(Circulation. 2000;101:1940.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Severe Aortic Stenosis With Low Transvalvular Gradient and Severe Left Ventricular Dysfunction
Result of Aortic Valve Replacement in 52 Patients
From the Division of Cardiovascular Diseases and Internal Medicine (H.M.C., J.K.O., V.L.R., S.L.O., A.J.T.), the Section of Cardiovascular Surgery (H.V.S.), and the Section of Biostatistics (D.O.H.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
Background—The outcome of aortic valve replacement in patients with severe aortic stenosis, low transvalvular gradient, and severe left ventricular dysfunction is not well known.
Methods and Results—Between 1985 and 1995, 52 patients with left
ventricular ejection fraction (EF) 
35% and aortic
stenosis with transvalvular mean gradient <30
mm Hg underwent aortic valve replacement. The mean (±SD) preoperative
characteristics included EF, 26±8%; aortic valve mean gradient,
23±4 mm Hg; aortic valve area, 0.7±0.2 cm2; and
cardiac output, 3.7±1.2 L/min. Simultaneous
coronary artery bypass graft surgery was performed in 32
patients (62%). Perioperative (30-day) mortality was
21% (11 of 52 patients). Ten additional patients died during
follow-up. Advanced age (P=0.048) and small aortic
prosthesis size (P=0.03) were significant
predictors of hospital mortality by univariate
analysis. By multivariate analysis, the
only predictor of surgical mortality was smaller prosthesis
size. The only predictor of postoperative survival was improvement in
postoperative functional class (P=0.04). Postoperative
functional improvement occurred in most patients. Postoperative EF was
assessed in 93% of survivors; 74% demonstrated improvement.
Positive change in EF was related to smaller preoperative aortic valve
area and female sex.
Conclusions—Despite severe left ventricular dysfunction, low transvalvular mean gradient, and increased operative mortality, aortic valve replacement was associated with improved functional status. Postoperative survival was related to younger patient age and larger aortic prosthesis size, and medium-term survival was related to improved postoperative functional class.
Key Words: prognosis • stenosis • valves • ventricles
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