Clinical evaluation of aortic valve replacement in patients with aortic stenosis and decreased left ventricular ejection fraction

Liu Yuhang; Song Laichun; Xiao Yong; Yang Mingyuan; Liu Wenhao; TaoLiang

doi:10.13498/j.cnki.chin.j.ecc.2024.02.10

Abstract：Objective To evaluate the clinical efficacy and prognosis of aortic valve replacement in patients with aortic stenosis and decreased left ventricular ejection fraction through retrospectively analyses.Methods A retrospective analysis of the clinical data of 44 patients undergoing surgical aortic valve replacement with aortic stenosis(AS)(valve area<1.5 cm2)and decreased left ventricular ejection fraction(LVEF<50%)from August 2020 to June 2022 in Asia Heart Hospital was conducted,including 39 males and 5 females,aged from 41 to 74 years(mean 59.30±8.65 years),with or without aortic regurgitation,except for moderate to severe mitral stenosis or regurgitation.The baseline data,past medical history,preoperative and postoperative cardiac ultrasound results as well as the procedure-related data were collected.All patients was assessed by echocardiography before AVR and before discharge,as well as 6 months,and 1 year after AVR.Results One patient was asked to be discharged from hospital by his family because for severe pulmonary infection and multiple organs dysfunction syndrome after operation.The other 43 patients were followed up for 1 year after operation.Compared with pre-operation,the aortic valve transvalvular flow velocity and aortic valve mean transvalvular pressure gradient had both decreased significantly as early as before discharge post operation(all P<0.05),the diameter of left atrium and the left ventricular end-diastolic diameter were significantly decreased as well(all P<0.05),and the left ventricular ejection fraction remained improved up to 6 months and 1 year post operation,increasing significantly from(40.23±4.96)%to(52.6±2.92)%(P<0.05).AV and AMG were significantly decreased before discharge after operation,but had no significant change in the follow-up period(P>0.05).During the follow-up period,one patient was admitted to the hospital for endocarditis and was cured and discharged.One patient had aortic valve stenosis during the follow-up period without obvious clinical symptoms and physical labor was not obviously restricted,performing regular follow-up observation.Conclusion Surgical aortic valve replacement is an effective and safe treatment for patients with aortic stenosis with decreased left ventricular ejection fraction,the transaortic gradient,aortic valve transvalvular flow velocity,left ventricular end-diastolic diameter and left ventricular ejection fraction were significantly improved after operation,therefore,this kind of patients should take active surgical treatment.