Prevalence and clinical impact of left coronary dominance in patients with aortic stenosis

J Heart Valve Dis. 2011 Jan;20(1):23-8.


Background and aim of the study: Left coronary dominance may be more prevalent in patients with valvular aortic stenosis (AS). A cohort study was conducted to: (i) determine the prevalence of coronary left dominance in patients with AS; (ii) assess if a possible higher prevalence of left dominance is confined to patients with bicuspid aortic valve; (iii) examine if left dominance is a risk factor for the progression of AS, independent of established risk factors; and (iv) assess in-hospital clinical outcome following valve replacement according to the coronary dominance pattern.

Methods: The prevalence of left coronary dominance was analyzed in 721 patients with severe isolated AS, and compared to a control cohort of 6,990 patients without AS. The clinical data and short-term outcome following valve replacement were assessed according to the coronary dominance pattern.

Results: Left coronary dominance was significantly more prevalent in patients with AS compared to those without AS (13.7% versus 10.2%, p = 0.003), and a pattern of right coronary dominance was less frequent in patients with AS (66.9% versus 71.6%, p = 0.008), irrespective of the presence of a bicuspid or tricuspid valve. Left coronary dominance was not an independent predictor of younger age at the time of valve replacement. There were no differences for in-hospital mortality and rates of myocardial infarction between coronary dominance types.

Conclusion: Although left coronary dominance is more prevalent in patients with AS, it is not a risk factor for disease progression, and is not associated with short-term adverse outcome following valve replacement.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aortic Valve / abnormalities
  • Aortic Valve / physiopathology*
  • Aortic Valve / surgery
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology*
  • Aortic Valve Stenosis / surgery
  • Case-Control Studies
  • Chi-Square Distribution
  • Coronary Circulation*
  • Coronary Vessels / physiopathology*
  • Coronary Vessels / surgery
  • Disease Progression
  • Female
  • Functional Laterality
  • Germany
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / mortality
  • Hospital Mortality
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome