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Abstract 18268: When is Left Ventricular Function Too Poor for Successful Aortic Valve Replacement? Analysis of 3,075 Cases

Introduction: Preoperative left ventricular (LV) dysfunction often improves after aortic valve replacement (AVR) due to relief of pressure or volume overload; however, LV function sometimes remains unimproved. We sought to determine the predictors of unimproved LV function after AVR, and its effects on clinical outcomes. Methods: A total of 3,075 patients who underwent surgical AVR (without concomitant mitral surgery) were longitudinally assessed in a follow-up clinic and with echocardiography (median follow-up 6.5yrs). At operation, mean age was 67.8±13.5yrs, 32% were female, and 29% had preoperative LV dysfunction (defined as: grade II, ejection fraction 35-49%; grade III, 20-34%; grade IV, Results: Actuarial survival at 15yrs was 62.0±2.4, 47.8±4.6, 40.7±5.7, and 34.9±8.0% ( P P =0.005) (Figure). Unimproved LV dysfunction was predicted by higher preoperative LV diastolic diameter (OR 1.9 per cm; P P =0.003), and older age (OR 1.3 per 10yrs; P =0.026). Notably, in patients with LV diastolic diameter≥55mm, the incidence of death or unimproved LV dysfunction at 2yrs was 55.1% ( P Conclusions: Unimproved LV dysfunction after AVR is a strong risk factor for decreased long-term survival. Older age, LV dilatation, and a low preoperative aortic valve gradient are significant risk factors for unimproved LV dysfunction and death, especially in those with LV diastolic diameter≥55mm.