Abstract 18268: When is Left Ventricular Function Too Poor for Successful Aortic Valve Replacement? Analysis of 3,075 Cases
Introduction: Preoperative left ventricular (LV) dysfunction often improves after aortic valve replacement (AVR) due to relief of pressure or volume overload; however, LV function sometimes remains unimproved. We sought to determine the predictors of unimproved LV function after AVR, and its effects on clinical outcomes.
Methods: A total of 3,075 patients who underwent surgical AVR (without concomitant mitral surgery) were longitudinally assessed in a follow-up clinic and with echocardiography (median follow-up 6.5yrs). At operation, mean age was 67.8±13.5yrs, 32% were female, and 29% had preoperative LV dysfunction (defined as: grade II, ejection fraction 35-49%; grade III, 20-34%; grade IV, <20%). LV function improvement was defined as a positive change in LV grade at any time during follow-up.
Results: Actuarial survival at 15yrs was 62.0±2.4, 47.8±4.6, 40.7±5.7, and 34.9±8.0% (P<0.001) in patients with preoperative LV grade I (ejection fraction≥50%), II, III, and IV, respectively. In patients with preoperative LV dysfunction (N=894), 25 (2.8%) died within 30 days, and another 206 (23.0%) during follow-up. LV dysfunction did not improve in 26.7% of patients by 2 years, resulting in worse long-term survival (hazard ratio 1.8; P=0.005) (Figure). Unimproved LV dysfunction was predicted by higher preoperative LV diastolic diameter (OR 1.9 per cm; P<0.001), lower preoperative mean aortic gradient (OR 0.8 per 10mmHg; P=0.003), and older age (OR 1.3 per 10yrs; P=0.026). Notably, in patients with LV diastolic diameter≥55mm, the incidence of death or unimproved LV dysfunction at 2yrs was 55.1% (P<0.001).
Conclusions: Unimproved LV dysfunction after AVR is a strong risk factor for decreased long-term survival. Older age, LV dilatation, and a low preoperative aortic valve gradient are significant risk factors for unimproved LV dysfunction and death, especially in those with LV diastolic diameter≥55mm.
Author Disclosures: D. Une: None. V. Chan: None. L. Mesana: None. M. Maklin: None. R. Chan: None. I. Burwash: None. R.G. Masters: None. T.G. Mesana: None. M. Ruel: Research Grant; Modest; Medtronic. Honoraria; Modest; Medtronic.
- © 2014 by American Heart Association, Inc.