Introduction and Aim of work

Introduction

Preoperative left ventricular hypertrophy is a negative factor in

aortic valve replacement. Several studies have documented the early and
late prognostic importance of a preoperatively increased left ventricular
mass index (LVMI) (Mehta et al., 2001).

Left ventricular hypertrophy is also a well-known predictor of

morbidity in hypertensive patients (Vasan et al., 1996).

Aortic valve replacement in patients with aortic stenosis and left

ventricular dysfunction continues to be associated with a high mortality
risk despite surgical and cardiological improvements (Tarantini et al.,
2003).

Increased left ventricular mass index (LVMI) could be responsible

of higher mortality by means of contractile impairment, diastolic
dysfunction, abnormalities of coronary flow reserve or cardiac
arrhythmias (Garcia Fuster, et al., 2003).

On one hand, incomplete recovery of left ventricular function and a

lower late survival after aortic valve replacement are frequently
associated with residual hypertrophy. This fact might be due to an
excessively high initial hypertrophy with an incomplete postoperative
reduction in left ventricular mass (Natsuaki et al., 2001).

On the other hand, the implications of increased left ventricular

mass index (LVMI) on early mortality are less evident (García Fuster et
al., 2005).

Aortic valve replacement in patients with aortic stenosis or

regurgitation and severe left ventricular dysfunction continues to be

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Introduction and Aim of work

associated with a high mortality risk despite surgical and cardiological

improvements (Tarantini et al., 2003). Early referral for surgery has
largely solved the problem of high mortality associated to left ventricular
dysfunction in the context of aortic regurgitation (Green et al., 1997). On
the contrary, patients with severe aortic stenosis constitute a challenging
group with a more heterogeneous response. On one side, patients with
critical aortic stenosis and low ejection fraction due to ‘afterload
mismatch’ (depressed ejection performance resulting from excessively
high systolic ventricular wall stress secondary to aortic stenosis) generally
respond well to surgery, which immediately normalizes left ventricular
afterload. Conversely, other patients with critical aortic stenosis and
advanced left ventricular systolic dysfunction, who usually present with
low gradients and cardiac output, constitute a high operative risk
subgroup (Sharony et al., 2003).

Other factors that increase morbimortality are: associated coronary

artery disease, renal insufficiency, advanced age, prior aortic valve
replacement, aortic regurgitation, atrial fibrillation, patient-prosthesis
mismatch, low body surface area, CPB time, type of prosthesis, etc.
Elevated LVMI has also been considered (Mehta et al., 2001 and Palta et
al., 2003). Unfortunately, many of previous studies have included patients
with aortic insufficiency or undergoing concomitant procedures, which
complicates comparisons. We were especially restrictive with the
selection criteria and we have only considered patients with isolated
aortic stenosis.

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Introduction and Aim of work

Aim of the work

Our aim was to analyze the effect of increased left ventricular mass
index (LVMI) on early outcomes in patients undergoing aortic valve
replacement due to sever aortic stenosis.