Operative Risk in Patients with Severe Aortic Stenosis

pp 608-615

Abstract

Some authors suggest patients with asymptomatic aortic valve stenosis should undergo aortic valve replacement. However, no consensus has been reached with regards to this indication since valvere placement mortality is higher than the one due to the natural evolution of the disease.

Objective

To identify populations with low operative risk among patients undergoing elective aortic valve replacement for symptomatic severe aortic stenosis.

Material and method

From June1996to February 2001, 2100 patients under went valvular replacement. Mean age was 68± 13years old; 373 patients(41% ) were female. Severe aortic stenosis was present in 934 patients(44%). Outcomes of isolated aortic valve replacement or combined with mitral valve replacement, coronary artery bypass graft or more than two procedures were analyzed. Parsonnet stratification score was used to assess operative risk.

Results

Univariate analysis revealed that mortality was related to combined aortic valve replacement (p >_0.0001), severe left ventricular dysfunction (p >_0.0001), age (p = 0.01), reoperation (p = 0.001),NYHA functional class (p =0.0002). Multivariate analysis showed a relationship between death and combined aortic valve replacement (p =0.002), reoperation (p =0.002), severe left ventricular dysfunction (p = 0.01). Parsonnet score of 5 (43patients,5%), identified a subset of patients without operative mortality, with scores from 6to 10(384patients,41%)mortality was2.6% (10patients) and with higher values in this scale (>_ 10) mortality reached> 4% (p = 0.0001).

Conclusion

Patients with aortic stenosis and Parsonnet < 10have low operative risk. The assessment of risks and benefits in aortic valve replacement should be made taking into account hospital results accord-ing to Parsonnet score.