Surgical aortic valve replacement for severe stenosis with low ejection fraction and low transvalvular gradient

ObjectivesEvaluation of early outcomes of surgical aortic valve replacement (AVR) for patients with isolated severe aortic stenosis (AS) associated with left ventricular (LV) dysfunction and low transvalvular gradient.BackgroundAS is the most common valvular heart disease in elderly people, with an incidence of 2-7% in the population above 65 years. Sudden death may be the first presentation for severe AS. AVR is the effective treatment for AS. Benefits versus mortality of surgical AVR is still controversial in patients who presented with severe AS associated with LV dysfunction and low gradient.Materials and methodsBetween October 2012 and January 2015, this multicenter prospective observational study included 20 consecutive patients who presented with isolated severe AS (valve area <1 cm 2 ), associated with LV dysfunction (ejection fraction <40%), and a low mean gradient (<40 mmHg). All patients underwent conventional surgical AVR using cardiopulmonary bypass. LV function improvement was evaluated, 6 months postoperatively for all survivors, by transthoracic Echo.ResultsOur study included 14 male and six female patients with a mean age of 64.75 years and a mean EUROSCORE II of 1.62. All participants underwent conventional AVR with a cardiopulmonary bypass mean time of 113.3 min and a mean cross-clamp time of 69.6 min. The postoperative course involved a mean ICU stay of 3.6 days but, unfortunately, with two (10%) cases requiring reopening and mortality occurring in two (10%) cases. Among the 18 survivors, we detect statistically significant improvements in LV dimensions and systolic function in the postoperative follow-up Echo after 6 months.ConclusionDespite the high mortality rate (10%), surgical AVR is still the gold standard management for severe AS even in the risky subgroup of patients with LV dysfunction and low gradient, due to its effect in the LV function improvement.