Long-term outcomes of Aortic Valve Replacement for Patients with Severe Aortic Regurgitation and Severe Left Ventricular Dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUANYu-long , PANJun ,  WANGDong-jin

Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, P. R. China;

Corresponding author：

WANGDong-jin, Email: gldjw@163.com

Keywords：

Aortic valve replacement; Left ventricular dysfunction; Left ventricular ejection fraction

DOI：

10.7507/1007-4848.20150084

Video：

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Objective To analyze long-term outcomes of aortic valve replacement (AVR) for patients with severe aortic regurgitation (AR) and left ventricular dysfunction (LVD). Methods We retrospectively analyzed clinical data of 44 patients with severe AR and LVD who received AVR in Drum Tower Hospital from January 2002 to December 2012. Left ventricular ejection fraction (LVEF) of all the patients was lower than 35%. There were 29 male and 15 female patients with their age of 23-78 (44±6) years and LVEF of 22%-34% (29%±3%). Results Two patients died because of heart failure postoperatively. Cardiopulmonary bypass time was 57-92 (73±8) minutes, aortic cross-clamping time was 33-61 (48±6)minutes, and length of ICU stay was 2-15 (8±3) days. All the patients were followed up for 1-11 (4.3±2.9) years. Two patients died during follow-up because of heart failure and stroke respectively. One-year survival rate was 93% and five-year survival rate was 91%. Conclusion AVR can significantly increase long-time survival of patients with severe AR and LVD.

Citation： XUANYu-long, PANJun, WANGDong-jin. Long-term outcomes of Aortic Valve Replacement for Patients with Severe Aortic Regurgitation and Severe Left Ventricular Dysfunction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 302-305. doi: 10.7507/1007-4848.20150084 Copy

1.	Bonow RO, Carabello BA, Chatterjee K, et al.ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease).Circulation, 2006, 114(5):e84-e231.
2.	Bonow RO, Nikas D, Elefteriades JA.Valve replacement for regurgitant lesions of the aortic or mitral valve in advanced left ventricular dysfunction.Cardiol Clin, 1995, 13(1):73-85.
3.	Chaliki HP, Mohty D, Avierinos JF, et al.Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function.Circulation, 2002, 106(21):2687-2693.
4.	Chukwuemeka A, Rao V, Armstrong S, et al.Aortic valve replacement:a safe and durable option in patients with impaired left ventricular systolic function.Eur J Cardiothorac Surg, 2006, 29(2):133-138.
5.	Iung B, Baron G, Butchart EG, et al.A prospective survey of patients with valvular heart disease in Europe:the Euro Heart Survey on valvular heart disease.Eur Heart J, 2003, 24(13):1231-1243.
6.	Cohn PF, Gorlin R, Cohn LH, et al.Left ventricular ejection fraction as a prognostic guide in surgical treatment of coronary and valvular heart disease.Am J Cardiol, 1974, 34(2):136-141.
7.	Forman R, Firth BG, Barnard MS.Prognostic significance of preoperative left ventricular ejection fraction and valve lesion in patients with aortic valve replacement.Am J Cardiol, 1980, 45(6):1120-1125.
8.	Greves J, Rahimtoola SH, McAnulty JH, et al.Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitation.Am Heart J, 1981, 101(3):300-308.
9.	Bonow RO, Picone AL, McIntosh CL, et al.Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983:impact of preoperative left ventricular function.Circulation, 1985, 72(6):1244-1256.
10.	Michel PL, Iung B, Abou Jaoude S, et al.The effect of left ventricular systolic function on long term survival in mitral and aortic regurgitation.J Heart Valve Dis, 1995, 4(Suppl 2):S160-S168.
11.	Stone PH, Clark RD, Goldschlager N, et al.Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement.J Am Coll Cardiol, 1984, 3(5):1118-1126.
12.	Sheiban I, Trevi GP, Casarotto D, et al.Aortic valve replacement in patients with aortic incompetence:preoperative parameters influencing long-term results.Z Kardiol, 1986, 75(Suppl 2):146-154.
13.	Paul S, Mihaljevic T, Rawn JD, et al.Aortic valve replacement in patients with severely reduced left ventricular function.Cardiology, 2004, 101(1-3):7-14.
14.	Zoghbi WA, Enriquez-Sarano M, Foster E, et al.Recommendation for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J Am Soc Echocardiogr, 2003, 16(7):777-802.
15.	Schiller NB, Shah PM, Crawford M, et al.Recommendations for quantitation of the left ventricle by two-dimensional echocardio-graphy.J Am Soc Echocardiogr, 1989, 2(5):358-367.
16.	Rosenbaum P, Rubin DB.The central role of the propensity score in observational studies for causal effects.Biometrika, 1983, 70(1):41-55.
17.	D'Agastino RB Jr.Propensity score methods for bias reduction in the comparison of a treatment group to a nonrandomized control group.Stat Med, 1998, 17(19):2265-2281.
18.	Kouchoukos NT, Blackstone EH, Hanley FL, et al.Kirklin/barratt-boyes cardiac surgery.4th ed.Philadelphia:Churchill Livingstone, 2013.543-643.
19.	Basraon J, Chandrashekhar YS, John R, et al.Comparison of risk scores to estimate perioperative mortality in aortic valve replace-ment surgery.Ann Thorac Surg, 2011, 92(2):535-540.
20.	Imasaka K, Tomita Y, Tanoue Y, et al.Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression.J Thorac Cardiovasc Surg, 2013, 146(1):61-69.
21.	Tanoue Y, Oishi Y, Sonoda H, et al.Left ventricular performance after aortic valve replacement in patients with low ejection fraction.J Artif Organs, 2013, 16(4):443-450.

