Aortic Valve Replacement for Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction - Mortality Risk Factors
PDF

Keywords

Severe aortic stenosis
Aortic valve replacement
Left ventricular dysfunction
Risk factors

Categories

How to Cite

1.
Bakkali A, Koulekey D, Sayah R, Jaabari I, Ait Houssa M, Laaroussi M. Aortic Valve Replacement for Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction - Mortality Risk Factors. Integr J Med Sci [Internet]. 2017 Feb. 3 [cited 2022 Jun. 30];4. Available from: https://www.mbmj.org/index.php/ijms/article/view/77

Abstract

Severe left ventricular dysfunction increases the surgical risk of aortic valve replacement on aortic valvular stenosis. Several risk factors of hospital mortality have been reported in heterogeneous series.
The aim of this study was to identify mortality risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. To avoid biases of associated diseases, our study has been focused on isolated aortic stenosis.
46 patients, with AS and severe left ventricular dysfunction who underwent AVR, were enrolled in this retrospective study. The mean age was 59 ± 12.70 years. 69.6% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF) was 32.3 ± 5.3%, and the mean EuroSCORE was 12.20 ± 8.70. The hospital mortality was 15.20%. The morbidity was marked mainly by low output syndrome in 30.4% of cases. Logistic regression in univariate analysis reveals functional class, renal failure, congestive heart failure, and LVEF as factors related to the risk of hospital mortality. Multivariate logistic regression analysis found renal failure (OR = 11.94, CI [2.65 -72.22], p = 0.03) and congestive heart failure (OR = 25.33, CI [3 43 -194.74], p = 0.009) as independents risk of hospital mortality. The mean follow-up was 59.6 ± 21 months. Late mortality was 5%. 
Congestive heart failure and preoperative renal failure are the main independent hospital mortality risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. Late mortality might be inversely related to LV recovery.

https://doi.org/10.15342/ijms.v4ir.129
PDF

References

Wiedemann D, Bonaros N, Kocher A. Aortic Valve Surgery and Reduced Ventricular Function. Aortic Valve Surgery; 2011. [Accessed 2021 Jun 26]. Available from: http://www.intechopen.com/books/aortic-valve-surgery/aortic-valve-surgery-and-reduced-ventricular-function

Cannolly HM, Oh JK, Schaff HV, Roger VL, Osborn SL, Hodge DO, et al. Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction. Results of aortic valve replacement in 52 patients. Circulation. 2000 Apr 25; 101(16): 1940-6. https://doi.org/10.1161/01.cir.101.16.1940

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: the Task Force on the management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007 Jan;28(2):230-68. https://doi.org/10.1093/eurheartj/ehl428

Connolly HM, Oh JK, Orszulok TA, Osborn SL, Roger VL, Hodge DO, et al. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction: prognostic indicators. Circulation. 1997 May 20; 95(10):2395–400. https://doi.org/10.1161/01.cir.95.10.2395

Cannolly HM, Oh JK, Schaff HV, Roger VL, Osborn SL, Hodge DO, et al. Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction. Results of aortic valve replacement in 52 patients. Circulation. 2000 Apr 25; 101(16): 1940-6. https://doi.org/10.1161/01.cir.101.16.1940

Corti R, Benggeli C, Turina M, Jenni R, Luscher TF, Turina J. Predictors of long-term survival after valve replacement for chronic aortic regurgitation. Is M-mode echocardiography sufficient? Eur Heart J. 2001 May; 22(10): 866-73. https://doi.org/10.1053/euhj.2000.2314

Sharony R, Grossi EQ, Saunders PC, Schwartz CF, Ciuffo GB, Baumann FG, et al. Aortic valve replacement in patients with impaired ventricular function. Ann Thorac Surg. 2003 Jun; 75(6): 1808-14. https://doi.org/10.1016/s0003-4975(03)00117-6

Pereira JJ, Lauer MS, Bashir M, Afridi I, Blackstone EH, Stewart WJ, 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 Apr 17; 39 (8):1356–63. https://doi.org/10.1016/s0735-1097(02)01759-x

