Key result
SAVR in young patients linked to persistent LVLS deterioration at 5 years.
Why the study?
Studies in adults report decreased left ventricular function early after aortic valve replacement, prompting the hypothesis that young adults with aortic valve dysfunction may experience incomplete recovery of left ventricular systolic function.
Does surgical prosthetic aortic valve replacement improve left ventricular systolic function and remodelling in young patients with aortic valve dysfunction?
Observational (n=15)
No
Does surgical prosthetic aortic valve replacement improve left ventricular systolic function and remodelling in young patients with aortic valve dysfunction?
In young patients undergoing surgical aortic valve replacement, left ventricular systolic function assessed by strain imaging deteriorates early post-operatively and remains abnormal at 5 years despite improvements in LV mass.
Persistent strain decline after SAVR cautions against assuming full LV recovery; leaves open whether prosthesis type independently impairs myocardial function.
Surgical prosthetic aortic valve replacement has been used for the management of aortic valve dysfunction. Studies in adults after aortic valve replacement report decreased left ventricular function in the early post-operative period. We hypothesised that young adults with aortic valve dysfunction who undergo aortic valve replacement may have incomplete recovery of left ventricular systolic function. This was a retrospective single-centre pilot study of patients with surgical aortic valve replacement at our institution over 20 years. Echocardiograms were analysed pre-operatively, at discharge, 1-year, and 5-year follow-up. Left ventricular systolic function was assessed using fractional shortening and ejection fraction. Speckle tracking measurements were performed for four-chamber longitudinal strain and peak systolic circumferential strain. Repeated-measure ANOVA (SPSS Inc.) was used for analysis. A p -value <0.05 was considered significant. Our cohort included 15 subjects (age 19.1 ± 9.0 years, 73% male). Left ventricular mass indexed to body surface area significantly improved (63.5 ± 25.3 pre-operatively to 41.2 ± 13.1 at 5 years, p = 0.009). Left ventricular longitudinal and circumferential strain measures deteriorated in the early post-operative period compared to pre-aortic valve replacement (−18.2 ± 3.4 versus −11.8 ± 3.3, p = 0.00) and (−25.1 ± 5.4 versus −18.9 ± 5.4, p = 0.06). Longitudinal strain continued to be abnormal at the 1- and 5-year follow-up compared to baseline. Children and young adults undergoing aortic valve replacement for aortic valve dysfunction had a decrease in left ventricular systolic function by strain imaging in the early post-operative period and abnormalities persisted on 5-year follow-up.
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Bhatia et al. (2025) conducted an observational in Aortic valve dysfunction (n=15). Surgical prosthetic aortic valve replacement vs. Pre-operative baseline was evaluated on Left ventricular longitudinal strain in the early post-operative period (p=0.00). Surgical aortic valve replacement in young patients was associated with a deterioration in left ventricular longitudinal strain from baseline (-18.2 vs -11.8; p=0.00) that persisted at 5 years.
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