Replacement of the aortic valve (AVR) dramatically improves prognosis in patients with severe aortic stenosis (AS). Not all the patients who survived surgery improve their symptoms. The aim of this study was identification of clinical factors, predicting improvement of functional class after AVR.
Methods and results: We retrospectively studied 89 patients, who underwent AVR for severe AS. Patients with previous valve replacement or repair were excluded. The preoperative and the follow up investigation included transthoracic echocardiography, physical examination and functional class assessment according to NYHA classification. NYHA II was identified in 19 patients (21.3%), NYHA III – in 51 (57.3%) and NYHA IV – in 19 (21.3%). 13 (14.6%) patients died within 120 days after operation. Remaining 76 patients were divided into 2 groups: 1 - 33 (43.4%) patients with improved functional class at least by 2 or those with NYHA I at follow up; 2 - 43 (56.6%) patients with reduction of less than 2 or with worsened functional class. Patients from group 1 were of younger age (71.6±9.0 vs 76.1±6.4, p=0.001), had less hypertension (67.5% vs 90.9%, p=0.014), atrial fibrillation (30.2% vs 54.6%, p=0.035) and renal insufficiency (18.6% vs 48.5%, p=0.007). Paradoxically, reduction of NYHA class was associated with smoking (41.9% vs 15.2%, p=0.009). There was no difference in following factors such as coronary disease, diabetes, dyslipidemia, obesity in 2 groups. More patients without clinical improvement were preoperatively treated with furosemide, ARB or CCB (p=0.01, 0.015, 0.002 respectively). No association was found with nitrates, aldospirone, ACEI, digitalis, beta blockers, carvedilol or statines.
Conclusions: For significant post-operative improvement of functional class after AVR the dominant predictors were younger age, absence of hypertension renal failure and atrial fibrillation.