Clavel MA, Fuchs C, Burwash IG, Mundigler G, Dumesnil JG, Baumgarter H, et al. Predictors of outcomes in low-flow, low-gradient aortic stenosis. Results of the multicenter TOPAS Study. Circulation. 2008 Sep 30;118 (14 Suppl):S234–42. https://doi.org/10.1161/circulationaha.107.757427

Ross J Jr, Braunwald E. Aortic stenosis. Circulation. 1968 Jul;38 (1 suppl ):61-7. https://doi.org/10.1161/01.cir.38.1s5.v-61

Caballero-Borrego J, Gómez-Doblas JJ, Valencia-Serrano F, Cabrera-Bueno F, Rodríguez-Bailón I, Sánchez-Espín G, et al. Influencia del género en el pronóstico perioperatorio de pacientes sometidos a sustitución valvular por estenosis aórtica severa. Rev Esp Cardiol. 2009 Jan; 62(1):31-8. https://doi.org/10.1016/S1885-5857(09)71511-7

Smith N, McAnulty JH, Rahimtoola SH. Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement. Circulation. 1978 Aug; 58(2):255–64. https://doi.org/10.1161/01.cir.58.2.255

Brogan WC, Grayburn PA, Lange RA, Hillis LD. Prognosis after valve replacement in patients with severe aortic stenosis and a low transvalvular pressure gradient. J Am Coll Cardiol. 1993 Jun; 21(7):1657–60. https://doi.org/10.1016/0735-1097(93)90383-c

Flores-Martin A, Gomez-Doblas JJ, Caballero-Borrego J, Cabera-Bueno F, Rodriguez-Bailon I, Melero J, et al. Long-term predictor of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev Esp Cardiol. 2010 Jan; 63(1): 36-45. https://doi.org/10.1016/s1885-5857(10)70007-4

Silver K, Aurigemma G, Krendel S, Barry N, Ockene I, Alpert J. pulmonary artery hypertension in severe aortic stenosis: Incidence and mechanism. Am Heart J. 1993 Jan;125(1):146-50. https://doi.org/10.1016/0002-8703(93)90067-j

Tribouilloy C, Levy F, Rusinaru D, Guéret P, Petit-Eisenmann H, Baleynaud S, et al. Outcome after aortic valve replace¬ment for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol. 2009 May 19;53(20):1865-73. https://doi.org/10.1016/j.jacc.2009.02.026

Powell DE, Tunick PA, Rosenzweig BP, Freedbeg RS, Katz ES, Applebaum RM, et al. Aortic valve replacement in patients with aortic stenosis and severe left ventricular dysfunction. Arch Intern Med. 2000 May 8; 160(9):1337–41. https://doi.org/10.1001/archinte.160.9.1337

Caballero-Borrego J, Gómez-Doblas JJ, Cabrera-Bueno F, García-Pinilla JM, Melero JM, Porras C, et al. Incidence, associate factors and evolution of non-severe functional mitral regurgitation in patients withsevere aortic stenosis undergoing aortic valve replacement. Eur J Cardiothorac Surg. 2008 Jul; 34(1):62-6. https://doi.org/10.1016/j.ejcts.2008.03.055

Badian S, ZalenJV,Treibel TA,Bhattacharyya S, Moon JC, Lloyd G. Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging. Curr Cardiol Rep. 2016 Aug; 18(8): 80. https://doi.org/10.1007/s11886-016-0753-6

Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low flow, low gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007 Jun 5; 115(22):2856–64. https://doi.org/10.1161/circulationaha.106.668681

Duncan AI, Lowe BS, Garcia MJ, Xu M, Gillinov AM, Mihaljevic T, et al. Influence of concentric left ventricular remodeling on early mortality after aortic valve replacement. Ann Thorac Surg. 2008 Jun;85(6):2030–9. https://doi.org/10.1016/j.athoracsur.2008.02.075

