title: Effect of preoperative ejection fraction, left ventricular systolic dimension and hemoglobin level on survival after aortic valve surgery in patients with severe chronic aortic regurgitation.
abstract: Surgical indications in patients with severe chronic aortic regurgitation (AR) and normal left ventricular (LV) ejection fractions (EF) remain to be established. The aim of this study was to identify prognostic indicators after surgery in patients with severe AR and normal LV systolic function. Preoperative clinical and echocardiographic characteristics were evaluated in 284 consecutive patients with chronic severe AR who underwent aortic valve surgery. Of these patients, 169 had normal (≥50%) and 115 had depressed (<50%) preoperative LV EFs. All-cause mortality was observed for a median of 39.9 months. Of 284 patients, 7 (4.4%) with normal LV EFs and 15 (12.0%) with depressed LV EFs died during follow-up after aortic valve surgery (p = 0.017). In patients with normal EFs, multivariate Cox regression analysis showed that large LV end-systolic dimension and low plasma hemoglobin level were independent predictors of postsurgical mortality. Receiver-operating characteristic analysis showed that LV end-systolic dimension ≥45 mm and hemoglobin level <13.4 g/dl were the best cut-off values for postoperative mortality. In conclusion, preoperative LV end-systolic dimension and hemoglobin level are independent prognostic factors of survival after aortic valve surgery in patients with chronic severe AR and normal LV EFs.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Park
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D006454:Hemoglobins