Aortic valve replacement in true severe aortic stenosis with low gradient and low ejection fraction.

OBJECTIVE: The results of aortic valve replacement are uncertain among patients with severe aortic stenosis, reduced left ventricular ejection fraction, and low mean transvalvular gradient. The aim of the present study was to report on 27 patients who underwent surgery for aortic stenosis with left ventricular ejection fraction
METHODS: The study was performed between January 2000 and December 2005. Twenty-seven patients with aortic stenosis with a calculated valve area <1.0 cm2, aortic mean transvalvular gradient <30 mmHg, and ejection fraction
RESULTS: One patient from group 2 died. The functional capacities of all of the patients in group 1 significantly improved in the postoperative period (P = .001). All of the patients except for 1 in group 1 had improved left ventricular ejection fraction after the operation (P <.001). The comparison of the preoperative and postoperative functional status of these patients in group 2 was also statistically significant (P = .001). The 10 of the 11 patients in group 2 who were alive had left ventricular ejection fraction value changes that were not significant statistically (P = .096). The comparison of the improvement of functional capacities of the groups revealed a significant difference; that is, the improvement was higher in group 1 (P = .039).

CONCLUSION: Left ventricular ejection fraction and functional capacity improved after aortic valve replacement in patients with left ventricular dysfunction, low mean transvalvular gradient, and aortic valve replacement in these patients has acceptable mortality rates with significantly improved functional status.