gradient 46 +/- 13 mmHg, and aortic valve area 0.58 +/- 0.15 cm2. Concomitant coronary artery bypass grafting was performed in 15 patients (35%). Perioperative (30-day) mortality was 2.3%, with 39.5% morbidity. During a mean follow up of 33.4 +/- 17.6 months, eight patients died. The Kaplan-Meier estimate of five-year survival was 75.3%. Postoperatively, none of the survivors remained in NYHA functional classes III-IV. The postoperative LVEF assessed in 81.8% of survivors had improved. Multivariate analysis associated improved LVEF with a higher preoperative mean transaortic pressure gradient (p = 0.0009) and a higher preoperative LVEF (p = 0.02).
  
  
  CONCLUSIONS
  Patients with severe AS and reduced LVEF can undergo valve replacement with low perioperative mortality and moderate postoperative morbidity. Good long-term survival with good NYHA functional status and improved LVEF can be obtained.
authors.affiliation: Department of Cardiac Surgery, Centre Cardiologique du Nord, Gemeaux, Saint-Denis, France. p.lebesnerais@ccncardio.com
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Maillet
authors.forename: Paul
authors.initials: P
authors.lastname: Le Besnerais
authors.forename: Christophe
authors.initials: C
authors.lastname: Benvenuti
authors.forename: Eric
authors.initials: E
authors.lastname: Noblesse
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffenach
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Denis
authors.initials: D
authors.lastname: Brodaty
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications*