The affection of trans-valvular gradient on patient’s outcome in cases of severe aortic stenosis with impaired left ventricular function

Abstract

Background

Severe Aortic stenosis (AS) is an advanced stage of the disease process. Underestimation of symptoms and delay of Aortic valve replacement (AVR) have a bad prognosis. The aim of this work was to study the results of AVR in patients with severe AS with impaired systolic left ventricle (LV) function.

Methods

This is retrospective study, from January 2007 to December 2014 at Zagazig University Hospital, Zagazig, Egypt. Group of 40 patients had severe AS with impaired the LV function. Patients were divided into 2 groups: Group 1 with mean gradient <40 mmHg (n = 17) and Group 2 with average gradient ≥ 40 mmHg (n = 23). The patient's outcome was compared and statistically analyzed regarding the terms of the clinical features, associated comorbidities, mortality and 30 days follow-up.

Results

The aortic valve area was smaller in the Group 1 than in Group 2 (0.64 ± 0,2 cm² 0.66 vs ± 0 cm², p = 0.002). In-hospital mortality was comparable in both groups: Group 1: 11.1% vs Group 2 13.6% (p = 0.24). Group 1 had improved its ejection fraction (EF) by 17.8 units and in Group 2, the EF increased by 16.4 units. The average NYHA class increased from 2.71 ± 0.81 to 1.41 ± 0.50 in the Group 1 (p = 0.002) and 3.13 ± 0.63 to 1.33 ± 0.48 in the Group 2. (p = 0.0001).

Conclusions

The surgical outcome in cases with severe aortic stenosis with impaired ventricular function was limitedly affected by the value of the aortic valve mean gradient.