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Submitted: 21 July 2009
HERDIN Record #: PCHRD072009060738

Outcome of aortic valve replacement in patients with impaired and normal ventricular function: A Philippine Heart Center experience.

Maria Cristina T. Atienza,
Kurt Glenn C. Jacoba

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Objective ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ To determine the short term and long term outcome of Aortic Valve Replacement in patients with impaired and normal ventricular function at the Philippine Heart Center from 1996 to 2005.

Methods ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ From January 1996 through January 2005, 140 consecutive patients who underwent isolated aortic valve surgery with or without coronary artery bypass grafting were retrospectively studied and followed up by phone or mail. Ejection fraction pre-operatively were gathered and analyzed The in-hospital mortality and morbidity were detailed according to left ventricular function. Patients were followed up and the long-term mortality rate was determined.

Results ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ 140 patients who underwent isolated aortic valve replacement with or without CABG from 1996 - 2005 were studied. Outcome in terms of length of hospital stay showed that 67 percent of studied patients had 50 percent. Patients with left ventricular dysfunction (EF < 50 percent) have higher occurrence of in-hospital complications. Congestive heart failure occurred in 8 percent of patients (82 percent less than 50 percent EF). 8 percent had pleural effusion (72 percent less than 50 percent EF). And arrythmias in 4 percent (80% less than 50 percent EF). Analyzing further the relationship between the patient's pre-operative ejection fraction and in-hospital complications, it shows that EF < 50 percent is a significant predictor of morbidity which include the peri - operative congestion(p 0.0003), pleural effusion (p 0.003) and arrythmias (p 0.03). In patients with severe LV dysfunction who underwent aortic valve replacement there were 4 in-hospital mortalities and 9 mortalities on long term follow-up. The in-hospital mortality rate is 4 percent and long term mortality is 10 percent with overall mortality rate of 14 percent, p values 0.03 and 0.005 respectively.

Conclusion ÃÆ'Æ'Æ’ÃÆ'‚¢ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Aortic valve surgery in patients with impaired ventricular function resulted in significant mortality and morbidity. Patients with markedly reduced ejection fraction and severe aortic valve lesion represents a high-risk group even after successful aortic valve replacement. There is also more co-morbidities compared to patients with normal left ventricular function.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Others
Publication Date
January-March 2007
Volume
13
Issue
1
Page(s)
6-11

Objectives

General Objective: To determine the short term and long term outcome of Aortic Valve Replacement in patients with impaired and normal ventricular function at the Philippine Heart Center from 1996 to 2005.

Specific Objectives:

(a) To describe the clinical profile of patients who underwent aortic valve replacement.
(b) To determine the pre-operative ventricular function of patients with aortic valve pathology undergoing aortic valve replacement.
(c) To determine the short term outcome in terms of length of hospital stay, in-hospital mortality and morbidity of patients with normal and impaired ventricular function.
(d) To determine the relationship between the Aortic valve lesion and mortality rate (short and long term) after aortic valve replacement.
(e) To determine the relationship between the preoperative ventricular function and mortality rate (short and long term) of patients who underwent aortic valve replacement.

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