Clinical Outcomes of Aortic valve Replacement for Surgical Treatment of Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGXi-wu , WANGLv , ZHANGBo-yao , ZHANGMi , XUJi-bin , LUFang-lin ,  XUZhi-yun

Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P. R. China;

Corresponding?author：

XUZhi-yun, Email: zhiyunx@hotmail.com

Keywords：

Aortic stenosis; Left ventricular ejection fraction; Aortic valve replacement

DOI：

10.7507/1007-4848.20140091

Video：

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Objective To investigate clinical outcomes of aortic valve replacement (AVR)for surgical treatment of patients with severe aortic stenosis (AS)and left ventricular dysfunction (LVD). Methods Clinical data of 29 patients with severe AS and LVD (left ventricular ejection fraction (LVEF) < 0.50)who underwent AVR in Changhai Hospital between January 2000 and December 2011 were retrospectively analyzed. Patients with mitral stenosis were excluded from this study. There were 22 male and 7 female patients with their age of 14-76 (56.3±12.9)years. Preoperative and postoperative clinical and echocardiographic findings were compared to assess AVR effects. Possible risk factors affecting postoperative recovery of left ventricular function were analyzed according to postoperative LVEF changes. Results One patient died within 30 days after AVR. In the other 28 patients, postoperative aortic pressure gradient (APG)decreased from 97.6±25.1 mm Hg to 25.0±9.7 mm Hg, while LVEF increased from 41%±6% to 56%±11%. Postoperative left ventricular end-diastolic/systolic diameter/volume all significantly improved (all P < 0.001). Conclusions AVR is an effective treatment for patients with severe AS and LVD. Left ventricular function improves significantly in most patients after AVR. Patients with a less dilated left ventricle may have a better LVEF recovery.

Citation： ZHANGXi-wu, WANGLv, ZHANGBo-yao, ZHANGMi, XUJi-bin, LUFang-lin, XUZhi-yun. Clinical Outcomes of Aortic valve Replacement for Surgical Treatment of Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 326-329. doi: 10.7507/1007-4848.20140091 Copy

1.	Tarantini G, Buja P, Scognamiglio R, et al. Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction:determinants of cardiac mortality and ventricular function recovery. Eur J Cardiothorac Surg, 2003, 24 (6):879-885.
2.	Connolly HM, Oh JK, Orszulak TA, et al. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation, 1997, 95 (10):2395-2400.
3.	Pereira JJ, Lauer MS, Bashir M, et al. Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction. J Am Coll Cardiol, 2002, 39 (8):1356-1363.
4.	Rabus MB, Kirali K, Kayalar N, et al. Aortic valve replacement in isolated severe aortic stenosis with left ventricular dysfunction:long-term survival and ventricular recovery. Anadolu Kardiyol Derg, 2009, 9 (1):41-46.
5.	崔勇, 陸方林, 徐志云, 等.主動脈瓣重度狹窄171例外科治療分析.中華外科雜志, 2008, 46 (19):1322-1324.
6.	Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J, 1980, 99 (4):419-424.
7.	Henkel DM, Malouf JF, Connolly HM, et al. Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis:characteristics and outcomes. J Am Coll Cardiol, 2012, 60 (22):2325-2329.
8.	Chan PH, Alegria-Barrero E, Patterson T, et al. Successful dual-valve transcatheter therapy for severe aortic stenosis and mitral regurgitation. Int J Cardiol, 2012, 157 (2):e35-e37.
9.	Mahmood F, Swaminathan M. Aortic stenosis and mitral regurgitation:not as simple as it looks. J Cardiothorac Vasc Anesth, 2011, 25 (5):887-888.
10.	Cerbak R. The most common heart valve diseases:aortic stenosis and mitral regurgitation. A few comments on guidelines and recommendations by societies of cardiology. Vnitrni lekarstvi, 2009, 55 (9):784-787.
11.	Caballero-Borrego J, Gomez-Doblas JJ, Cabrera-Bueno F, et al. Incidence, associated factors and evolution of non-severe functional mitral regurgitation in patients with severe aortic stenosis undergoing aortic valve replacement. Eur J Cardiothorac Surg, 2008, 34 (1):62-66.
12.	Flores-Marin A, Gomez-Doblas JJ, Caballero-Borrego J, et al. Long-term predictors of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev Esp Cardiol, 2010, 63 (1):36-45.
13.	Czer LS, Goland S, Soukiasian HJ, et al. Aortic valve replacement or heart transplantation in patients with aortic stenosis and severe left ventricular dysfunction. Transplant Proc, 2013, 45 (1):364-368.
14.	Dweck MR, Boon NA, Newby DE. Calcific aortic stenosis:a disease of the valve and the myocardium. J Am Coll Cardiol, 2012, 60 (19):1854-1863.
15.	Beach JM, Mihaljevic T, Svensson LG, et al. Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol, 2013, 61 (8):837-848.
16.	Jung SH, Lee JW, Je HG, et al. Surgical outcomes and post-operative changes in patients with significant aortic stenosis and severe left ventricle dysfunction. J Korean Med Sci, 2009, 24 (5):812-817.
17.	Rothenburger M, Drebber K, Tjan TD, et al. Aortic valve replacement for aortic regurgitation and stenosis, in patients with severe left ventr-icular dysfunction. Eur J Cardiothorac Surg, 2003, 23 (5):703-709.
18.	Vaquette B, Corbineau H, Laurent M, et al. Valve replacement in patients with critical aortic stenosis and depressed left ventricular function:predictors of operative risk, left ventricular function reco-very, and long term outcome. Heart, 2005, 91 (10):1324-1329.
19.	Powell DE, Tunick PA, Rosenzweig BP, et al. Aortic valve replac-ement in patients with aortic stenosis and severe left ventricular dysfun-ction. Arch Intern Med, 2000, 160 (9):1337-1341.
20.	Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation, 1996, 93 (5):841-842.

