Abstract 13023: Pre-Operative Left Ventricular Ejection Fraction and Long-term Survival After Aortic Valve Replacement
Introduction: Previous small series have provided conflicting results regarding the independent effect of preoperative left ventricular ejection fraction (EF) on long-term survival after aortic valve surgery (AVR). The objective of this multi-center, regional study was to evaluate the independent effect of preoperative LVEF on long-term survival of patients undergoing isolated AVR for aortic stenosis (AS).
Methods: From our northern New England registry of consecutive valve procedures we identified patients undergoing isolated AVR for AS from 2000–2008. Survival through 2008 was obtained by linkage to the Social Security Administration Death Index. Survival curves were stratified into five categories by pre-operative EF and were adjusted for age, sex, NY Heart Association Class, acuity, prior stroke, congestive heart failure (CHF), atrial fibrillation, coronary artery disease, diabetes, elevated creatinine, body surface area. Adjusted survival curves were estimated using inverse probability weighting.
Results: 1454 patients (EF<30%: n=73; EF 30–39%: n=76; EF 40–49%: n=127; EF 50–59%: n=246; EF 60%+: n=932) were followed for 5181 person-yrs, accounting for 266 deaths (5.1 deaths/100 person-yrs) (Figure). Patients having lower EF were more likely to have more comorbid conditions and urgent surgery. After adjustment, EF was not significantly associated with worse long-term survival (HR 1.03, p=0.58).
Conclusions: Poor ejection fraction was not significantly associated with long-term survival after isolated AVR. To what extent this effect represents improved selection of patients with a low EF undergoing AVR and/or recovery of LV function following surgery is unknown.
- © 2010 by American Heart Association, Inc.