1. Bonow RO, Carabello BA, Chatterjee K, et al.ACC/AHA 2006 guidelines for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Valvular Heart Disease).Circulation, 2006, 114(5):e84-e231.
2. Bonow RO, Nikas D, Elefteriades JA.Valve replacement for regurgitant lesions of the aortic or mitral valve in advanced left ventricular dysfunction.Cardiol Clin, 1995, 13(1):73-85.
3. Chaliki HP, Mohty D, Avierinos JF, et al.Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function.Circulation, 2002, 106(21):2687-2693.
4. Chukwuemeka A, Rao V, Armstrong S, et al.Aortic valve replacement:a safe and durable option in patients with impaired left ventricular systolic function.Eur J Cardiothorac Surg, 2006, 29(2):133-138.
5. Iung B, Baron G, Butchart EG, et al.A prospective survey of patients with valvular heart disease in Europe:the Euro Heart Survey on valvular heart disease.Eur Heart J, 2003, 24(13):1231-1243.
6. Cohn PF, Gorlin R, Cohn LH, et al.Left ventricular ejection fraction as a prognostic guide in surgical treatment of coronary and valvular heart disease.Am J Cardiol, 1974, 34(2):136-141.
7. Forman R, Firth BG, Barnard MS.Prognostic significance of preoperative left ventricular ejection fraction and valve lesion in patients with aortic valve replacement.Am J Cardiol, 1980, 45(6):1120-1125.
8. Greves J, Rahimtoola SH, McAnulty JH, et al.Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitation.Am Heart J, 1981, 101(3):300-308.
9. Bonow RO, Picone AL, McIntosh CL, et al.Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983:impact of preoperative left ventricular function.Circulation, 1985, 72(6):1244-1256.
10. Michel PL, Iung B, Abou Jaoude S, et al.The effect of left ventricular systolic function on long term survival in mitral and aortic regurgitation.J Heart Valve Dis, 1995, 4(Suppl 2):S160-S168.
11. Stone PH, Clark RD, Goldschlager N, et al.Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement.J Am Coll Cardiol, 1984, 3(5):1118-1126.
12. Sheiban I, Trevi GP, Casarotto D, et al.Aortic valve replacement in patients with aortic incompetence:preoperative parameters influencing long-term results.Z Kardiol, 1986, 75(Suppl 2):146-154.
13. Paul S, Mihaljevic T, Rawn JD, et al.Aortic valve replacement in patients with severely reduced left ventricular function.Cardiology, 2004, 101(1-3):7-14.
14. Zoghbi WA, Enriquez-Sarano M, Foster E, et al.Recommendation for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J Am Soc Echocardiogr, 2003, 16(7):777-802.
15. Schiller NB, Shah PM, Crawford M, et al.Recommendations for quantitation of the left ventricle by two-dimensional echocardio-graphy.J Am Soc Echocardiogr, 1989, 2(5):358-367.
16. Rosenbaum P, Rubin DB.The central role of the propensity score in observational studies for causal effects.Biometrika, 1983, 70(1):41-55.
17. D'Agastino RB Jr.Propensity score methods for bias reduction in the comparison of a treatment group to a nonrandomized control group.Stat Med, 1998, 17(19):2265-2281.
18. Kouchoukos NT, Blackstone EH, Hanley FL, et al.Kirklin/barratt-boyes cardiac surgery.4th ed.Philadelphia:Churchill Livingstone, 2013.543-643.
19. Basraon J, Chandrashekhar YS, John R, et al.Comparison of risk scores to estimate perioperative mortality in aortic valve replace-ment surgery.Ann Thorac Surg, 2011, 92(2):535-540.
20. Imasaka K, Tomita Y, Tanoue Y, et al.Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression.J Thorac Cardiovasc Surg, 2013, 146(1):61-69.
21. Tanoue Y, Oishi Y, Sonoda H, et al.Left ventricular performance after aortic valve replacement in patients with low ejection fraction.J Artif Organs, 2013, 16(4):443-450.

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Long-term outcomes of Aortic Valve Replacement for Patients with Severe Aortic Regurgitation and Severe Left Ventricular Dysfunction

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