Mihaljevic T, Nowicki ER, Rajeswaran J, Blackstone EH, Lagazzi L, Thomas J, et al. Survival after valve replacement for aortic stenosis: implications for decision making. J Thorac Cardiovasc Surg.2008 Jun;135(6):1270–8. https://doi.org/10.1016/j.jtcvs.2007.12.042

Spriginds DC, Chambers JB, Cochrane T, Allen J, Jackson G. Ventricular stroke work loss: vali¬dation of a method of quantifying the severity of aortic stenosis and derivation of an orifice formula. J Am Coll Cardiol. 1990 Dec;16(7):1608-14. https://doi.org/10.1016/0735-1097(90)90309-d

Borowski A, Ghodsizad A, Vchivkov I, Gams E. Surgery for severe aortic stenosis with low transvalvular gradient and poor left ventricular function-a single centre experience and review of the literature. J Cardiothorac Surg. 2007 Jan 31; 2:9. https://doi.org/10.1186/1749-8090-2-9

Quéré JP, Monin Jl, Levy F, Petit H, Baleynaud S, Chauvel, et al. Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis. Circulation. 2006 Apr 11;113(14):1738-44. https://doi.org/10.1161/circulationaha.105.568824

Monin JL, Monchi M, Gest V, Duval-Moulin AM, Dubois-Rande JL, Gueret P. Aortic stenosis with severe left ventricular dysfunction and low transval¬vular pressure gradients, Risk stratification by low-dose dobutamine echocar-diography. J Am Coll Cardiol. 2001 Jun 15;37(8):2101-7. https://doi.org/10.1016/s0735-1097(01)01339-0

Monin JL, Quéré JP, Monichi M, Petit H, Baleynaud S, Chauvel C, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003 Jul 22; 108(3):319-24. https://doi.org/10.1161/01.cir.0000079171.43055.46

Subramanian H, Kunadian B, Dunning J. Is it ever worth contemplating an aortic valve replacement on patients with low gradient severe aortic stenosis but poor left ventricular function with no contractile reserve? Interact CardioVasc Thorac Surg. 2008 Apr; 7(2):301-5. https://doi.org/10.1510/icvts.2008.175463

Duarte IG, Murphy CO, Kosinski AS, Jones EL, Craver JM, Gott JP, et al. Late Survival After Valve Operation in Patients With Left Ventricular Dysfunction. Ann Thorac Surg. 1997 Oct; 64(4):1089 -95. https://doi.org/10.1016/s0003-4975(97)00800-x

Rabus MB, Kirali K, Kayalar N, Yayla-Tuncer E, Toker ME, Yakut C. Aortic valve replacement in isolated severe aortic stenosis with left ventricular dysfunction: long-term survival and ventricular recovery/Sol ventrikul disfonksiyonunun eslik ettigi izole ileri aort darliginda aort kapagi replasmani: uzun donem sagkalim ve ventrikuler duzelme. Anadolu Kardiyol Derg. 2009 Feb;9(1):41-6.

Ruel M, Al-Faleh H, Kulik A, Chan KL, Mesana TG, Burwash IG. Prosthesis–patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regression. J Thorac Cardiovasc Surg. 2006 May;131(5):1036-44. https://doi.org/10.1016/j.jtcvs.2005.10.028

Morris JJ, Schaff HV, Mullany CJ, Rastogi A, McGregor CG, Daly RC, et al. Determinants of survival and recovery of left ventricular function after aortic valve replacement. Ann Thorac Surg. 1993 Jul; 56(1):22–9. https://doi.org/10.1016/j.jtcvs.2005.10.028

Vaquette B, Corbineau H, Laurent M, Lelong B, Langanay T, De Place C, et al. Valve replacement in patients with critical aortic stenosis and depressed left ventricular function: predictors of operative risk, left ventricular function recovery, and long term outcome. Heart. 2005 Oct;91(10):1324–9. https://doi.org/10.1136/hrt.2004.044099

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2017 Abderrahmane Bakkali et al.

Downloads

Download data is not yet available.