Operative risk stratification and predictors for long-term outcome in low-gradient aortic stenosis.

Term Outcome in Low-Gradient Aortic Stenosis To the Editor: We would like to congratulate Monin et al1 for their important multicenter study concerning risk stratification for valve replacement in low-gradient aortic stenosis using dobutamine echocardiography. It is possible that the lack of correlation in their study between the presence of previous myocardial infarction (MI) and perioperative mortality (a correlation that we did find in our study2) occurred because of a difference in our patient populations (the average ejection fraction of their patients was 31%, and that of our patients was 21%). In our patient population, 90% of the perioperative deaths occurred in those with a previous MI (mortality was 45% in those with prior MI, and only 3% in those without, despite very poor left ventricular (LV) function and relatively low aortic gradients). Apparently when LV damage is permanent (scar) and severe, replacing the aortic valve, with or without revascularization, does not result in recovery of LV function.