Reverse left ventricular remodelling after aortic valve replacement for severe aortic insufficiency

Teppei Toya, Satsuki Fukushima, Yusuke Shimahara, Shingo Kasahara, Junjiro Kobayashi, Tomoyuki Fujita

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: The goal of this study was to investigate the long-term outcome of aortic valve replacement (AVR) for severe aortic insufficiency with a focus on pre- and postoperative left ventricular (LV) function to explore predictive factors that influence the recovery of LV function and clinical outcome. METHODS: A total of 478 patients who underwent AVR for pure severe aortic insufficiency were grouped according to the preoperative echocardiographical LV ejection fraction (EF): low (LO) EF <35% (n = 43), moderate EF 35-50% (n = 150) or normal EF >50% (n = 285). RESULTS: Actuarial survival at 10 years post-AVR was 64% with a LO EF, 92% with a moderate EF and 93% with a normal EF (P = 0.016), whereas 10-year rates of freedom from major adverse cerebral and cardiovascular events were 47%, 79% and 84%, respectively (P < 0.0001). Echocardiography at 1 year post-AVR demonstrated that EF substantially improved in all groups. We noted a significant difference in survival (P = 0.0086) and in freedom from major adverse cerebral and cardiovascular events (P = 0.024) between patients with an EF ≥35% and those with an EF <35% in the LO EF group. The multivariable logistic regression model showed that predictive factors for lack of improvement in EF 1 year post-AVR in the LO EF group included plasma brain natriuretic peptide >365 pg/mL (P = 0.0022) and echocardiographic LV mass index) >193 g/m2 (P = 0.0018). CONCLUSIONS: Long-term outcome post-AVR for severe aortic insufficiency was largely influenced by preoperative LV function. Predictive factors of failure to recover ventricular function post-AVR included EF <25%, pre-brain natriuretic peptide >365 pg/mL or LV mass index >193 g/m2.

Original languageEnglish
Pages (from-to)846-854
Number of pages9
JournalInteractive cardiovascular and thoracic surgery
Volume32
Issue number6
DOIs
Publication statusPublished - Jun 1 2021
Externally publishedYes

Keywords

  • Aortic insufficiency
  • Left ventricular dysfunction
  • Left ventricular mass index
  • Post-AVR

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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