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The Annals of Thoracic Surgery, Vol 56, 22-29, Copyright © 1993 by The Society of Thoracic Surgeons
JJ Morris, HV Schaff, CJ Mullany, A Rastogi, CG McGregor, RC Daly, RL Frye and TA Orszulak
To determine factors that influence survival and recovery of ventricular
function in patients undergoing aortic valve replacement in the current
surgical era, baseline risk factors related to outcome were analyzed in
1,012 consecutive patients undergoing aortic valve replacement between 1983
and 1990. Forty-two percent of patients underwent concomitant coronary
bypass. Observed survival probabilities (expressed as 30-day/5-year) were
0.97/0.81 overall, 0.99/0.89 for patients aged less than 70 years, and
0.95/0.74 for patients aged 70 years or greater. Advanced age (p <
0.0001), decreased ejection fraction (p < 0.0001), extent of coronary
disease (p < 0.006), smaller prosthetic valve (p < 0.03), and
advanced New York Heart Association class (p < 0.04) were incremental
risk factors for mortality. In patients with preoperative ventricular
dysfunction (ejection fraction < or = 0.45), ejection fraction measured
1.4 years after aortic valve replacement improved in 72% and the mean
increment in ejection fraction was 0.175 (95% confidence interval, 0.154 to
0.195). The increment in ejection fraction was greater in female patients
than in male patients (p < 0.02) and greater in patients without than
with coronary disease (p < 0.02). Female sex (p < 0.02) and lesser
extent of coronary disease (p < 0.05) were independent predictors of
change in ejection fraction. In all patients, early improvement in ejection
fraction conveyed an independent subsequent survival benefit (p <
0.0001). The results of aortic valve replacement in the current era are
excellent, and the majority of patients with ventricular dysfunction
demonstrate significant improvement. Early improvement in ejection
fraction, influenced by coexistent coronary artery disease and
sex-associated factors, importantly affects subsequent survival.
ARTICLES
Determinants of survival and recovery of left ventricular function after aortic valve replacement
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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W.R. E. Jamieson, F. H. Edwards, M. Schwartz, J. W. Bero, R. E. Clark, and F. L. Grover Risk stratification for cardiac valve replacement. National Cardiac Surgery Database Ann. Thorac. Surg., April 1, 1999; 67(4): 943 - 951. [Abstract] [Full Text] [PDF]
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X. Y. Jin, R. Pillai, and S. Westaby Medium-term determinants of left ventricular mass index after stentless aortic valve replacement Ann. Thorac. Surg., February 1, 1999; 67(2): 411 - 416. [Abstract] [Full Text] [PDF]
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O. Bech-Hanssen, I. Wallentin, E. Houltz, M. Beckman Suurkula, S. Larsson, and K. Caidahl Gender differences in patients with severe aortic stenosis: impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortality Eur. J. Cardiothorac. Surg., January 1, 1999; 15(1): 24 - 30. [Abstract] [Full Text] [PDF]
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 J. W. Borowiec, T. W. Dubiel, H.-E. Hansson, J. Landelius, S.-O. Nystrom, and J. W. Borowiec Pericarbon Pericardial Valve Prosthesis: Midterm Results of the Aortic Valve Replacement Angiology, January 1, 1998; 49(1): 1 - 11. [Abstract] [PDF]
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K. E. Sommers and T. E. David Aortic Valve Replacement With Patch Enlargement of the Aortic Annulus Ann. Thorac. Surg., June 1, 1997; 63(6): 1608 - 1612. [Abstract] [Full Text]
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R. B. Hokken, A. H. Cromme-Dijkhuis, A. J. J. C. Bogers, S. E. C. Spitaels, M. Witsenburg, J. Hess, and E. Bos Clinical Outcome and Left Ventricular Function After Pulmonary Autograft Implantation in Children Ann. Thorac. Surg., June 1, 1997; 63(6): 1713 - 1717. [Abstract] [Full Text]
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H. M. Connolly, J. K. Oh, T. A. Orszulak, S. L. Osborn, V. L. Roger, D. O. Hodge, K. R. Bailey, J. B. Seward, and A. J. Tajik Aortic Valve Replacement for Aortic Stenosis With Severe Left Ventricular Dysfunction: Prognostic Indicators Circulation, May 20, 1997; 95(10): 2395 - 2400. [Abstract] [Full Text]
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I. Kadir, M. B. Izzat, P. Wilde, B. Reeves, A. J. Bryan, and G. D. Angelini Dynamic Evaluation of the 21-mm Medtronic Intact Aortic Bioprosthesis by Dobutamine Echocardiography Ann. Thorac. Surg., April 1, 1997; 63(4): 1128 - 1132. [Abstract] [Full Text]
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T. A. Orszulak, H. V. Schaff, F. J. Puga, G. K. Danielson, C. J. Mullany, B. J. Anderson, and D. M. Ilstrup Event Status of the Starr-Edwards Aortic Valve to 20 Years: A Benchmark for Comparison Ann. Thorac. Surg., March 1, 1997; 63(3): 620 - 626. [Abstract] [Full Text]
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B. A. Carabello Aortic Regurgitation in Women: Does the Measuring Stick Need a Change? Circulation, November 15, 1996; 94(10): 2355 - 2357. [Full Text]
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E. Klodas, M. Enriquez-Sarano, A. J. Tajik, C. J. Mullany, K. R. Bailey, and J. B. Seward Surgery for Aortic Regurgitation in Women: Contrasting Indications and Outcomes Compared With Men Circulation, November 15, 1996; 94(10): 2472 - 2478. [Abstract] [Full Text]
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R. C. Ashton Jr., D. J. Goldstein, D. D'Alessandro, A. D. Weinberg, D. Burkhoff, H. D. Rosskothen, G. M. Lemole, and M. C. Oz DEVELOPMENT OF AN INTRALUMINAL DEVICE FOR THE TREATMENT OF AORTIC REGURGITATION: PROTOTYPE AND IN VITRO TESTING SYSTEM J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 979 - 983. [Abstract] [Full Text]
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X. Y. Jin, Z.-M. Zhang, D. G. Gibson, M. H. Yacoub, and J. R. Pepper Effects of Valve Substitute on Changes in Left Ventricular Function and Hypertrophy After Aortic Valve Replacement Ann. Thorac. Surg., September 1, 1996; 62(3): 683 - 690. [Abstract] [Full Text]
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D. H. Harpole Jr, S. A. Gall Jr, W. G. Wolfe, J. S. Rankin, and R. H. Jones Effects of Valve Replacement on Ventricular Mechanics in Mitral Regurgitation and Aortic Stenosis Ann. Thorac. Surg., September 1, 1996; 62(3): 756 - 761. [Abstract] [Full Text]
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A. Gehlot, C. J. Mullany, D. Ilstrup, H. V. Schaff, T. A. Orszulak, J. J. Morris, and R. C. Daly AORTIC VALVE REPLACEMENT IN PATIENTS AGED EIGHTY YEARS AND OLDER: EARLY AND LONG-TERM RESULTS J. Thorac. Cardiovasc. Surg., May 1, 1996; 111(5): 1026 - 1036. [Abstract] [Full Text]
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