PURPOSE: Severe left ventricular (LV) dysfunction is a significant risk factor of mortality in aortic valve replacement (AVR) for aortic stenosis (AS). The purpose of this study was to assess the validity of The European System for Cardiac Operative Risk Evaluation (EuroSCORE) on mortality after high-risk AVR for AS in patients with severe LV dysfunction.
METHODS: Between 2002 and 2009, 33 patients with left ventricular ejection fraction (LVEF) of 40% or lower underwent AVR due to aortic stenosis. Mean age was 71 years, and 67 % were male. Multivariate analysis was used to identify predictors of early and late mortality, with logistic EuroSCORE as the primary variable of interest. Mean logistic EuroSCORE was 17% (range: 2.2 to 61.2%).
RESULTS: There were three early deaths (9%), and four cardiac-related late deaths. The observed early mortality was very high (50%) in 6 patients with logistic EuroSCORE > 30%. Freedom rate from cardiac-related late deaths at 2 years in patients with logistic EuroSCORE > 30% and those with logistic EuroSCORE < 29% were 50% and 96%, respectively (p=0.0002). Multivariate analysis identified elevated logistic EuroSCORE as the independent predictor for early death (p=0.03) and cardiac-related late death (p=0.006).
CONCLUSION: Logistic EuroSCORE is useful risk stratification model for high-risk AVR in patients with AS and severe LV dysfunction.
CLINICAL IMPLICATIONS: Transcatheter aortic valve implantation could be considered as an alternative treatment for AS in these extremely high-risk patients stratified by the elevated logistic EuroSCORE (> 30%).
DISCLOSURE: Kenji Kuwaki, No Financial Disclosure Information; No Product/Research Disclosure Information