Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function

作     者：Mahdi Ait Houssa Younes Moutakiallah Abdessamad Abdou Abdedaim Hatim Mohamed Drissi Brahim Amahzoune Youssef El Bekkali Atif Benyass Abdelatif Boulahya 

作者机构：Cardiac Surgery DepartmentMohammed V Military HospitalRabatMorocco ICU of Cardiac Surgery DepartmentMohammed V Military HospitalRabatMorocco Cardiology DepartmentMohammed V Military HospitalRabatMorocco 

出 版 物：《World Journal of Cardiovascular Diseases》 (心血管病（英文）)

年 卷 期：2013年第3卷第9期

页      面：543-550页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Aortic Valve Disease Aortic Valve Replacement Left Ventricular Dysfunction 

摘      要：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.