Valvular Replacement for Patients with Aortic Stenosis and Severe Left Ventricular Dysfunction

Liu, Chung-Pin
Hsu, Ron-Bin
Hua, Shi-Zhe
Ho, Yi-Lwun

Received: August 12, 2004 Accepted: November 17, 2004 Departments of Internal Medicine (Division of Cardiology) and ¹Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei 100, Taiwan.

Address correspondence and reprint requests to: Dr. Yi-Lwun Ho, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.

Tel: 886–2-2312–3456 ext. 2328; Fax: 886–2-2396–6013;

E-mail: [email protected]

Acta Cardiologica Sinica 21(1):p 21-27, March 2005.

Background and Purpose:

The 2-year survival of patients with aortic stenosis (AS) and congestive heart failure is less than 10% under medical treatment. On the other hand, the surgical risk of aortic valve replacement (AVR) also increases for patients with AS and severe left ventricular (LV) dysfunction. The aim of this study was to evaluate the risk and benefit of AVR for such patients.

Methods:

From May 1999 to April 2003, 8 consecutive patients with AS and severe LV dysfunction (ejection fraction [EF] ≤30%) underwent aortic valve replacement in National Taiwan University Hospital. The myocardial protection was initially achieved with antegrade perfusion and maintained with continuous retrograde cold blood or crystalloid cardioplegia. The indication for aortic valve replacement was severe AS, which was defined as an aortic valve area of ≤1.0 cm or a maximum pressure gradient of ≥ 50 mmHg assessed by Doppler echocardiography. The mean age was 67 ± 9 years; and 7 of 8 patients suffered from severe exertional dyspnea (functional class III-IV of New York Heart Association). Respiratory failure developed in 5 patients prior to surgery.

Results:

The perioperative (30-day) mortality was 0%. During a mean follow-up period of 32 ± 18 months (range 16–61 months), the survival rate was 75%. The clinical symptoms of heart failure improved at least one functional class in all patients. The mean change of LVEF was an increase of 26 ± 18 EF units (p = 0.005), and the mean reductions of LV end-systolic dimension and LV end-diastolic dimension were 16 ± 8 (p = 0.001) and 11 ± 8 mm (p = 0.005), respectively.

Conclusions:

The surgical risk was acceptable for AVR in patients with AS and severe LV dysfunction. Improvements in symptoms, heart size and LV systolic function were observed in most patients.