Key result
Aortic valve replacement in patients with severe aortic stenosis, low ejection fraction, and low gradient improved functional capacity, with significantly greater improvement in those with recruitable myocardium (P=0.039).
Why the study?
Does aortic valve replacement improve functional capacity and left ventricular ejection fraction in patients with true severe aortic stenosis, low gradient, and low ejection fraction?
Cohort (n=27)
No
Does aortic valve replacement improve functional capacity and left ventricular ejection fraction in patients with true severe aortic stenosis, low gradient, and low ejection fraction?
p-value: p=0.039
Aortic valve replacement in patients with severe aortic stenosis, low gradient, and low ejection fraction improves functional capacity and LVEF, particularly in those with recruitable myocardium.
AVR may improve functional capacity in low-gradient severe AS with low EF; leaves open need for RCTs to confirm LVEF gains and outcomes.
OBJECTIVE: The results of aortic valve replacement are uncertain among patients with severe aortic stenosis, reduced left ventricular ejection fraction, and low mean transvalvular gradient. The aim of the present study was to report on 27 patients who underwent surgery for aortic stenosis with left ventricular ejection fraction <or=30% and mean transvalvular gradient <30 mmHg. METHODS: The study was performed between January 2000 and December 2005. Twenty-seven patients with aortic stenosis with a calculated valve area <1.0 cm2, aortic mean transvalvular gradient <30 mmHg, and ejection fraction <or=30% were studied. Exclusion criteria were coronary artery disease, concomitant valvular operation, previous aortic valve replacement, or more than moderate aortic valve regurgitation. Preoperative clinical, echocardiography and dobutamine echocardiography, cardiac catheterization and coronary angiography, and operative data were recorded in all patients. Patients who were diagnosed with true aortic stenosis were divided into 2 groups according to left ventricular ejection fraction changes during dobutamine echocardiography, 16 with recruitable myocardium (group 1) versus 11 without (group 2). RESULTS: One patient from group 2 died. The functional capacities of all of the patients in group 1 significantly improved in the postoperative period (P = .001). All of the patients except for 1 in group 1 had improved left ventricular ejection fraction after the operation (P <.001). The comparison of the preoperative and postoperative functional status of these patients in group 2 was also statistically significant (P = .001). The 10 of the 11 patients in group 2 who were alive had left ventricular ejection fraction value changes that were not significant statistically (P = .096). The comparison of the improvement of functional capacities of the groups revealed a significant difference; that is, the improvement was higher in group 1 (P = .039). CONCLUSION: Left ventricular ejection fraction and functional capacity improved after aortic valve replacement in patients with left ventricular dysfunction, low mean transvalvular gradient, and aortic valve replacement in these patients has acceptable mortality rates with significantly improved functional status.
No takes yet. Share an insight, caveat, or question.
Özsöyler et al. (2006) conducted a cohort in Severe aortic stenosis with low ejection fraction and low gradient (n=27). Aortic valve replacement vs. Patients without recruitable myocardium was evaluated on Improvement of functional capacities (NYHA class) (p=0.039). Aortic valve replacement in patients with severe aortic stenosis, low ejection fraction, and low gradient improved functional capacity, with significantly greater improvement in those with recruitable myocardium (P=0.039).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: