title: Surgery for severe aortic stenosis with low transvalvular gradient and poor left ventricular function -- a single centre experience and review of the literature.
abstract: BACKGROUND
  A retrospective comparative study was designed to determine whether the transvalvular gradient has a predictive value in the assessment of operative outcome in patients with severe aortic stenosis and poor left ventricular function.
  
  
  METHODS
  From a surgical database, a series of 30 consecutive patients, who underwent isolated aortic valve replacement for severe aortic stenosis with depressed left ventricular (LV) function (EF < 40%), were enrolled in the study and divided into two groups according to the mean transvalvular gradient (TVG): LG(low gradient)-Group < 40 mmHg (n = 13), and HG(high gradient)-Group > 40 mmHg (n = 17). Both groups were then comparatively assessed with respect to perioperative organ functions and mortality.
  
  
  RESULTS
  Both groups were well matched with respect to the preoperative clinical status. LG-Group had a larger aortic valve area, higher LVEDP, larger LVESD and LVEDD, and higher mean pulmonary pressures. The immediate postoperative outcome, hospital morbidity and mortality did not differ significantly among the groups.
  
  
  CONCLUSIONS
  In patients with severe aortic stenosis and poor LV function, the mean transvalvular gradient, although corresponds to reduced LV performance, has a limited prognostic value in the assessment of surgical outcome. Generally, operating on this select group of patients is safe.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Düsseldorf, Germany. Borowski@med.uni-duesseldorf.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Borowski
authors.forename: Ali
authors.initials: A
authors.lastname: Ghodsizad
authors.forename: Ilja
authors.initials: I
authors.lastname: Vchivkov
authors.forename: Emmeran
authors.initials: E
authors.lastname: Gams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology