Predictors of Hospital Mortality and Left Ventricular Function Recovery After Aortic Valve Replacement for Severe and Isolated Aortic Stenosis with Left Ventricular Dysfunction

Abderrahmane Bakkali, Imad Jaabari, Rochde Sayah, Koulekey Dadji, Mahdi Ait Houssa, Mohamed Laaroussi

Objective: The aim of this study was to evaluate postoperative outcomes of AVR for isolated AS with severe left ventricular dysfunction and to identify predictors of hospital mortality and left ventricular function recovery. Methods: This retrospective bicentric study covers over a 15-year period between January 2000 and April 2016, 61 patients with isolated AS and severe left ventricular dysfunction who underwent AVR were enrolled. Results: Mean age was 58.21 ± 12.50 years. 70.5% of patients were in NYHA class III or IV. The mean left ventricular ejection fraction (LVEF) was 32.9 ± 5.6%, and the mean EuroSCORE was 12.20 ± 4.50. The hospital mortality was 11.50%. Multivariate logistic regression analysis found renal failure (OR = 8.98, CI [1.64; 48.70], p = 0.03) and congestive heart failure (OR = 10.90, CI [2.4; 59.83], p <0.001) as related to the risk of hospital mortality. The median follow-up time was 38 [21; 84] months. Late mortality was 7.7% due to non cardiovascular causes in all cases. The functional status and LVEF were significantly improved. In the multivariate analysis early postoperative LVEF (OR, 0.44; CI [0.14; 0.75]; p=0.006) and transprosthetic gradient (OR, -0.72; CI, [-1.42; -0.02]; p=0.04) influence long term LVEF. Conclusions: Despite a high rate of hospital mortality, long term outcome of AVR for severe and isolated AS with left ventricular dysfunction is excellent. Preoperative renal failure and congestive heart failure are predictors of hospital mortality. Early postoperative LVEF and transprosthetic gradient influence left ventricular function recovery.