Long-Term Predictors of Mortality and Functional Recovery After Aortic Valve Replacement for Severe Aortic Stenosis With Left Ventricular Dysfunction

Flores-Marín, Ana; Gómez‐Doblas, Juan José; Caballero-Borrego, Juan; Cabrera-Bueno, Fernando; Rodríguez–Bailón, Isabel; Melero, José M.; Porras, Carlos; Sánchez-Espín, Gemma; Such, Miguel; Olalla, Eduardo; Teresa, Eduardo de

doi:10.1016/s1885-5857(10)70007-4

Cited by 17 publications

(18 citation statements)

References 33 publications

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“…Operative mortality in the current study was 12.5% among AS patients, it correlates with the results reported in contemporary study in which operative mortality rate ranged from 8% to 21% [11,[20][21][22][23]. This mortality does, however, contrast with those reporters in other published studies: Chukwuemeka [24] 1.5% bevilacqua [25] 5.7%, Rediker [26] 0%.…”

Section: Discussionsupporting

confidence: 87%

Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function

Houssa¹,

Moutakiallah²,

Abdou³

et al. 2013

WJCD

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Objective: The aim of the study was to assess the effects of aortic valve replacement (AVR) in patients with aortic stenosis (AS) or regurgitation (AR) and left ventricular (LV) dysfunction. Patients and methods: Retrospective analysis identified 75 consecutive patients with left ventricular ejection fraction (LVEF) assessed by echocardiography < 40% who underwent AVR for AS (n = 40) or AR (n = 35) between 1994 and 2011. Exclusion criteria were previous myocardial infarction or concomitant valvular disorders other than aortic disease. Follow-up evaluated the New York Heart Association (NYHA) functional class, LVEF and survival rate. Results: Mean ages were respectively 56.5 ± 9.3 and 47.9 ± 11.7 years in AS and AR groups, p = 0.001. Before surgery, 88% and 75% of patients were in NYHA III-IV respectively in AS and AR. In the AS group, the mean LVEF and aortic valve area (AVA) were respectively 32.2% ± 8% and 0.65 ± 0.15 cm². AR group had a mean LVEF of 33.8 ± 6.7% and a mean LV systolic diameter of 62 ± 8.8 mm. All patients underwent AVR under cardiopulmonary bypass. There were 5 operative deaths (12.5%) in AS group and 6 (17.6%) in AR group, p = 0.57. LVEF increased to 49% ± 14.7% and 51.2% ± 10.9% in the AS and AR groups after echocardiography control. The survival rates at 1, 5 and 10 years were respectively 94.4%, 87% and 80% in AS group and 95.2%, 93% and 89% in AR group. Conclusion: Despite higher perioperative mortality in patients with aortic valve disease (AS or AR) and LV dysfunc-tion, long-term outcome is excellent. We, therefore, conclude that AVR can be performed and it should not be denied to patients on the basis of low EF alone.

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Section: Discussionsupporting

confidence: 87%

Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function

Houssa¹,

Moutakiallah²,

Abdou³

et al. 2013

WJCD

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“…The increased risk of patients with severe valvular heart disease, particularly aortic stenosis, is well documented 25. The confirmation in our study of the increased risk of these patients when admitted for acute HF is important, adding to the evidence encouraging a low threshold for evaluation and treatment of patients with suspected aortic stenosis.…”

Section: Discussionsupporting

confidence: 69%

Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF

Sani

Davison

Cotter

et al. 2017

CVJA

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SummaryBackground:The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure.Methods:Out of the 1 006 patients in the THESUS-HF registry, 954 had had an echocardiogram performed within a few weeks of admission. Echocardiographic measurements were performed according to the American Society of Echocardiography guidelines. We examined the associations between each echocardiographic predictor and outcome using regression models.Results:Heart rate and left atrial size predicted death within 60 days or re-admission. Heart rate, left ventricular posterior wall thickness in diastole (PWTd), and presence of aortic stenosis were associated with the risk of death within 180 days. PTWd added to clinical variables in predicting 180-day mortality rates.Conclusions:Echocardiographic variables, especially those of left ventricular size and function, were not found to have additional predictive value in patients admitted for acute HF. Left atrial size, aortic stenosis, heart rate and measures of hypertrophy (LV PWTd) had some predictive value, suggesting the importance of early treatment of hypertension and severe valvular heart disease.

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“…Patients undergoing AVR with a reduced left ventricular systolic function are at a substantial risk for perioperative morbidity and mortality, and account for approximately 11.5-13% of patients undergoing AVR (6). The operative mortality is also increased in those undergoing double valve procedures, being 9.4% to 10.7% for those undergoing concomitant aortic and MV surgery (21,22).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, clinically significant mitral regurgitation may coexist in up to 35% of this population, which often necessitates a double valve operation (4). However, despite a higher operative mortality, AVR appears to be beneficial in the majority of patients demonstrating better survival coupled with improved ventricular function and functional class (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

Santana¹,

Xydas²,

Williams³

et al. 2017

J. Thorac. Dis.

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Background: We evaluated the outcomes of patients with aortic valve pathology in the setting of a left ventricular ejection fraction ≤35% who underwent minimally invasive aortic valve replacement (AVR), with or without concomitant mitral valve (MV) surgery. Results: There were 75 patients identified: 51 who underwent isolated AVR, and 24 who had combined AVR plus MV surgery for moderate to severe mitral regurgitation. In patients undergoing MV surgery, there were 22 (91.7%) MV repairs [ring annuloplasty =7 (37.5%), transaortic edgeto-edge repair =15 (62.5%)], and 2 (8.3%) replacements. No patient required conversion to sternotomy for inadequate surgical field exposure. The median total mechanical ventilation time and intensive care unit length of stay were 14 (IQR,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and 42 hours (IQR, in the isolated AVR group, and 16.5 hours (IQR, 12-61.5 hours) and 95.5 hours (IQR, in the AVR plus MV surgery group, respectively. The most common post-operative complication was newonset atrial fibrillation, which occurred in 15 (29.4%) isolated AVR and 4 (16.7%) AVR plus MV surgery patients. The median hospital length of stay and 30-day mortality was 7 days (IQR, 5-12 days) and 1 (2%) in the isolated AVR group, and 10.5 days (IQR, 5-21 days) and 1 (4.3%) for AVR plus MV surgery. Conclusions:In patients with aortic valve pathology in the setting of a left ventricular ejection fraction ≤35%, minimally invasive AVR can be performed, with or without concomitant MV surgery, with a low morbidity and mortality.

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Long-Term Predictors of Mortality and Functional Recovery After Aortic Valve Replacement for Severe Aortic Stenosis With Left Ventricular Dysfunction

Cited by 17 publications

References 33 publications

Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function

Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function

Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF

Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

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