Determinants of survival and recovery of left ventricular function after aortic valve replacement

Morris, James J.; Schaff, Hartzell V.; Mullany, Charles J.; Rastogi, Amita; McGregor, Christopher G.A.; Daly, Richard C.; Frye, Robert L.; Orszulak, Thomas A.

doi:10.1016/0003-4975(93)90398-2

Cited by 152 publications

(73 citation statements)

References 22 publications

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“…Other international studies 4,15 that covered the approximately 20-year period prior to our study have shown that the expected cardiac survival as well as the overall survival for patients undergoing surgery for chronic aortic insufficiency was lower than that experienced with our patients. Turina et al 4 published a study on 192 patients with chronic AR operated on between 1970 and 1983.…”

Section: Discussioncontrasting

confidence: 55%

Are patients with isolated chronic aortic regurgitation operated in time? Analysis of survival data over a decade

Tamás

Nylander

Olin

2005

Clinical Cardiology

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SummaryBackground: Patients suffering from chronic isolated aortic regurgitation have a less favorable outcome than patients with aortic stenosis. According to international recommendations, these patients should undergo surgery as soon as left ventricular function begins to deteriorate, that is, surgery is not to be postponed until clinical symptoms become relevant.Hypothesis: The study was undertaken to evaluate how satisfactory our timing of surgery was, as reflected by survival data.Methods: Survival was studied retrospectively in a consecutive series of patients undergoing surgery for chronic isolated aortic regurgitation during a 10-year period in our institution. Results were compared with data from the literature. By excluding patients with aortic aneurysms and acute endocarditis, we formed a homogeneous patient group of 88 subjects.Results: Thirty-day mortality was 1% and late mortality after a mean follow-up period of 6 years was 11%. Compared with survival data from an earlier study in which the patient population was similar and resided in the same geographic area, the results in our patient group seem to be better. It is noteworthy that despite a strong effort to recommend surgery at an earlier stage of the disease than previously, 35% of the patients had moderate or severe left ventricular dysfunction preoperatively because of late referrals.Conclusion: This stresses the importance of early detection and careful preoperative follow-up with noninvasive methods in patients with aortic regurgitation.

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Section: Discussioncontrasting

confidence: 55%

Are patients with isolated chronic aortic regurgitation operated in time? Analysis of survival data over a decade

Tamás

Nylander

Olin

2005

Clinical Cardiology

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“…[3][4][5] One possible mechanism is nonrecovery of LV dysfunction after AVR. Because LV function affects clinical outcomes, 3,6 incomplete LV recovery postoperatively may translate into decreased survival and quality of life. Usually, LV function worsens with long-standing pressure or volume overload and recovers after AVR with relief of this overload.…”

mentioning

confidence: 99%

Clinical Impact of Changes in Left Ventricular Function After Aortic Valve Replacement

et al. 2015

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Background-Our objectives were to identify correlates of mortality and congestive heart failure after aortic valve replacement (AVR) according to preoperative left ventricular (LV) function and to describe the incidence, time course, and correlates of LV recovery and mass regression postoperatively. Methods and Results-A total of 3112 patients with AVR were assessed in a follow-up clinic with echocardiography (median follow-up, 6.0 years). At operation, their mean age was 67.8±13.4 years, one third were female, and 29% had LV dysfunction (ejection fraction <50%). In severe patients with severe aortic stenosis and LV dysfunction, transaortic valve mean pressure gradient <40 mm Hg, longer cardiopulmonary bypass duration, and prosthesis-patient mismatch (indexed effective orifice area ≤0.85 cm 2 /m 2 ) were independent correlates of the composite outcome of death or congestive heart failure after AVR. In patients with severe aortic regurgitation and LV dysfunction, older age and higher preoperative LV mass were identified. LV recovery correlated with better survival and freedom from heart failure in patients with aortic stenosis. Maximum LV mass regression took 24 months in patients with aortic stenosis and nearly 5 years with aortic regurgitation; independent correlates included smaller LV end-systolic diameter in patients with aortic stenosis and low New York Heart Association class with aortic regurgitation. Conclusions-Incomplete LV recovery, prosthesis-patient mismatch, low transaortic valve pressure gradient, and higher LV mass are associated with increased mortality or heart failure after AVR in patients with LV dysfunction. Higher LV end-systolic diameter and symptoms correlate with less LV mass regression, which takes at least 2 years. These findings help surgeons and cardiologists refine the indications, timing, prognostication, and follow-up of patients before and after AVR. (Circulation. 2015;132:741-747.

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“…(6) In patients undergoing AVR for severe AS, LVD is a major prognostic indicator, with mortality rates of between 10 -25% reported. (7,8) Despite increased mortality, AVR has been demonstrated to improve symptoms in survivors and improve survival compared to conservative management.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following aortic valve replacement for isolated aortic stenosis with left ventricular dysfunction

Naicker

Brown

Ponnusamy

2017

SAHJ

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Outcomes following aortic valve replacement for isolated aortic stenosis with left ventricular dysfunction study was to determine the effects of AVR on left ventricular function and to describe the clinical outcomes in patients with isolated severe AS and LVD. The hypothesis was that AVR in patients with isolated AS and LVD improves LV function. MATERIALS AND METHODS Study populationBetween 2004 and 2013, 1 573 chart records were analysed from the medical database of Inkosi Albert Luthuli Central Hospital, utilising the ICD-9 coding of AVR and AS. These ABSTRACT OUTCOMES FOLLOWING AVR INTRODUCTIONSevere aortic stenosis (AS) is associated with a poor prognosis in patients with left ventricular dysfunction (LVD). Survival is estimated at less than 2 years in patients without aortic valve replacement (AVR).(1,2) A reduced ejection fraction may be related to the severity of the AS and chronic pressure overload of the left ventricle, rather than depressed myocardial contractility (afterload mismatch). Relief of the valvular obstruction, by valve replacement, should allow recovery of left ventricular size and function.(3,4) However, there is a greater surgical risk and morbidity in patients with AS and LVD, which need to be considered. (5,6) Most studies that have described the effects of AVR on ventricular function included patients with coronary artery disease (CAD), which may contribute independently to LVD. Since the presence of CAD is associated with a reduced survival rate following AVR, (2) we aimed to eliminate this variable and evaluate the isolated effect of AVR in those without concomitant CAD. There is no known published data available on survival, changes in ventricular function and long-term follow up from any South African institute to date. The purpose of this

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Determinants of survival and recovery of left ventricular function after aortic valve replacement

Cited by 152 publications

References 22 publications

Are patients with isolated chronic aortic regurgitation operated in time? Analysis of survival data over a decade

Are patients with isolated chronic aortic regurgitation operated in time? Analysis of survival data over a decade

Clinical Impact of Changes in Left Ventricular Function After Aortic Valve Replacement

Outcomes following aortic valve replacement for isolated aortic stenosis with left ventricular dysfunction

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