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Background: Due to ventricular compensatory mechanisms, patients with severe aortic regurgitation are generally asymptomatic. Severe left ventricular dysfunction develops annually in 20% of non-operated cases, and the prognosis in those cases is poor. Although surgery is recommend in patients with left ventricular dysfunction, surgeons are wary. We investigated the changes in ventricular and effort capacity after surgery in patients with normal and abnormal left ventricular function., Methods: We retrospectively examined the data of patients with aortic regurgitation who underwent aortic valve replacement in our clinic between 1993 and 2013. Those who had previous cardiac surgery, chemotherapy, radiotherapy, renal dysfunction, diabetes mellitus, or preoperative arrhythmias were excluded. The 113 patients were divided into 2 groups according to ejection fraction., Results: In patients with ejection fraction <50%, interventricular septal thickness, posterior wall thickness, and left ventricular mass were significantly greater than in the ejection fraction ≥50% group (p < 0.01). No significant differences in intensive care unit stay and hospitalization were determined. No mortality was observed. Ejection fraction and effort capacity increased significantly after aortic valve replacement in both groups, and interventricular septal thickness, posterior wall thickness, and left ventricular mass decreased in both groups., Conclusions: Significant left ventricular functional improvements can be achieved after aortic valve replacement in patients with severe aortic regurgitation who develop left ventricular dysfunction. Despite the reported higher surgical mortality in this patient group, surgical treatment offers a survival benefit. We recommend surgical treatment in patients with severe aortic regurgitation who develop left ventricular dysfunction., (© The Author(s) 2016.)

Objective: The aim of this study was to assess the effects of aortic valve replacement (AVR) on the recovery of left ventricular function and the predictors for long-term survival in patients suffering from isolated severe aortic stenosis (AS) with a significant left ventricular dysfunction (LVD)., Methods: This retrospective study was conducted on 46 patients with isolated severe AS and LVD [left ventricular ejection fraction (LVEF) = or < 40%] who underwent AVR in our clinic between January 1993 and March 2006. Patients with coronary artery disease, with more than moderate aortic regurgitation (>2), with previous valve replacement or repair, and with other valve pathologies were excluded. The mean aortic valve area was 0.7+/- 0.09 cm2. The following fourteen variables were analyzed: etiology, age (= or >70 years), sex, preoperative New York Heart Association (NYHA) functional class, chronic obstructive pulmonary disease, hypertension, diabetes, peripheral arterial disease, chronic renal insufficiency, need for concomitant procedures for the ascending aorta, cardiopulmonary bypass time = or >120 min, aortic cross-clamp time = or >90 min, intraaortic balloon pump support and inotropic support. Statistical analysis for comparison of pre- and postoperative changes in clinical and functional variables was performed using Wilcoxon rank test. The predictors of early mortality after AVR were analyzed using logistic regression analysis and late survival was studied using Cox proportional regression and Kaplan Meier survival analyses., Results: Operative mortality was 8.6% with four patients. As the result of univariate logistic regression analysis, preoperative NYHA functional class = or >3 was found to be predictive of early mortality. Patients with NYHA class = or >3 had 12.6 times (OR: 12.6; 95%CI: 1.2-131.3; p=0.035) higher probability of early mortality than those with a lower NYHA class. However, multivariate logistic regression analysis demonstrated no predictor for early mortality. A positive change was observed in the LVEF in 79.3% of survivors and the mean LVEF increased from 34.5+/- 3.9% to 44.7+/- 10.4% (p<0.001). There were eight (19%) late deaths. Actuarial survival was 83. +/- 5.9% at 5 years and 59.6% +/- 10.9% at 10 years. Cox proportional hazards regression analysis demonstrated diabetes mellitus (HR: 6.6; 95% CI: 1.19-36.9, p=0.031) and intraaortic balloon pump use (HR: 10.7; 95% CI: 2.9-39.7, p<0.001) as significant predictors for late mortality., Conclusion: Left ventricular ejection fraction and symptoms improve after AVR in patients with isolated severe AS and LVD with an acceptable operative mortality and satisfactory long-term survival.

Objective: The adverse effects of extracorporeal circulation increase the morbidity and mortality risk of coronary bypass surgery, especially in patients with left ventricular dysfunction. The purpose of this study was to provide a comparison of the early and long-term outcome between patient groups with left ventricular dysfunction (LVEF<40% or LVPS>or=15) operated with or without using cardiopulmonary bypass., Methods: Fifty-one patients with left ventricular dysfunction, who were operated on between October 1992 and March 1994, were investigated retrospectively. They were divided into two groups: BH-group included 26 patients and cardiopulmonary bypass group had 25 patients. Mean age and risk factors were identical. All patients received one vessel bypass left internal mammary artery to left descending artery., Results: There was no early mortality and perioperative myocardial infarction in either group. In the early postoperative period the need of cardiac support therapy was significantly higher in the cardiopulmonary-bypass group than in the beating heart-group: 32% versus 7.7% (p<0.05). The need for blood products (for fresh frozen plasma 3.63 +/- 2.15u versus 2.5 +/- 1.34u; p = 0.023; for packed red blood cells 1.8 +/- 0.75u versus 1.25 +/- 0.46u; p = 0.048), the extubation time (18.2 +/- 5.5 hours versus 15.3 +/- 3.8 hours; p = 0.03) and the hospital stay (10.64 +/- 3.2 days versus 7.92 +/- 2.25 days; p = 0.001) were higher in the cardiopulmonary bypass -group than in the beating heart-group. Actuarial survival for the beating heart-group was 92.3 +/- 5.2% at 6 years, and for the cardiopulmonary bypass group was 92 +/- 5.4% at 6 years (p = 0.67)., Conclusions: In spite of more than four times as many patients in the cardiopulmonary bypass group requiring inotropic support after surgery, survival and cardiac death rates were similar for both groups. Off-pump bypass surgery conserves the blood constituents. The benefits of both techniques to improve the left ventricular performance score and ejection fraction were similar, but postoperative extubation time, length of intensive care unit and hospital stay were reduced significantly in the beating heart group. With these good results of the beating heart coronary bypass surgery and considering its cost effectiveness, we concluded that coronary bypass on a beating heart can be an alternative to cardiopulmonary bypass technique in selective patient groups.