Patients (pts) with aortic stenosis (AS) have a good prognosis after aortic valve replacement (AVR). Morbidity and mortality of AS pts with severe septal hypertrophy (SSH,≥16mm) or supranormal (≥70%) left ventricular ejection fraction (LVEF) have been poorly investigated. We retrospectively analysed complications and outcome of such pts after surgery.
Between 10/98 and 03/03, 280 pts underwent AVR. Only pure AS pts were included; excluding aortic regurgitation, ischaemic cardiomyopathy, associated coronary or thoracic aortic surgery, or mitral disease. Eighty seven pts met the criteria. Analysis was performed on 2 criteria: preoperative LVEF and septal thickness (ST). For LVEF analysis, pts were divided in 2 groups: GA: LVEF 50 to 69% (n=29) and GB: LVEF ≥70% (n=44); and in 3 for the ST criteria: G1: ST<13mm (n=18); G2: 13≤ST<16mm (n=31); and G3: ST≥16mm (n=11). We analysed length of ICU and hospital stay; duration of ventilation; use of vasoactive drugs, calcium channel’s blockers or b-blockers; arrhythmia events, occurrence of renal failure or need for haemodialysis, and mortality. Usually pts after AVR stay at least 2 nights in our ICU.
In LVEF analysis, 17% of pts in GB were ventilated ≥24 hours in comparison with 0% in GA [p=0.036]. In ST analysis, 27.8% of pts in G1, 35.5% in G2, and 54.5% in G3 stayed >2 nights in the ICU (NS). Two pts from G3 required haemodialysis [p=0.032]. There were no difference in the length of ICU and hospital stay, use of vasoactive or vasodilator drugs, and occurrence of arrhythmia in group GA vs. GB, or in group G1 vs. G2 vs. G3. No patient died during hospital stay.
Using selective criteria, pure AS pts have an excellent prognosis after AVR; however pts with LVEF ≥70% have a higher risk of prolonged ventilation, and SSH pts have a higher incidence of haemodialysis.
Diastolic dysfunction consecutive to SSH or supranormal LVEF pts could be improved by pharmacological intervention. Further studies are necessary to confirm this hypothesis.
Jean-Louis Mariage, None.