Resumen

CRISTAR, Florencia; FERREIRO, Alejandro; MURGUIA, Elena  y  CURA, Leandro. Impacto pronóstico de la clase funcional preoperatoria en la cirugía por estenosis valvular aórtica. Rev.Urug.Cardiol. [online]. 2014, vol.29, n.2, pp.181-186. ISSN 1688-0420.

Background: aortic stenosis is the most common valvular heart disease in the elderly. There is not much evidence concerning the impact of preoperative NYHA functional class on short-term and long-term prognosis in patients undergoing valve replacement for aortic stenosis. Objective: to analyze the association between preoperative NYHA functional class (NYHA) and the short and long-term prognosis in patients who underwent aortic valve replacement for stenosis, adjusted for co-morbidity. Methods: analytical study cohort. Out of 8340 patients undergoing cardiac surgery at our institution from 1/01/2000 to 31/12/2010 that were prospectively incorporated into the Department´s database, only those who had an aortic valve replacement performed as a single procedure and also had at least 1 year of active follow-up until 31/12/2011 were included. Comorbidities, preoperative functional class according to the NYHA classification, LVEF and calculated EuroSCORE index (EC) and logistic EuroSCORE (ECL) as global indicators of the burden of co -morbidity were recorded in all patients. Results: 570 patients met the inclusion criteria. Mean age was 69.3 ± 9.8 years, 50.9 % were women. The mean LVEF was 56.4 ± 10.9%. NYHA I: 51.3%, NYHA II: 40.1%, NYHA III: 8.1%, NYHA IV: 0.5%. According to the NYHA, LVEF was: NYHA I: 59.4 ±8.9 %, NYHA II: 55. ± 12.3, NYHA III: 51.1 ±12.4, NYHA IV: 50.6 ± 9.2 (p<0.05). Operative mortality (30 days) was 3.9 %. Overall survival at 10 years was 64 %. Patients in NYHA ³ II had a lower 10-year survival than those in NYHA I: 0.53 vs. 0.79 (p<0.05), with a change in slope towards higher mortality after the fifth year after surgery (p<0.05). In multivariate analysis, NYHA II or above (OR: 1.59) and EC score (OR: 1.18) were independently associated with late mortality after valve surgery (p<0.05). Conclusions: patients who underwent aortic valve replacement in NYHA class II or above have a significantly lower long-term survival, after adjusting for confounding variables such as co -morbidity and age. These results suggest that this group of patients may benefit from surgery before symptoms of heart failure start.

Palabras clave : AORTIC VALVE STENOSIS; THORACIC SURGERY; PROGNOSIS.

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