Surgical outcomes and post-operative changes in patients with significant aortic stenosis and severe left ventricle dysfunction.
Little is known regarding long-term survival and changes in systolic function following surgery after the occurrence of a severe left ventricular (LV) dysfunction in patients with severe aortic stenosis. Inclusion criteria were an aortic valve area less than 1 cm(2) and an LV ejection fraction (EF) less than 35%. Between January 1990 and July 2007, 41 (male: 30) patients were identified. The pre-operative mean EF and mean aortic valve area were 26.7+/-6.1% and 0.54+/-0.2 cm(2), respectively. Concomitant coronary artery bypass surgery was performed in 8 patients (19.6%). Immediate post-operative echocardiogram showed to be much improved in LV EF (27.2+/-5.5 vs. 37.4+/-11.3, P<0.001), LV mass index (244.2+/-75.3 vs. 217.5+/-71.6, P=0.006), and diastolic LV internal diameter (62.5+/-9.3 vs. 55.8+/-9.6, P<0.001). Post-operative LV changes were mostly complete by 6 months, and were maintained thereafter. There was one in-hospital mortality (2.4%) and 12 late deaths including one patient diagnosed with malignancy in whom LV function was normal. Multivariate analysis showed pre-operative atrial fibrillation and NYHA FC IV to be significant risk factors for cardiac-related death. Aortic valve replacement in patients with significant aortic stenosis and severe LV dysfunction showed acceptable surgical outcomes. Moreover, LV function improved significantly in many patients.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Sung-Ho
SH
Jung
Jae Won
JW
Lee
Hyung Gon
HG
Je
Suk Jung
SJ
Choo
Cheol Hyun
CH
Chung
Hyun
H
Song
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality* / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis; D001026:Coronary Artery Bypass / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis; D004452:Echocardiography; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000401:mortality* / Q000601:surgery