PMID- 16162627 OWN - NLM STAT- MEDLINE DCOM- 20050927 LR - 20181113 IS - 1468-201X (Electronic) IS - 1355-6037 (Print) IS - 1355-6037 (Linking) VI - 91 IP - 10 DP - 2005 Oct TI - 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. PG - 1324-9 AB - 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. FAU - Vaquette, B AU - Vaquette B AD - Department of Cardiology, University Hospital, Rennes, France. bruno.vaquette@chu-rennes.fr FAU - Corbineau, H AU - Corbineau H FAU - Laurent, M AU - Laurent M FAU - Lelong, B AU - Lelong B FAU - Langanay, T AU - Langanay T FAU - de Place, C AU - de Place C FAU - Froger-Bompas, C AU - Froger-Bompas C FAU - Leclercq, C AU - Leclercq C FAU - Daubert, C AU - Daubert C FAU - Leguerrier, A AU - Leguerrier A LA - eng PT - Journal Article PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM CIN - Heart. 2005 Oct;91(10):1254-6. PMID: 16162603 MH - Aged MH - Aortic Valve MH - Aortic Valve Stenosis/mortality/*surgery MH - Female MH - Follow-Up Studies MH - Heart Valve Prosthesis Implantation/*methods/mortality MH - Hospitalization MH - Humans MH - Intraoperative Complications/mortality/*prevention & control MH - Male MH - Postoperative Complications/mortality/*prevention & control MH - Recovery of Function MH - Risk Assessment MH - Risk Factors MH - Survival Analysis MH - Treatment Outcome MH - Ventricular Dysfunction, Left/*etiology PMC - PMC1769144 EDAT- 2005/09/16 09:00 MHDA- 2005/09/28 09:00 PMCR- 2008/10/01 CRDT- 2005/09/16 09:00 PHST- 2005/09/16 09:00 [pubmed] PHST- 2005/09/28 09:00 [medline] PHST- 2005/09/16 09:00 [entrez] PHST- 2008/10/01 00:00 [pmc-release] AID - 91/10/1324 [pii] AID - 0911324 [pii] AID - 10.1136/hrt.2004.044099 [doi] PST - ppublish SO - Heart. 2005 Oct;91(10):1324-9. doi: 10.1136/hrt.2004.044099.