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Noninvasive Estimation of Left Ventricular Filling Pressure is a Major Determinant of Early and Midterm Postoperative Cardiovascular Events after Isolated Aortic Valve Replacement in Severe Aortic Stenosis
성균관의대 삼성서울병원 심장혈관센터 순환기내과¹, 흉부외과² , Mayo Clinic³
장성아¹, 박표원², 최진오¹ , 성기익², 이상철¹ , 박승우¹ , 김욱성², 이영탁², 오재건¹,³
Objectives –The aim of this study was to investigate whether preoperative estimated LV filling pressure predicts the postoperative outcome in patients with severe aortic stenosis (AS). Methods - Two hundred and ten patients who underwent isolated AVR due to severe AS were analyzed. LV filling pressure was noninvasively assessed by E/E’ which was calculated from mitral inflow and mitral annulus tissue Doppler. Early postoperative outcomes including ventilator time, intensive care unit stay, inotropics support, and hospital stay were reviewed. Postoperative mortality and morbidity was searched and compared according to LV filling pressure. Results - Preoperative functional class was associated with elevated E/E’. E/E’, LV ejection fraction, and age were associated with postoperative hospital course. E/E’ was the major determinant of postoperative hospital stay in multivariate analysis. Midterm mortality of overall population was very low after AVR (2%). Cardiovascular event free survival including hospital visit due to heart failure symptom, embolic infarction, and sudden cardiac death was significantly higher in the patients with elevated LV filling pressure with E/E’>12 (p = 0.03). Multivariate analysis showed a high hazard ratio of elevated E/E’>12 (HR=41, p < 0.001). Conclusions - Postoperative mortality of isolated AVR due to severe AS is very small in current era. E/E’ representing diastolic filling pressure is the most important determinant of early postoperative hospital course and postoperative morbidity. LV filling pressure should be considered as a predictor of the postoperative life-quality of severe AS patients.


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