Left ventricular reverse remodelling post-AVR: comparing isolated aortic stenosis with mixed aortic valve disease

Introduction Aortic valve disease, including isolated aortic stenosis (IAS) and mixed aortic valve disease (MAVD), contributes to adverse left ventricular (LV) remodelling characterized by structural alterations and impaired function. Aortic valve replacement (AVR) is the primary treatment, however, limited research compares how the LV remodels after AVR in IAS versus MAVD patients. This study aimed to explore the differences in reverse remodelling in these two groups using echocardiographic data. Methods Adult patients (≥18 years) who underwent AVR for either severe IAS or MAVD—between 2019 and 2023 were included. Patients with significant atherosclerosis, atrial arrhythmias, other valvular disease (≥ moderate), or heart failure were excluded. Echocardiographic parameters including AV hemodynamics, LV volumes and dimensions, ejection fraction, and diastology were assessed pre- and post-AVR. Appropriate statistical tests were used to evaluate changes in echocardiographic parameters pre- and post-AVR. Results A total of 59 patients met the inclusion criteria: IAS (n=22, 68.9±14.6 years, males 68.2%), and MAVD (n=37, 67.1±10.6 years, males 56.8%). Following AVR, both groups showed significant improvements in aortic valve hemodynamics and decreaseed LV mass. However, only the MAVD group showed significant reductions in indexed LV end-diastolic volume (LV-EDVi) (Table 1). Conclusion Following AVR, both IAS and MAVD patients showed improved valve hemodynamics and LV mass regression. However, only MAVD patients had additional benefits in a reduction in LVEDVi. This could suggest more favourable reverse remodelling and recovery, highlighting the differential impact of AVR based on underlying valve pathology and underscore the importance of tailored post-operative assessment.