Document Detail


Valve replacement in patients with critical aortic stenosis and depressed left ventricular function: predictors of operative risk, left ventricular function recovery, and long term outcome.
MedLine Citation:
PMID:  16162627     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To identify predictors of operative and postoperative mortality and of functional reversibility after aortic valve replacement (AVR) in patients with aortic stenosis (AS) and severe left ventricular (LV) systolic dysfunction.
METHODS AND RESULTS: Between 1990 and 2000, 155 consecutive patients (mean (SD) age 72 (9) years) in New York Heart Association (NYHA) heart failure functional class III or IV (n = 138) and with LV ejection fraction (LVEF) < or = 30% underwent AVR for critical AS (mean (SD) valve area index 0.35 (0.09) cm2/m2). Thirty day mortality was 12%. NYHA class (3.7 (0.6) v 3.2 (0.7), p = 0.004), cardiothoracic ratio (CTR) (0.63 (0.07) v 0.56 (0.06), p < 0.0001), pulmonary artery systolic pressure (63 (25) v 50 (19) mm Hg, p = 0.03), and prevalence of complete left bundle branch block (22% v 8%, p = 0.03) and of renal insufficiency (p = 0.001) were significantly higher in 18 non-survivors than in 137 survivors. In multivariate analysis, the only independent predictor of operative mortality was a CTR > or = 0.6 (odds ratio (OR) 12.2, 95% confidence interval (CI) 5.4 to 27.4, p = 0.002). The difference between preoperative and immediate postoperative LVEF (early-DeltaEF) was > 10 ejection fraction units (EFU) in 55 survivors. In multivariate analysis, CTR (OR 5.95, 95% CI 3.0 to 11.6, p = 0.006) and mean transaortic gradient (OR 1.05, 95% CI 1.0 to 1.1, p < 0.05) were independent predictors of an early-DeltaEF > 10 EFU. During a mean (SD) follow up of 4.6 (3) years, 50 of 137 (36%) 30 day survivors died, 31 of non-cardiac causes. Diabetes (OR 3.8, 95% CI 2.4 to 6.0, p = 0.003), age > or = 75 years (OR 2.6, 95% CI 2.1 to 4.5, p = 0.004), and early-DeltaEF < or = 10 EFU (OR 0.96, 95% CI 0.94 to 0.97, p = 0.01) were independent predictors of long term mortality. Among 127 survivors, the percentage of patients in NYHA functional class III or IV decreased from 89% preoperatively to 3% at one year. The decrease in functional class was significantly greater in patients with an early-DeltaEF > 10 EFU than patients with an early-DeltaEF < or = 10 EFU (p = 0.02). In addition, the mean (SD) LVEF at one year was 53 (11)% in patients with an early-DeltaEF > 10 EFU and 42 (11)% in patients with early-DeltaEF < or = 10 EFU (p < 0.001).
CONCLUSIONS: Despite a relatively high operative mortality, AVR for AS and severely depressed LVEF was beneficial in the majority of patients. Early postoperative recovery of LV function was associated with significantly greater relief of symptoms and longer survival.
Authors:
B Vaquette; H Corbineau; M Laurent; B Lelong; T Langanay; C de Place; C Froger-Bompas; C Leclercq; C Daubert; A Leguerrier
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  91     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-15     Completed Date:  2005-09-27     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1324-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, University Hospital, Rennes, France. bruno.vaquette@chu-rennes.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve
Aortic Valve Stenosis / mortality,  surgery*
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation / methods*,  mortality
Hospitalization
Humans
Intraoperative Complications / mortality,  prevention & control*
Male
Postoperative Complications / mortality,  prevention & control*
Recovery of Function
Risk Assessment
Risk Factors
Survival Analysis
Treatment Outcome
Ventricular Dysfunction, Left / etiology*
Comments/Corrections
Comment In:
Heart. 2005 Oct;91(10):1254-6   [PMID:  16162603 ]

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