Key Points
- To identify predictors of operative mortality, left ventricular function recovery, and long-term outcomes following aortic valve replacement in patients with critical aortic stenosis and severe left ventricular systolic dysfunction.
- Analyzed 155 consecutive patients (mean age 72 years) with critical aortic stenosis (mean valve area index 0.35 cm²/m²) and left ventricular ejection fraction (LVEF) ≤ 30% undergoing aortic valve replacement between 1990 and 2000.
- Evaluated clinical, hemodynamic, and echocardiographic variables over a mean follow-up of 4.6 years, tracking 30-day mortality, functional class, and changes in ejection fraction.
- Operative 30-day mortality was 12% (18/155), with a cardiothoracic ratio ≥ 0.6 identified as the sole independent predictor of operative death (OR 12.2, 95% CI 5.4–27.4, p = 0.002).
- An early postoperative LVEF improvement > 10 units occurred in 55 survivors and was independently predicted by cardiothoracic ratio (OR 5.95, 95% CI 3.0–11.6, p = 0.006) and mean transaortic gradient (OR 1.05, 95% CI 1.0–1.1, p < 0.05).
- Independent predictors of long-term mortality among 30-day survivors included diabetes (OR 3.8, 95% CI 2.4–6.0, p = 0.003), age ≥ 75 years (OR 2.6, 95% CI 2.1–4.5, p = 0.004), and early LVEF gain ≤ 10 units (OR 0.96, 95% CI 0.94–0.97, p = 0.01).
Structured PICO
What are the predictors of operative risk, LV function recovery, and long-term outcome after aortic valve replacement in patients with critical aortic stenosis and LVEF ≤ 30%?
PPopulation155 consecutive patients with critical aortic stenosis (mean valve area index 0.35 cm2/m2) and severe left ventricular systolic dysfunction (LVEF ≤ 30%), mean age 72 years, predominantly in NYHA functional class III or IV (n=138).
IInterventionAortic valve replacement (AVR)
OOutcomePredictors of operative mortality, postoperative mortality, and functional reversibility (early postoperative recovery of LV function)hard clinical
Despite a 12% operative mortality, aortic valve replacement in patients with critical aortic stenosis and severely depressed LVEF provides significant symptomatic relief and long-term survival, particularly in those who experience early postoperative recovery of LV function.