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Background <p>Patients with severe left ventricular (LV) dysfunction (ejection fraction [EF] ≤ 35%) undergoing surgical aortic valve replacement (SAVR) are considered high-risk patients. This study evaluated contemporary outcomes in such patients undergoing SAVR for severe aortic stenosis (AS) or aortic regurgitation (AR) and identified clinical and echocardiographic predictors of mortality.</p> Methods <p>This retrospective cohort study included 84 patients (&gt; 18 years) with EF ≤ 35% who underwent SAVR between 2015 and 2024. The cohort comprised 53 patients with AS and 31 with AR. Clinical, echocardiographic, and myocardial strain data were collected before and 6 months after SAVR. Mortality data were obtained from national registries, with follow-up through March 2025. Cox proportional hazards models were used to identify mortality predictors.</p> Results <p>Median EF was 28% in AS and 31.1% in AR. Patients with AR were significantly younger than AS (44 vs. 63 years, <i>p</i> &lt; 0.001). In-hospital mortality for AS was 9.4%, increasing to 13.2% at 1 year and 43.4% at 55 months. AR patients showed no in-hospital deaths and 32.3% mortality at 55 months. Eight-year survival was 38.7% in patients with AS and 43.1% in patients with AR. In AS, creatinine (hazard ratio [HR] = 1.01, <i>p</i> = 0.022) and preoperative peak velocity (HR = 0.52, <i>p</i> = 0.020) predicted mortality. In AR, only length of hospital stays (HR = 1.13, <i>p</i> = 0.017) was predictive.</p> Conclusion <p>SAVR in severe LV dysfunction offers better medium-term survival, with clinical factors guiding prognosis.</p> Trial Registration <p>Institut Jantung Negara Ethics Committee (IJNREC/779/2025).</p> Graphical Abstract <p></p>

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Surgical aortic valve replacement in severe left ventricular dysfunction: mortality, echocardiographic, and strain outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月20日

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  • Roslan Aslannif,
  • Si Ling Soh,
  • Yee Sin Tey,
  • Am Haris Norhaliza,
  • Teo Jassie,
  • Lynne Murray Rowina,
  • Kee Soon Chong,
  • Kian Boon Wong,
  • Dillon Jeswant,
  • Mohamed Yunus Alwi,
  • Mohd Ghazi Azmee

摘要

Background

Patients with severe left ventricular (LV) dysfunction (ejection fraction [EF] ≤ 35%) undergoing surgical aortic valve replacement (SAVR) are considered high-risk patients. This study evaluated contemporary outcomes in such patients undergoing SAVR for severe aortic stenosis (AS) or aortic regurgitation (AR) and identified clinical and echocardiographic predictors of mortality.

Methods

This retrospective cohort study included 84 patients (> 18 years) with EF ≤ 35% who underwent SAVR between 2015 and 2024. The cohort comprised 53 patients with AS and 31 with AR. Clinical, echocardiographic, and myocardial strain data were collected before and 6 months after SAVR. Mortality data were obtained from national registries, with follow-up through March 2025. Cox proportional hazards models were used to identify mortality predictors.

Results

Median EF was 28% in AS and 31.1% in AR. Patients with AR were significantly younger than AS (44 vs. 63 years, p < 0.001). In-hospital mortality for AS was 9.4%, increasing to 13.2% at 1 year and 43.4% at 55 months. AR patients showed no in-hospital deaths and 32.3% mortality at 55 months. Eight-year survival was 38.7% in patients with AS and 43.1% in patients with AR. In AS, creatinine (hazard ratio [HR] = 1.01, p = 0.022) and preoperative peak velocity (HR = 0.52, p = 0.020) predicted mortality. In AR, only length of hospital stays (HR = 1.13, p = 0.017) was predictive.

Conclusion

SAVR in severe LV dysfunction offers better medium-term survival, with clinical factors guiding prognosis.

Trial Registration

Institut Jantung Negara Ethics Committee (IJNREC/779/2025).

Graphical Abstract