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      Severe Aortic Stenosis With Low Transvalvular Gradient and Severe Left Ventricular Dysfunction : Result of Aortic Valve Replacement in 52 Patients

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          Abstract

          Background —The outcome of aortic valve replacement in patients with severe aortic stenosis, low transvalvular gradient, and severe left ventricular dysfunction is not well known.

          Methods and Results —Between 1985 and 1995, 52 patients with left ventricular ejection fraction (EF) ≤35% and aortic stenosis with transvalvular mean gradient <30 mm Hg underwent aortic valve replacement. The mean (±SD) preoperative characteristics included EF, 26±8%; aortic valve mean gradient, 23±4 mm Hg; aortic valve area, 0.7±0.2 cm 2 ; and cardiac output, 3.7±1.2 L/min. Simultaneous coronary artery bypass graft surgery was performed in 32 patients (62%). Perioperative (30-day) mortality was 21% (11 of 52 patients). Ten additional patients died during follow-up. Advanced age ( P =0.048) and small aortic prosthesis size ( P =0.03) were significant predictors of hospital mortality by univariate analysis. By multivariate analysis, the only predictor of surgical mortality was smaller prosthesis size. The only predictor of postoperative survival was improvement in postoperative functional class ( P =0.04). Postoperative functional improvement occurred in most patients. Postoperative EF was assessed in 93% of survivors; 74% demonstrated improvement. Positive change in EF was related to smaller preoperative aortic valve area and female sex.

          Conclusions —Despite severe left ventricular dysfunction, low transvalvular mean gradient, and increased operative mortality, aortic valve replacement was associated with improved functional status. Postoperative survival was related to younger patient age and larger aortic prosthesis size, and medium-term survival was related to improved postoperative functional class.

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          Most cited references22

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          Aortic Stenosis

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            Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I

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              Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients.

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                Author and article information

                Journal
                Circulation
                Circulation
                Ovid Technologies (Wolters Kluwer Health)
                0009-7322
                1524-4539
                April 25 2000
                April 25 2000
                : 101
                : 16
                : 1940-1946
                Affiliations
                [1 ]From the Division of Cardiovascular Diseases and Internal Medicine (H.M.C., J.K.O., V.L.R., S.L.O., A.J.T.), the Section of Cardiovascular Surgery (H.V.S.), and the Section of Biostatistics (D.O.H.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
                Article
                10.1161/01.CIR.101.16.1940
                10779460
                a3572ed2-cb16-4788-b724-d0f4cb5658a8
                © 2000

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