Surgery for severe aortic stenosis with low transvalvular gradient and poor left ventricular function ├óÔé¼ÔÇ£ a single centre experien

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Abstract

Abstract Background
A retrospective comparative study was designed to determine whether the transvalvular gradient has a predictive value in the assessment of operative outcome in patients with severe aortic stenosis and poor left ventricular function.

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Methods
From a surgical database, a series of 30 consecutive patients, who underwent isolated aortic valve replacement for severe aortic stenosis with depressed left ventricular (LV) function (EF < 40%), were enrolled in the study and divided into two groups according to the mean transvalvular gradient (TVG): LG(low gradient)-Group < 40 mmHg (n = 13), and HG(high gradient)-Group > 40 mmHg (n = 17). Both groups were then comparatively assessed with respect to perioperative organ functions and mortality.

Results
Both groups were well matched with respect to the preoperative clinical status. LG-Group had a larger aortic valve area, higher LVEDP, larger LVESD and LVEDD, and higher mean pulmonary pressures. The immediate postoperative outcome, hospital morbidity and mortality did not differ significantly among the groups.

Conclusion
In patients with severe aortic stenosis and poor LV function, the mean transvalvular gradient, although corresponds to reduced LV performance, has a limited prognostic value in the assessment of surgical outcome. Generally, operating on this select group of patients is safe.

Background
In patients with severe aortic stenosis (AS) scheduled for aortic valve replacement (AVR), the operative risk as well as the late postoperative outcome increases with the onset of LV systolic and diastolic dysfunction [1,2]. As the results of AVR in patients with severely reduced LV function and low TVG are uncertain, this patient subset still remains the most controversial in terms of decision making for surgery [3].

Few data are available on the immediate postoperative and long-term outcome in patients with isolated severe AS and poor LV function, especially in regard to the severity of TVG.

We tested the hypothesis that AVR in patients with isolated severe AS and poor LV function, the mean TVG has no impact on immediate postoperative outcome. Indications for surgery in the light of current opinions published in the literature are discussed.

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References
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