1. Tarantini G, Buja P, Scognamiglio R, et al. Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction:determinants of cardiac mortality and ventricular function recovery. Eur J Cardiothorac Surg, 2003, 24 (6):879-885.
2. Connolly HM, Oh JK, Orszulak TA, et al. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation, 1997, 95 (10):2395-2400.
3. Pereira JJ, Lauer MS, Bashir M, et al. Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction. J Am Coll Cardiol, 2002, 39 (8):1356-1363.
4. Rabus MB, Kirali K, Kayalar N, et al. Aortic valve replacement in isolated severe aortic stenosis with left ventricular dysfunction:long-term survival and ventricular recovery. Anadolu Kardiyol Derg, 2009, 9 (1):41-46.
5. 崔勇, 陸方林, 徐志云, 等.主動脈瓣重度狹窄171例外科治療分析.中華外科雜志, 2008, 46 (19):1322-1324.
6. Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J, 1980, 99 (4):419-424.
7. Henkel DM, Malouf JF, Connolly HM, et al. Asymptomatic left ventricular systolic dysfunction in patients with severe aortic stenosis:characteristics and outcomes. J Am Coll Cardiol, 2012, 60 (22):2325-2329.
8. Chan PH, Alegria-Barrero E, Patterson T, et al. Successful dual-valve transcatheter therapy for severe aortic stenosis and mitral regurgitation. Int J Cardiol, 2012, 157 (2):e35-e37.
9. Mahmood F, Swaminathan M. Aortic stenosis and mitral regurgitation:not as simple as it looks. J Cardiothorac Vasc Anesth, 2011, 25 (5):887-888.
10. Cerbak R. The most common heart valve diseases:aortic stenosis and mitral regurgitation. A few comments on guidelines and recommendations by societies of cardiology. Vnitrni lekarstvi, 2009, 55 (9):784-787.
11. Caballero-Borrego J, Gomez-Doblas JJ, Cabrera-Bueno F, et al. Incidence, associated factors and evolution of non-severe functional mitral regurgitation in patients with severe aortic stenosis undergoing aortic valve replacement. Eur J Cardiothorac Surg, 2008, 34 (1):62-66.
12. Flores-Marin A, Gomez-Doblas JJ, Caballero-Borrego J, et al. Long-term predictors of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev Esp Cardiol, 2010, 63 (1):36-45.
13. Czer LS, Goland S, Soukiasian HJ, et al. Aortic valve replacement or heart transplantation in patients with aortic stenosis and severe left ventricular dysfunction. Transplant Proc, 2013, 45 (1):364-368.
14. Dweck MR, Boon NA, Newby DE. Calcific aortic stenosis:a disease of the valve and the myocardium. J Am Coll Cardiol, 2012, 60 (19):1854-1863.
15. Beach JM, Mihaljevic T, Svensson LG, et al. Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol, 2013, 61 (8):837-848.
16. Jung SH, Lee JW, Je HG, et al. Surgical outcomes and post-operative changes in patients with significant aortic stenosis and severe left ventricle dysfunction. J Korean Med Sci, 2009, 24 (5):812-817.
17. Rothenburger M, Drebber K, Tjan TD, et al. Aortic valve replacement for aortic regurgitation and stenosis, in patients with severe left ventr-icular dysfunction. Eur J Cardiothorac Surg, 2003, 23 (5):703-709.
18. Vaquette B, Corbineau H, Laurent M, et al. Valve replacement in patients with critical aortic stenosis and depressed left ventricular function:predictors of operative risk, left ventricular function reco-very, and long term outcome. Heart, 2005, 91 (10):1324-1329.
19. Powell DE, Tunick PA, Rosenzweig BP, et al. Aortic valve replac-ement in patients with aortic stenosis and severe left ventricular dysfun-ction. Arch Intern Med, 2000, 160 (9):1337-1341.
20. Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation, 1996, 93 (5):841-842.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Aortic valve Replacement for Surgical Treatment of Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction

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