J Korean Med Sci.  2009 Oct;24(5):812-817. 10.3346/jkms.2009.24.5.812.

Surgical Outcomes and Post-Operative Changes in Patients with Significant Aortic Stenosis and Severe Left Ventricle Dysfunction

• Jung SH
• Lee JW
• Je HG
• Choo SJ
• Chung CH
• Song H

• KMID: 1781999
• DOI: http://doi.org/10.3346/jkms.2009.24.5.812

Abstract

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 cm2 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 cm2, 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.

Keyword

Aortic Valve Stenosis; Ventricular Dysfunction, Left; Heart Valve Prosthesis

MeSH Terms

Adult
Aged
Aortic Valve/*surgery
Aortic Valve Stenosis/complications/*mortality/surgery
Atrial Fibrillation/diagnosis
Coronary Artery Bypass/methods
Coronary Artery Disease/diagnosis
Echocardiography
Hospital Mortality
Humans
Male
Middle Aged
Risk Factors
Severity of Illness Index
Treatment Outcome
Ventricular Dysfunction, Left/complications/*mortality/surgery

Figure

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  Fig. 1 The number of operation per year.

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  Fig. 2 Post-operative changes in echocardiographic findings; (A) left ventricular ejection fraction (LV EF), (B) Left ventricular mass, (C) Diastolic left ventricular internal dimension (LVIDd), (D) Systolic left ventricular internal dimension (LVIDs), (E) left ventricular end-systolic volume (ESV), and (F) left ventricular end-diastolic volume (EDV). *P=0.437; †P=0.822; ‡P=0.645; §P=0.856; ∥P=0.044; ¶P=0.597; ††P=0.4; ‡‡P=0.725.

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