Impact of Preoperative Left Ventricular Ejection Fraction on Long-Term Survival After Aortic Valve Replacement for Aortic Stenosis

Author:

Goldberg Joshua B.1,DeSimone Joseph P.1,Kramer Robert S.1,DiScipio Anthony W.1,Russo Louis1,Dacey Lawrence J.1,Leavitt Bruce J.1,Helm Robert E.1,Baribeau Yvon R.1,Sardella Gerald1,Clough Robert A.1,Surgenor Stephen D.1,Sorensen Meredith J.1,Ross Cathy S.1,Olmstead Elaine M.1,MacKenzie Todd A.1,Malenka David J.1,Likosky Donald S.1,

Affiliation:

1. From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);...

Abstract

Background— The survival of patients who undergo aortic valve replacement (AVR) for severe aortic stenosis with reduced preoperative ejection fractions (EFs) is not well described in the literature. Methods and Results— Patients undergoing AVR for severe aortic stenosis were analyzed using the Northern New England Cardiovascular Disease Study Group surgical registry. Patients were stratified by preoperative EF (≥50%, 40%–49%, and <40%) and concomitant coronary artery bypass grafting. Crude and adjusted survival across strata of EF was estimated for patients up to 8 years beyond their index admission. A total of 5277 patients underwent AVR for severe aortic stenosis between 1992 and 2008. There were 727 (14%) patients with preoperative EF <40%. Preoperative EF had minimal effect on postoperative morbidity. There was no difference in 30-day mortality across EF strata among the isolated AVR cohort. Preserved EF conferred 30-day survival benefit among the AVR+coronary artery bypass grafting population (EF≥50%, 96%; EF<40%, 91%; P =0.003). Patients with preserved EF had significantly improved 6-month and 8-year survival compared with their reduced EF counterparts. Conclusions— Survival after AVR or AVR+coronary artery bypass grafting was most favorable among patients with preoperative preserved EF. However, patients with mild to moderately depressed EF experienced a substantial survival benefit compared with the natural history of medically treated patients. Furthermore, minor reductions of EF carried equivalent increased risk to those with more compromised function suggesting patients are best served when an AVR is performed before even minor reductions in myocardial function.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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