Key result
Preoperative left ventricular end-systolic dimension >50 mm and fractional shortening <25% delayed hemodynamic recovery, requiring 3 years to normalize LV function compared to 1 year for others.
Why the study?
Does early aortic valve replacement prior to excessive ventricular remodeling improve hemodynamic recovery and outcomes in patients with aortic valve disease?
Does early aortic valve replacement prior to excessive ventricular remodeling improve hemodynamic recovery and outcomes in patients with aortic valve disease?
Operative procedures should be recommended in aortic valve disease patients prior to excessive ventricular remodeling to avoid delayed hemodynamic recovery and increased mortality.
With great interest, I read a paper by Fuster and colleagues in this Journal's May 2003 issue [1]. They detailed the use of echocardiographic left ventricular dimensions to calculate a left ventricular mass index in 614 patients, and analyzed the effect of increased left ventricular mass index on outcomes in patients undergoing aortic valve replacement. They concluded that increased left ventricular mass index was associated with an in-hospital adverse outcome with higher in-hospital mortality in the patients. We have reported our clinical experience with 25 consecutive patients undergoing aortic valve replacement because of isolated aortic valve regurgitation (AR). All the patients survived through follow-ups of a mean 55±30 months after operation. We analyzed relations between preoperative left ventricular dimensions and postoperative left ventricular remodeling by serial echocardiographic assessment; concluding that in order to normalize the left ventricular function in isolated AR patients, those patients who had left ventricular end-systolic dimension (LVD) greater than 50 mm and fractional shortening (FS) less than 25% required 3 years after operation, while those who had LVDs less than or equal to 50 mm and/or FS greater than or equal to 25% required only 1 year after operation [2]. Left ventricular mass index depends on left ventricular dimensions and wall thickness. As mentioned above, Fuster and colleagues have shown the higher mortality in the patients with increased left ventricular mass index, and we have shown the delayed hemodynamic recovery in patients with dilated left ventricles. These studies indicate that operative procedures should be recommended in aortic valve disease patients prior to excessive ventricular remodeling.
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Yoshio Misawa (2003) conducted a letter in Isolated aortic valve regurgitation (n=25). Preoperative left ventricular end-systolic dimension >50 mm and fractional shortening <25% vs. Left ventricular end-systolic dimension ≤50 mm and/or fractional shortening ≥25% was evaluated on Time to normalize left ventricular function. Preoperative left ventricular end-systolic dimension >50 mm and fractional shortening <25% delayed hemodynamic recovery, requiring 3 years to normalize LV function compared to 1 year for others.
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