title: Aortic valve replacement in true severe aortic stenosis with low gradient and low ejection fraction.
abstract: OBJECTIVE
  The results of aortic valve replacement are uncertain among patients with severe aortic stenosis, reduced left ventricular ejection fraction, and low mean transvalvular gradient. The aim of the present study was to report on 27 patients who underwent surgery for aortic stenosis with left ventricular ejection fraction <or=30% and mean transvalvular gradient <30 mmHg.
  
  
  METHODS
  The study was performed between January 2000 and December 2005. Twenty-seven patients with aortic stenosis with a calculated valve area <1.0 cm2, aortic mean transvalvular gradient <30 mmHg, and ejection fraction <or=30% were studied. Exclusion criteria were coronary artery disease, concomitant valvular operation, previous aortic valve replacement, or more than moderate aortic valve regurgitation. Preoperative clinical, echocardiography and dobutamine echocardiography, cardiac catheterization and coronary angiography, and operative data were recorded in all patients. Patients who were diagnosed with true aortic stenosis were divided into 2 groups according to left ventricular ejection fraction changes during dobutamine echocardiography, 16 with recruitable myocardium (group 1) versus 11 without (group 2).
  
  
  RESULTS
  One patient from group 2 died. The functional capacities of all of the patients in group 1 significantly improved in the postoperative period (P = .001). All of the patients except for 1 in group 1 had improved left ventricular ejection fraction after the operation (P <.001). The comparison of the preoperative and postoperative functional status of these patients in group 2 was also statistically significant (P = .001). The 10 of the 11 patients in group 2 who were alive had left ventricular ejection fraction value changes that were not significant statistically (P = .096). The comparison of the improvement of functional capacities of the groups revealed a significant difference; that is, the improvement was higher in group 1 (P = .039).
  
  
  CONCLUSIONS
  Left ventricular ejection fraction and functional capacity improved after aortic valve replacement in patients with left ventricular dysfunction, low mean transvalvular gradient, and aortic valve replacement in these patients has acceptable mortality rates with significantly improved functional status.
authors.affiliation: Department of Cardiovascular Surgery, Atatürk Training and Research Hospital, Izmir, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Ozsöyler
authors.forename: Banu
authors.initials: B
authors.lastname: Lafci
authors.forename: Bilgin
authors.initials: B
authors.lastname: Emrecan
authors.forename: Mert
authors.initials: M
authors.lastname: Kestelli
authors.forename: Sahin
authors.initials: S
authors.lastname: Bozok
authors.forename: Cengiz
authors.initials: C
authors.lastname: Ozbek
authors.forename: Murat
authors.initials: M
authors.lastname: Yesil
authors.forename: Ali
authors.initials: A
authors.lastname: Gürbüz
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*