Surgical Outcomes and Post-Operative Changes in Patients with Significant Aortic Stenosis and Severe Left Ventricle Dysfunction.
10.3346/jkms.2009.24.5.812
- Author:
Sung Ho JUNG
1
;
Jae Won LEE
;
Hyung Gon JE
;
Suk Jung CHOO
;
Cheol Hyun CHUNG
;
Hyun SONG
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. jwlee@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Aortic Valve Stenosis;
Ventricular Dysfunction, Left;
Heart Valve Prosthesis
- MeSH:
Adult;
Aged;
Aortic Valve/*surgery;
Aortic Valve Stenosis/complications/*mortality/surgery;
Atrial Fibrillation/diagnosis;
Coronary Artery Bypass/methods;
Coronary Artery Disease/diagnosis;
Echocardiography;
Hospital Mortality;
Humans;
Male;
Middle Aged;
Risk Factors;
Severity of Illness Index;
Treatment Outcome;
Ventricular Dysfunction, Left/complications/*mortality/surgery
- From:Journal of Korean Medical Science
2009;24(5):812-817
- CountryRepublic of Korea
- Language:English
-
Abstract:
Little is known regarding long-term survival and changes in systolic function following surgery after the occurrence of a severe left ventricular (LV) dysfunction in patients with severe aortic stenosis. Inclusion criteria were an aortic valve area less than 1 cm2 and an LV ejection fraction (EF) less than 35%. Between January 1990 and July 2007, 41 (male: 30) patients were identified. The pre-operative mean EF and mean aortic valve area were 26.7+/-6.1% and 0.54+/-0.2 cm2, respectively. Concomitant coronary artery bypass surgery was performed in 8 patients (19.6%). Immediate post-operative echocardiogram showed to be much improved in LV EF (27.2+/-5.5 vs. 37.4+/-11.3, P<0.001), LV mass index (244.2+/-75.3 vs. 217.5+/-71.6, P=0.006), and diastolic LV internal diameter (62.5+/-9.3 vs. 55.8+/-9.6, P<0.001). Post-operative LV changes were mostly complete by 6 months, and were maintained thereafter. There was one in-hospital mortality (2.4%) and 12 late deaths including one patient diagnosed with malignancy in whom LV function was normal. Multivariate analysis showed pre-operative atrial fibrillation and NYHA FC IV to be significant risk factors for cardiac-related death. Aortic valve replacement in patients with significant aortic stenosis and severe LV dysfunction showed acceptable surgical outcomes. Moreover, LV function improved significantly in many patients.
