Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery

Background: Increased left ventricular mass index has been shown to be asso ciated with higher mortality in epidemiologic studies. However, the effect of increased left ventricular mass index on outcomes in patients undergoing aortic valve replacement is unknown. Methods: We studied 473 consecutive patients undergoing elective aortic val ve replacement to assess the influence of left ventricular mass index on ou tcomes in patients having this procedure. Echocardiographic left ventricula r dimensions were used to calculate left ventricular mass index (considered increased if > 134 g/m(2) in male patients and > 110 g/m(2) in female pati ents). Results: Left ventricular mass index was increased in 24% of patients under going aortic valve replacement. Postprocedural complications (respiratory f ailure, renal insufficiency, congestive heart failure, and atrial and ventr icular arrhythmias), length of stay in the intensive care unit, and in-hosp ital mortality were increased in patients with increased left ventricular m ass index. Multivariable analysis identified prior valve surgery (odds rati o, 4.3; 95% confidence interval, 1.2-15.7; P =.030), left ventricular eject ion fraction (odds ratio, 1.07; 95% confidence interval, 1.01-1.14; P =.020 ), history of hypertension (odds ratio, 8.2; 95% confidence interval, 2.2-3 0.4; P =.002), history of liver disease (odds ratio, 50.4; 95% confidence i nterval, 4.2-609.0; P =.002), and increased left ventricular mass index (od ds ratio, 38; 95% confidence interval, 9.3-154.1; P < .001) as independent predictors of in-hospital mortality. Furthermore, low output syndrome was i dentified as the most common mode of death (36%) after aortic valve replace ment in patients with increased left ventricular mass index. Conclusions: Increased left ventricular mass index is associated with incre ased adverse in-hospital clinical outcomes in patients undergoing aortic va lve replacement. Although this finding warrants special modification in per ioperative management, further studies are needed to address whether outcom es in asymptomatic patients with aortic valve disease could be improved by earlier aortic valve replacement before a significant increase in left vent ricular mass index.