Impaired left ventricular function in chronic aortic valve disease: survival and function after replacement by Björk-Shiley prosthesis.

Abstract

Postoperative survival and left ventricular function were studied in 128 patients who underwent isolated aortic valve replacement by the Björk-Shiley valve between 1973 and 1977. The average follow-up was 2.1 years. Patients with associated coronary artery disease or mitral valve disease were excluded. Preoperative ejection fraction ranged from 15-84%. Forty-two patients were restudied by cardiac catheterization 9.1 +/- 1.1 months (mean +/- SEM) after valve replacement. The hospital mortality was 11%. Preoperative type of valve lesion, functional class, cardiothoracic ratio, and ejection fraction (EF) had no significant effect on postoperative survival up to 4 years. After operation, left ventricular mass (LVMI) and peak systolic wall stress (PSWS) fell significantly, while EF and mean normalized systolic ejection rate (MNSER) increased in aortic stenosis and in aortic insufficiency. Neither in aortic stenosis nor in aortic insufficiency was there a significant relation between preoperative ejection fraction and postoperative LVMI, EF, MNSER and PSWS. We attributed this to a marked improvement of left ventricular function in patients with preoperative impaired ventricular function. Six patients with paravalvular leak to restudy has a significantly lower EF and MNSER, and a higher PSWS than patients without leak. Patients without leak had normal EF, MNSER and PSWS when compared with 10 normal persons, but LVMI remained moderately elevated. Postoperative transprosthetic gradient was 11.9 mm Hg (range 0-64 mm Hg). We conclude that impaired cardiac function is completely restored after aortic valve replacement by Björk-Shiley valve, if valve function is good. Patients with impaired cardiac function preoperatively did not have a poorer prognosis after operation than patients with normal function.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…[235][236][237][238][239][240][241][242][243][244][245][246] With time, during which the ventricle develops progressive chamber enlargement and a more spherical geometry, depressed myocardial contractility predominates over excessive loading as the cause of progressive systolic dysfunction. This can progress to the extent that the full benefit of surgical correction of the regurgitant lesion, in terms of recovery of LV function and improved survival, can no longer be achieved.…”

The effect of aortic valve replacement on survival.

“…The American Heart Association (AHA) has established guidelines for the prophylaxis of SBE among predisposed patients." 2 …”

Left Ventricular Function during Exercise after Aortic Valve Replacement

“…Kennedy and Schwarz et al [3,6] indi cated that reduced left ventricular pump func tion was reversible after successful aortic valve replacement regardless of preoperative aortic valve disease. Many previous reports showed that substantial left ventricular re modeling took place within the first few months following aortic valve replacement [3,25,26], On the other hand.…”

“…The importance of evaluating left ventricu lar pump function after aortic valve replace ment for effective clinical management has replacement [3][4][5][6], In daily living, it is impor tant to assess cardiovascular reserve in pa tients with aortic valve replacement [7,8], However, the difference in the hemodynamic response during exercise after aortic prostheses between patients with aortic stenosis and aortic insufficiency has not been studied in detail.…”