Timing of aortic valve surgery

Heart

Volumn 84, Issue 2, 2000, Pages 211-218

  Otto, Catherine M ^a  

^a UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AORTA FLOW; AORTA STENOSIS; AORTA SURGERY; AORTA VALVE REGURGITATION; HEART HEMODYNAMICS; HEART OUTPUT; HUMAN; PRIORITY JOURNAL; REVIEW;

ADULT; AGED; AGED, 80 AND OVER; AORTIC VALVE INSUFFICIENCY; AORTIC VALVE STENOSIS; FEMALE; HEART VALVE PROSTHESIS IMPLANTATION; HEMODYNAMIC PROCESSES; HUMANS; MALE; MIDDLE AGED; PATIENT SELECTION; TIME FACTORS;

EID: 0033854864     PISSN: 13556037     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (10)

1. Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997;29:630-634. In the population based Cardiovascular Health Study, aortic valve stenosis or sclerosis on echocardiography was associated with older age, male sex, hypertension, current smoking, elevated serum low density lipoprotem (LDL) and lipoprotem Lp(a) concentrations, shorter height, and the presence of diabetes.
2. Otto CM, Lind BK, Kitzman DW, et al. for the Cardiovascular Health Study. Association of aortic valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999;341:142-7. Aortic valve sclerosis, defined as irregular leaflet thickening without obstruction to outflow, was associated with an approximately 50% increase in risk for myocardial infarction and cardiovascular mortality in patients without known coronary disease at study entry.
3. Otto CM, Burwash IG, Legget ME, et al. A prospective study of asymptomatic valvular aortic stenosis: clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997;95:2262-70. In a prospective study of 123 adults with asymptomatic aortic stenosis the only predictors of symptom onset (and valve replacement) on multivariate analysis were the baseline aortic jet velocity, baseline functional status score, and the rate of increase in jet velocity over time.
4. Connolly HM, Oh JK, Orszulak TA, et al. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation 1997;95.2395-400. In 154 consecutive patients with aortic stenosis and a left ventricular ejection fraction ≤ 35%, operative mortality was 9% with predictors of operative mortality including coronary artery disease and reduced cardiac output at baseline. Left ventricular ejection fraction improved after valve surgery in 76% of survivors and only 7% were in New York Heart Association functional class postoperatively, compared to 88% at baseline.
5. Lund O, Kristensen, Baandrup U, et al. Myocardial structure as a determinant of pre-and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis. Eur Heart J 1998;19:1099-108. Based on intraoperative transmural biopsies of the myocardium in 49 patients undergoing valve replacement for aortic stenosis, the authors propose that the degree of muscle hypertrophy is an important factor both for preoperative symptoms and for early and late mortality after valve replacement.
6. Bonow RO, Lakatos E, Maron BJ, et al. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation 1991;84:1625-35. In 104 asymptomatic patients with chronic aortic regurgitation followed prospectively, 58 (9)% remained asymptomatic with normal left ventricular function at 11 years. Multivariate predictors of clinical outcome were age, initial end systolic dimension, and the rate of change in end systolic dimension and rest ejection fraction during serial studies.
7. Borer JS, Hochreiter C, Herrold EM, et al. Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance. Circulation 1997;97:525-34. The change in ejection fraction from rest to exercise, normalised for the change in end systolic wall stress, was the strongest predictor of clinical outcome in this prospective study of 104 adults with severe aortic stenosis followed for an average of 7.3 years.
8. Scognamiglio R, Rahimtoola SH, Fasoli G, et al. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 1994;331:689-94. In order to evaluate the effect of afterload reduction treatment on clinical outcome, 143 patients with severe asymptomatic aortic regurgitation and normal systolic function were randomised to treatment with nifedipine or digoxin. After six years. 34 (±6)% of the digoxin group and 15 (±3)% of the nifedipine group have undergone aortic valve replacement.
9. Donovan CL, Starling MR. Role of echocardiography in the timing of surgical intervention for chronic mitral and aortic regurgitation. In: Otto CM, ed. The practice of clinical echocardiography. Philadelphia: WB Saunders, 1997:327-54. Comprehensive review (159 references) of the literature on timing of intervention for aortic regurgitation, with proposal of an algorithm for clinical decision making.
10. Klodas E, Enriquez Sarano M, Tajik AJ, et al. Aortic regurgitation complicated by extreme left ventricular dilation: long-term outcome after surgical correction. J Am Coll Cardiol 1996;27:670-7. In 31 patients with severe aortic regurgitation and extreme left ventricular dilation (end diastolic dimension ≥ 80 mm), operative mortality was only 5.6% with a 10 year survival of 73 (5)%, which is no different than expected for age. Ejection fraction increased from 44 (11)% to 49 (15)%. www.heartjnl.com