PMID- 23267804
OWN - NLM
STAT- MEDLINE
DCOM- 20130828
LR  - 20130204
IS  - 1873-2623 (Electronic)
IS  - 0041-1345 (Linking)
VI  - 45
IP  - 1
DP  - 2013 Jan-Feb
TI  - Aortic valve replacement or heart transplantation in patients with aortic 
      stenosis and severe left ventricular dysfunction.
PG  - 364-8
LID - S0041-1345(12)00665-3 [pii]
LID - 10.1016/j.transproceed.2012.04.032 [doi]
AB  - INTRODUCTION: The decision to perform aortic valve replacement (AVR) or heart 
      transplantation (HTx) for aortic stenosis (AS) with severe left ventricular 
      dysfunction is difficult and may be affected by prior myocardial infarction (MI) 
      and coronary artery disease (CAD). METHODS: Patients who underwent AVR from 1988 
      to 2001 with left ventricular ejection fraction (LVEF) <30% and severe AS (aortic 
      valve area [AVA] < 1.0 cm(2); n = 51) were assessed for operative mortality, late 
      survival, and predictors of outcome, and were compared with HTx. Subsequently, 
      131 patients with LVEF </= 35% who underwent AVR for critical AS (AVA < 0.8 cm(2)) 
      were evaluated. RESULTS: In the first 51 patients, 3-year survival was 100% +/- 0% 
      with no CAD, and 45% +/- 10% with CAD (P < .05); 3-year survival was 88% +/- 12% with 
      no bypass, 73% +/- 12% with one to two grafts, and 18% +/- 11% with three grafts (P < 
      .01). Survival with HTx was 78% at 3 years. In the subsequent analysis of 131 
      patients, 90-day survivors were followed for a mean 4.6 +/- 3.5 years. Advanced age 
      (P = .001) was the only predictor of long-term mortality. LVEF improved from 
      28.5% +/- 5.2% before AVR to 45.4% +/- 13.2% at 1-month postoperatively (P < .0001). 
      New York Heart Association (NYHA) class III/IV decreased from 94.2% pre-AVR to 
      12.8% at 1 year (P < .0001). Predictors of LVEF recovery were no previous MI (P = 
      .007) and higher AS gradient (P = .03). CONCLUSIONS: In severe AS and LVEF <30% 
      with no concomitant CAD or with CAD requiring one to two bypass grafts, AVR has a 
      survival equal to or exceeding that of HTx. In patients with CAD requiring more 
      than two bypass grafts, survival is significantly reduced, and HTx can be 
      considered.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Czer, L S C
AU  - Czer LS
AD  - Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California 
      90048, USA. lawrence.czer@cshs.org
FAU - Goland, S
AU  - Goland S
FAU - Soukiasian, H J
AU  - Soukiasian HJ
FAU - Gallagher, S
AU  - Gallagher S
FAU - De Robertis, M A
AU  - De Robertis MA
FAU - Mirocha, J
AU  - Mirocha J
FAU - Siegel, R J
AU  - Siegel RJ
FAU - Kass, R M
AU  - Kass RM
FAU - Trento, A
AU  - Trento A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20120919
PL  - United States
TA  - Transplant Proc
JT  - Transplantation proceedings
JID - 0243532
SB  - IM
MH  - Aged
MH  - Algorithms
MH  - Aortic Valve/*pathology/*surgery
MH  - Aortic Valve Stenosis/complications/mortality/*surgery
MH  - Cardiopulmonary Bypass/methods
MH  - Female
MH  - Heart Transplantation/*methods
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*methods/mortality
MH  - Heart Ventricles/pathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Models, Statistical
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/complications/mortality/*surgery
EDAT- 2012/12/27 06:00
MHDA- 2013/08/29 06:00
CRDT- 2012/12/27 06:00
PHST- 2012/03/23 00:00 [received]
PHST- 2012/04/17 00:00 [accepted]
PHST- 2012/12/27 06:00 [entrez]
PHST- 2012/12/27 06:00 [pubmed]
PHST- 2013/08/29 06:00 [medline]
AID - S0041-1345(12)00665-3 [pii]
AID - 10.1016/j.transproceed.2012.04.032 [doi]
PST - ppublish
SO  - Transplant Proc. 2013 Jan-Feb;45(1):364-8. doi: 
      10.1016/j.transproceed.2012.04.032. Epub 2012 Sep 19.