Aortic valve replacement or heart transplantation in patients with aortic stenosis and severe left ventricular dysfunction

Journal article


Czer, L. S. C., Goland, S., Soukiasian, H. J., Gallagher, Susan Kay, De Robertis, M. A., Mirocha, J., Siegel, R. J., Kass, R. M. and Trento, A.. (2013). Aortic valve replacement or heart transplantation in patients with aortic stenosis and severe left ventricular dysfunction. Transplantation Proceedings. 45(1), pp. 364 - 368. https://doi.org/10.1016/j.transproceed.2012.04.032
AuthorsCzer, L. S. C., Goland, S., Soukiasian, H. J., Gallagher, Susan Kay, De Robertis, M. A., Mirocha, J., Siegel, R. J., Kass, R. M. and Trento, A.
Abstract

Introduction: The decision to perform aortic valve replacement ( AVR ) or heart transplantation ( HTx ) for aortic stenosis ( AS ) with severe left ventricular dysfunction is difficult and may be affected by prior myocardial infarction ( MI ) and coronary artery disease ( CAD ). Methods: Patients who underwent AVR from 1988 to 2001 with left ventricular ejection fraction ( LVEF ) < 30% and severe AS ( aortic valve area [AVA] < 1.0 cm2; n = 51 ) were assessed for operative mortality, late survival, and predictors of outcome, and were compared with HTx. Subsequently, 131 patients with LVEF ≤35% who underwent AVR for critical AS ( AVA < 0.8 cm2 ) were evaluated. Results: In the first 51 patients, 3-year survival was 100% ± 0% with no CAD, and 45% ± 10% with CAD ( P < .05 ); 3-year survival was 88% ± 12% with no bypass, 73% ± 12% with one to two grafts, and 18% ± 11% with three grafts ( P < .01 ). Survival with HTx was 78% at 3 years. In the subsequent analysis of 131 patients, 90-day survivors were followed for a mean 4.6 ± 3.5 years. Advanced age ( P = .001 ) was the only predictor of long-term mortality. LVEF improved from 28.5% ± 5.2% before AVR to 45.4% ± 13.2% at 1-month postoperatively ( P < .0001 ). New York Heart Association ( NYHA ) class III/IV decreased from 94.2% pre-AVR to 12.8% at 1 year ( P < .0001 ). Predictors of LVEF recovery were no previous MI ( P = .007 ) and higher AS gradient ( P = .03 ). Conclusions: In severe AS and LVEF < 30% with no concomitant CAD or with CAD requiring one to two bypass grafts, AVR has a survival equal to or exceeding that of HTx. In patients with CAD requiring more than two bypass grafts, survival is significantly reduced, and HTx can be considered.

Year2013
JournalTransplantation Proceedings
Journal citation45 (1), pp. 364 - 368
PublisherAppleton & Lange
ISSN0041-1345
Digital Object Identifier (DOI)https://doi.org/10.1016/j.transproceed.2012.04.032
Scopus EID2-s2.0-84873310043
Page range364 - 368
Research GroupSchool of Nursing, Midwifery and Paramedicine
Publisher's version
File Access Level
Controlled
Place of publicationUnited States
Permalink -

https://acuresearchbank.acu.edu.au/item/8v62z/aortic-valve-replacement-or-heart-transplantation-in-patients-with-aortic-stenosis-and-severe-left-ventricular-dysfunction

Restricted files

Publisher's version

  • 68
    total views
  • 0
    total downloads
  • 3
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Simulation in nursing education: iPod as a teaching tool for undergraduate nurses
Evans, Jennifer, Webster, Sue, Gallagher, Susan Kay, Brown, Peter and Sinclair, John. (2015). Simulation in nursing education: iPod as a teaching tool for undergraduate nurses. Issues in Mental Health Nursing (online version). 36(7), pp. 505 - 512. https://doi.org/10.3109/01612840.2014.1003667
The challenges for families managing an adolescent with an intellectual disability and type 1 diabetes
Hillege, Sharon, Gallagher, Susan and Evans, Jennifer. (2013). The challenges for families managing an adolescent with an intellectual disability and type 1 diabetes. The Australian Journal of Advanced Nursing.
The perceptions of nurses in their management of patients experiencing anxiety
Sayumporn, Webster, Gallagher, Susan Kay, Brown, Peter, Evans, Jennifer, Flynn, Margaret and Lopez, Violeta. (2012). The perceptions of nurses in their management of patients experiencing anxiety. Journal of Nursing Education and Practice. 2(3), pp. 38 - 45. https://doi.org/10.5430/jnep.v2n3p38
Patients' satisfaction with mental health nursing interventions in the management of anxiety : Results of a questionnaire study
Webster, Sue, Gallagher, Susan Kay, Lopez, Violeta, Brown, Peter and Evans, Jennifer. (2012). Patients' satisfaction with mental health nursing interventions in the management of anxiety : Results of a questionnaire study. Journal of Nursing Education and Practice. 2(2), pp. 52 - 62. https://doi.org/10.5430/jnep.v2n2p52
Patient anxiety levels after heart transplantation: A single-centre Australian pilot study
Harkess, Michelle, Gallagher, Susan Kay and Boxer, Elaine. (2009). Patient anxiety levels after heart transplantation: A single-centre Australian pilot study. Transplant Nurses Journal. 18(1), pp. 18 - 24.