{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:26:39Z","timestamp":1761863199569},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The survival of patients who undergo aortic valve replacement (AVR) for severe aortic stenosis with reduced preoperative ejection fractions (EFs) is not well described in the literature.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Patients undergoing AVR for severe aortic stenosis were analyzed using the Northern New England Cardiovascular Disease Study Group surgical registry. Patients were stratified by preoperative EF (\u226550%, 40%\u201349%, and &lt;40%) and concomitant coronary artery bypass grafting. Crude and adjusted survival across strata of EF was estimated for patients up to 8 years beyond their index admission. A total of 5277 patients underwent AVR for severe aortic stenosis between 1992 and 2008. There were 727 (14%) patients with preoperative EF &lt;40%. Preoperative EF had minimal effect on postoperative morbidity. There was no difference in 30-day mortality across EF strata among the isolated AVR cohort. Preserved EF conferred 30-day survival benefit among the AVR+coronary artery bypass grafting population (EF\u226550%, 96%; EF&lt;40%, 91%;\n              <jats:italic>P<\/jats:italic>\n              =0.003). Patients with preserved EF had significantly improved 6-month and 8-year survival compared with their reduced EF counterparts.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Survival after AVR or AVR+coronary artery bypass grafting was most favorable among patients with preoperative preserved EF. However, patients with mild to moderately depressed EF experienced a substantial survival benefit compared with the natural history of medically treated patients. Furthermore, minor reductions of EF carried equivalent increased risk to those with more compromised function suggesting patients are best served when an AVR is performed before even minor reductions in myocardial function.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.112.965772","type":"journal-article","created":{"date-parts":[[2013,1,9]],"date-time":"2013-01-09T13:40:48Z","timestamp":1357738848000},"page":"35-41","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of Preoperative Left Ventricular Ejection Fraction on Long-Term Survival After Aortic Valve Replacement for Aortic Stenosis"],"prefix":"10.1161","volume":"6","author":[{"given":"Joshua B.","family":"Goldberg","sequence":"first","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph P.","family":"DeSimone","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S.","family":"Kramer","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony W.","family":"DiScipio","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis","family":"Russo","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence J.","family":"Dacey","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce J.","family":"Leavitt","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Helm","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvon R.","family":"Baribeau","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald","family":"Sardella","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Clough","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen D.","family":"Surgenor","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meredith J.","family":"Sorensen","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy S.","family":"Ross","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaine M.","family":"Olmstead","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd A.","family":"MacKenzie","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Malenka","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald S.","family":"Likosky","sequence":"additional","affiliation":[{"name":"From the Departments of Medicine, Surgery, and Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Hanover, NH (J.B.G., J.P.D., A.W.D., L.J.D., S.D.S., M.J.S., C.S.R., E.M.O., T.A.M., D.J.M., D.S.L.); Department of Surgery, Maine Medical Center, Portland, ME (R.S.K.); Department of Surgery, Central Maine Medical Center, Lewiston, ME (L.R.); Department of Surgery, Fletcher Allen Health Care, Burlington, VT (B.J.L.);..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the Northern New England Cardiovascular Disease Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90377-8"},{"key":"e_1_3_3_4_2","first-page":"284","article-title":"Prevalence and characteristics of unoperated patients with severe aortic stenosis.","volume":"20","author":"Bach DS","year":"2011","unstructured":"Bach DS. Prevalence and characteristics of unoperated patients with severe aortic stenosis. J Heart Valve Dis. 2011;20:284\u2013291.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.176857"},{"issue":"9","key":"e_1_3_3_6_2","first-page":"I344","article-title":"Coronary artery bypass grafting in patients with low ejection fraction.","volume":"112","author":"Topkara VK","year":"2005","unstructured":"Topkara VK, Cheema FH, Kesavaramanujam S, Mercando ML, Cheema AF, Namerow PB, Argenziano M, Naka Y, Oz MC, Esrig BC. Coronary artery bypass grafting in patients with low ejection fraction. Circulation. 2005;112(9 suppl):I344\u2013I350.","journal-title":"Circulation"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.07.059"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.12.042"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.05.078"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2005.11.028"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)35759-9"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(02)03840-7"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)35524-2"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03470060065028"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.68.5.939"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.85.6.2110"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpb.2007.07.010"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.02.026"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.08.058"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.894170"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.38.1S5.V-61"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr084"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq026"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000079171.43055.46"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.757427"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200008313430903"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.01.072"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2006.07.043"},{"key":"e_1_3_3_29_2","first-page":"396","article-title":"Barriers to surgery in severe aortic stenosis patients with Class I indications for aortic valve replacement.","volume":"20","author":"Dua A","year":"2011","unstructured":"Dua A, Dang P, Shaker R, Varadarajan P, Pai RG. Barriers to surgery in severe aortic stenosis patients with Class I indications for aortic valve replacement. J Heart Valve Dis. 2011;20:396\u2013400.","journal-title":"J Heart Valve Dis"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.112.965772","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:37:38Z","timestamp":1715567858000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.112.965772"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,1]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2013,1]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.112.965772"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.112.965772","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"type":"print","value":"1941-7713"},{"type":"electronic","value":"1941-7705"}],"subject":[],"published":{"date-parts":[[2013,1]]},"assertion":[{"value":"2012-02-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-09-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-01-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}