sábado, 9 de noviembre de 2013

Impact of preoperative left ve... [Circ Cardiovasc Qual Outcomes. 2013] - PubMed - NCBI

Impact of preoperative left ve... [Circ Cardiovasc Qual Outcomes. 2013] - PubMed - NCBI

Circ Cardiovasc Qual Outcomes. 2013 Jan 1;6(1):35-41. doi: 10.1161/CIRCOUTCOMES.112.965772. Epub 2013 Jan 8.

Impact of preoperative left ventricular ejection fraction on long-term survival after aortic valve replacement for aortic stenosis.


Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH 03756, USA. joshua.b.goldberg@hitchcock.org



The survival of patients who undergo aortic valve replacement (AVR) for severe aortic stenosis with reduced preoperative ejection fractions (EFs) is not well described in the literature.


Patients undergoing AVR for severe aortic stenosis were analyzed using the Northern New England Cardiovascular Disease Study Group surgical registry. Patients were stratified by preoperative EF (≥50%, 40%-49%, and <40 1992="" 2008.="" 30-day="" 5277="" 6-month="" 727="" 8-year="" 8="" 91="" 96="" a="" across="" adjusted="" admission.="" among="" and="" aortic="" artery="" avr="" benefit="" between="" beyond="" bypass="" cohort.="" compared="" concomitant="" conferred="" coronary="" counterparts.="" crude="" difference="" ef="" effect="" estimated="" for="" grafting.="" grafting="" had="" improved="" in="" index="" isolated="" minimal="" morbidity.="" mortality="" no="" of="" on="" p="" patients="" population="" postoperative="" preoperative="" preserved="" reduced="" severe="" significantly="" stenosis="" strata="" survival="" the="" their="" there="" to="" total="" underwent="" up="" was="" were="" with="" years="">


Survival after AVR or AVR+coronary artery bypass grafting was most favorable among patients with preoperative preserved EF. However, patients with mild to moderately depressed EF experienced a substantial survival benefit compared with the natural history of medically treated patients. Furthermore, minor reductions of EF carried equivalent increased risk to those with more compromised function suggesting patients are best served when an AVR is performed before even minor reductions in myocardial function.
[PubMed - indexed for MEDLINE]

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