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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.

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