Key result
Patients with ejection fraction <50% had significantly greater baseline left ventricular mass and wall thickness (p<0.01), but both groups showed significant functional improvements after aortic valve replacement.
Why the study?
Does aortic valve replacement improve left ventricular remodeling and effort capacity in patients with severe aortic regurgitation and left ventricular dysfunction compared to those with normal left ventricular function?
Cohort (n=113)
No
Does aortic valve replacement improve left ventricular remodeling and effort capacity in patients with severe aortic regurgitation and left ventricular dysfunction compared to those with normal left ventricular function?
Aortic valve replacement leads to significant improvements in left ventricular function and effort capacity in patients with severe aortic regurgitation, even in those with preoperative left ventricular dysfunction (ejection fraction <50%).
AVR may improve function in low-EF AR; leaves open differential remodeling by baseline EF in prospective studies.
BACKGROUND: Due to ventricular compensatory mechanisms, patients with severe aortic regurgitation are generally asymptomatic. Severe left ventricular dysfunction develops annually in 20% of non-operated cases, and the prognosis in those cases is poor. Although surgery is recommend in patients with left ventricular dysfunction, surgeons are wary. We investigated the changes in ventricular and effort capacity after surgery in patients with normal and abnormal left ventricular function. METHODS: We retrospectively examined the data of patients with aortic regurgitation who underwent aortic valve replacement in our clinic between 1993 and 2013. Those who had previous cardiac surgery, chemotherapy, radiotherapy, renal dysfunction, diabetes mellitus, or preoperative arrhythmias were excluded. The 113 patients were divided into 2 groups according to ejection fraction. RESULTS: In patients with ejection fraction <50%, interventricular septal thickness, posterior wall thickness, and left ventricular mass were significantly greater than in the ejection fraction ≥50% group (p < 0.01). No significant differences in intensive care unit stay and hospitalization were determined. No mortality was observed. Ejection fraction and effort capacity increased significantly after aortic valve replacement in both groups, and interventricular septal thickness, posterior wall thickness, and left ventricular mass decreased in both groups. CONCLUSIONS: Significant left ventricular functional improvements can be achieved after aortic valve replacement in patients with severe aortic regurgitation who develop left ventricular dysfunction. Despite the reported higher surgical mortality in this patient group, surgical treatment offers a survival benefit. We recommend surgical treatment in patients with severe aortic regurgitation who develop left ventricular dysfunction.
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Günay et al. (2016) conducted a cohort in Aortic regurgitation (n=113). Ejection fraction <50% vs. Ejection fraction ≥50% was evaluated on Changes in ventricular remodeling (interventricular septal thickness, posterior wall thickness, left ventricular mass) and effort capacity (p=< 0.01). Patients with ejection fraction <50% had significantly greater baseline left ventricular mass and wall thickness (p<0.01), but both groups showed significant functional improvements after aortic valve replacement.
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