Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function ()
ABSTRACT
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 dysfunction, 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.
Share and Cite:
Houssa, M. , Moutakiallah, Y. , Abdou, A. , Hatim, A. , Drissi, M. , Amahzoune, B. , Bekkali, Y. , Benyass, A. and Boulahya, A. (2013) Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function.
World Journal of Cardiovascular Diseases,
3, 543-550. doi:
10.4236/wjcd.2013.39086.