HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): G. Michael Deeb Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mehta, R. H. Articles by Deeb, G. M. Search for Related Content PubMed PubMed Citation Articles by Mehta, R. H. Articles by Deeb, G. M. Related Collections Cardiac - physiology Valve disease

J Thorac Cardiovasc Surg 2001;122:919-928
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery

From the Division of Cardiology and Section of Adult Cardiac Surgery (Heart Care Program), Division of General Pediatrics, University of Michigan, Ann Arbor, Mich.

Received for publication Sept 18, 2000. Revisions requested Jan 3, 2001; revisions received April 17, 2001. Accepted for publication April 19, 2001. Address for reprints: G. Michael Deeb, MD, Professor of Surgery, Section of Adult Cardiac Surgery, 1500 E Medical Center Dr, Room 2124G/Box 0348, Ann Arbor, MI 48109-0348 (E-mail: mdeeb{at}umich.edu).

Abstract

Background: Increased left ventricular mass index has been shown to be associated with higher mortality in epidemiologic studies. However, the effect of increased left ventricular mass index on outcomes in patients undergoing aortic valve replacement is unknown.
Methods: We studied 473 consecutive patients undergoing elective aortic valve replacement to assess the influence of left ventricular mass index on outcomes in patients having this procedure. Echocardiographic left ventricular dimensions were used to calculate left ventricular mass index (considered increased if >134 g/m² in male patients and >110 g/m² in female patients).
Results: Left ventricular mass index was increased in 24% of patients undergoing aortic valve replacement. Postprocedural complications (respiratory failure, renal insufficiency, congestive heart failure, and atrial and ventricular arrhythmias), length of stay in the intensive care unit, and in-hospital mortality were increased in patients with increased left ventricular mass index. Multivariable analysis identified prior valve surgery (odds ratio, 4.3; 95% confidence interval, 1.2-15.7; P = .030), left ventricular ejection fraction (odds ratio, 1.07; 95% confidence interval, 1.01-1.14; P = .020), history of hypertension (odds ratio, 8.2; 95% confidence interval, 2.2-30.4; P = .002), history of liver disease (odds ratio, 50.4; 95% confidence interval, 4.2-609.0; P = .002), and increased left ventricular mass index (odds ratio, 38; 95% confidence interval, 9.3-154.1; P < .001) as independent predictors of in-hospital mortality. Furthermore, low output syndrome was identified as the most common mode of death (36%) after aortic valve replacement in patients with increased left ventricular mass index.
Conclusions: Increased left ventricular mass index is associated with increased adverse in-hospital clinical outcomes in patients undergoing aortic valve replacement. Although this finding warrants special modification in perioperative management, further studies are needed to address whether outcomes in asymptomatic patients with aortic valve disease could be improved by earlier aortic valve replacement before a significant increase in left ventricular mass index.

This article has been cited by other articles:

				A. I. Duncan, B. S. Lowe, M. J. Garcia, M. Xu, A. M. Gillinov, T. Mihaljevic, and C. G. Koch Influence of Concentric Left Ventricular Remodeling on Early Mortality After Aortic Valve Replacement Ann. Thorac. Surg., June 1, 2008; 85(6): 2030 - 2039. [Abstract] [Full Text] [PDF]

				T. Mihaljevic, E. R. Nowicki, J. Rajeswaran, E. H. Blackstone, L. Lagazzi, J. Thomas, B. W. Lytle, and D. M. Cosgrove Survival after valve replacement for aortic stenosis: Implications for decision making. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1270 - 1279.e12. [Abstract] [Full Text] [PDF]

				K. Taniguchi, T. Takahashi, K. Toda, H. Matsue, Y. Shudo, H. Shintani, M. Mitsuno, and Y. Sawa Left ventricular mass: impact on left ventricular contractile function and its reversibility in patients undergoing aortic valve replacement Eur. J. Cardiothorac. Surg., October 1, 2007; 32(4): 588 - 595. [Abstract] [Full Text] [PDF]

				J. T Butcher and R. M Nerem Valvular endothelial cells and the mechanoregulation of valvular pathology Phil Trans R Soc B, August 29, 2007; 362(1484): 1445 - 1457. [Abstract] [Full Text] [PDF]

				G. Tasca, Z. Mhagna, S. Perotti, P. B. Centurini, T. Sabatini, A. Amaducci, F. Brunelli, M. Cirillo, M. D. Tomba, E. Quiani, et al. Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis Circulation, January 31, 2006; 113(4): 570 - 576. [Abstract] [Full Text] [PDF]

				H Baumgartner What influences the outcome of valve replacement in critical aortic stenosis? Heart, October 1, 2005; 91(10): 1254 - 1256. [Abstract] [Full Text] [PDF]

				C. Stefanidis, A. M. Nana, D. De Canniere, M. Antoine, J.-L. Jansens, C.-H. Huynh, and J.-L. Le Clerc 10-Year Experience With the ATS Mechanical Valve in the Mitral Position Ann. Thorac. Surg., June 1, 2005; 79(6): 1934 - 1938. [Abstract] [Full Text] [PDF]

				R. G. Fuster, J. A. Montero Argudo, O. G. Albarova, F. Hornero Sos, S. Canovas Lopez, M. Bueno Codoner, J. A. Buendia Minano, and I. Rodriguez Albarran Left ventricular mass index as a prognostic factor in patients with severe aortic stenosis and ventricular dysfunction Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 260 - 266. [Abstract] [Full Text] [PDF]

				R. G. Fuster, J. A. M. Argudo, O. G. Albarova, F. H. Sos, S. C. Lopez, M. B. Codoner, J. A. B. Minano, and I. R. Albarran Patient-prosthesis mismatch in aortic valve replacement: really tolerable? Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 441 - 449. [Abstract] [Full Text] [PDF]

				G. Tasca, F. Brunelli, M. Cirillo, M. DallaTomba, Z. Mhagna, G. Troise, and E. Quaini Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement Ann. Thorac. Surg., February 1, 2005; 79(2): 505 - 510. [Abstract] [Full Text] [PDF]

				M. Gaudino, F. Alessandrini, F. Glieca, N. Luciani, C. Cellini, C. Pragliola, M. Morelli, C. Canosa, G. Nasso, and G. Possati Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate? Eur. Heart J., January 1, 2005; 26(1): 51 - 57. [Abstract] [Full Text] [PDF]

				C. Blais, J. G. Dumesnil, R. Baillot, S. Simard, D. Doyle, and P. Pibarot Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement Circulation, August 26, 2003; 108(8): 983 - 988. [Abstract] [Full Text] [PDF]

				R. G. Fuster, J. A. M. Argudo, O. G. Albarova, F. H. Sos, S. C. Lopez, M. J. D. Sorli, M. B. Codoner, and J. A. B. Minano Left ventricular mass index in aortic valve surgery: a new index for early valve replacement? Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 696 - 702. [Abstract] [Full Text] [PDF]

				R. W. Emery, G. J. Van Nooten, and P. J. Tesar The initial experience with the ATS Medical mechanical cardiac valve prosthesis Ann. Thorac. Surg., February 1, 2003; 75(2): 444 - 452. [Abstract] [Full Text] [PDF]

				I. Friehs and P. J. del Nido Increased susceptibility of hypertrophied hearts to ischemic injury Ann. Thorac. Surg., February 1, 2003; 75(2): S678 - 684. [Abstract] [Full Text] [PDF]