Early and long-term outcomes after surgical treatment in patients with aortic stenosis and severe left ventricular heart failure without concomitant coronary artery disease with respect to preoperative mean transvalvular pressure gradient.

INTRODUCTION

There are limited data on early and long-term prognosis in patients after aortic valve replacement who have left ventricular dysfunction, reduced ejection fraction (EF) < or =35% and no concomitant coronary artery disease.

AIM

To assess the prognosis in this group of patients depending on the mean aortic gradient (MAG) value.

METHODS

This study involved 60 patients with severe aortic stenosis and EF < or =35%. Patients with coronary artery disease, more than moderate aortic regurgitation and any other valvular lesion were excluded. Patients were divided into two groups based on the MAG values: group I included patients with MAG < or =35 mmHg, and group II included patients with MAG >35 mmHg.

RESULTS

Early mortality after aortic valve replacement was 14.2% in group I, and 5.1% in group II. During a mean follow-up of 48 months mortality in groups I and II was 16.6% and 2.6%, respectively. In the follow-up period, a significant functional improvement according to NYHA scale as well as significant decrease of left ventricular dimensions and increase of EF was observed in both groups of patients.

CONCLUSIONS

Patients with severe aortic stenosis, left ventricular ejection fraction <35% and MAG < or =35 mmHg constitute a group of the highest early and long-term mortality risk after valve replacement. In turn, patients with MAG >35 mmHg should be classified as the group of slightly increased risk.