Challenge of Timing Redo Aortic Valve Replacement

The management of valvular heart disease has markedly changed during the past decades. The timing of intervention—surgically and more recently also by catheter intervention—is no longer primarily driven by the goal of symptom relief for the patient. Treatment strategies aim now for an optimal long-term outcome with regard to both morbidity and mortality.1,2 The observation that patients may have already developed irreversible damage of their cardiovascular system—in particular of the ventricular myocardium—when they present with symptoms and that this damage has negative impact on their postoperative long-term outcome has moved the recommendations toward earlier intervention.1,2 Because any intervention is also associated with a certain risk and negative long-term consequences by itself, these risks need to be carefully weighed against the potential risk of delaying intervention in an asymptomatic or mildly symptomatic patient.1,2 Because both risks are determined by many individual factors, the timing of intervention has become a real challenge, and potential predictors of outcome that may help to guide decision making have gained high interest in the management of valvular heart disease.See Article by Naji et al Left ventricular ejection fraction (LVEF) is a generally accepted predictor of outcome in valvular heart disease.1,2 However, it has also been recognized that LVEF has a poor sensitivity to detect early myocardial damage, which may already have negative impact on the patient’s outcome. In this regard, left ventricular global longitudinal strain (LVGLS) has gained particular interest and is increasingly used with prognostic and clinical decision-making implications.3 …