Key result
Aortic valve replacement improved left ventricular efficiency over a 1-year period in all groups, although efficiency worsened early after surgery in patients with aortic regurgitation.
Why the study?
Does isolated aortic valve replacement improve left ventricular performance in patients with aortic stenosis, aortic regurgitation, or both?
Observational (n=263)
Does isolated aortic valve replacement improve left ventricular performance in patients with aortic stenosis, aortic regurgitation, or both?
Isolated AVR has contrasting early effects on LV contractility and afterload depending on the underlying aortic valve lesion, but leads to improved LV efficiency at 1 year across all groups.
Caution advised for early post-AVR efficiency decline in AR; supports long-term LV benefit hypothesis across lesions but leaves open causal confirmation.
We analyzed the mid-term left ventricular (LV) performance after aortic valve replacement (AVR). We measured LV contractility (end-systolic elastance: Ees), afterload (effective arterial elastance: Ea) and efficiency (ventriculoarterial coupling: Ea/Ees; ratio of stroke work and pressure-volume area: SW/PVA) based on transthoracic echocardiography data obtained before, after and approximately 1 year after isolated AVR in 263 patients with aortic stenosis (AS group; n=116), aortic regurgitation (AR group; n=93) or aortic stenosis and regurgitation (ASR group; n=54). The LV volume was calculated by the Teichholz M-mode method. Ees and Ea were approximated as follows: Ees=mean blood pressure/minimal LV volume; Ea=systolic blood pressure/(maximal LV volume-minimal LV volume). Thereafter, Ea/Ees and SW/PVA were calculated. Arterial blood pressure was measured using manchette methods. Ees and Ea decreased after AVR in the AS group, but increased in the AR group. Ea/Ees and SW/PVA worsened after AVR in the AR group, but improved during a 1-year period after AVR in all groups. Contrasting effects of AVR on LV contractility and afterload between AS and AR were clearly demonstrated. The mid-term LV contractility and efficiency after AVR were excellent and satisfactory. However, LV efficiency worsened early after AVR in AR patients.
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Tanoue et al. (2009) conducted an observational in Aortic stenosis and/or aortic regurgitation (n=263). Aortic valve replacement vs. Pre-operative baseline was evaluated on Left ventricular performance (contractility, afterload, and efficiency). Aortic valve replacement improved left ventricular efficiency over a 1-year period in all groups, although efficiency worsened early after surgery in patients with aortic regurgitation.
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