Premium
Aortic Valve Repair Versus Replacement for Aortic Regurgitation: Effects on Left Ventricular Remodeling
Author(s) -
Regeer Madelien V.,
Versteegh Michel I.M.,
Klautz Robert J.M.,
Stijnen Theo,
Schalij Martin J.,
Bax Jeroen J.,
Ajmone Marsan Nina,
Delgado Victoria
Publication year - 2015
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12457
Subject(s) - medicine , ejection fraction , aortic valve replacement , cardiology , interquartile range , ventricular remodeling , regurgitation (circulation) , aortic valve , aortic root , aortic valve regurgitation , bicuspid aortic valve , diastole , heart failure , aorta , blood pressure , stenosis
Background Left ventricular (LV) reverse remodeling after aortic valve replacement (AVR) for aortic regurgitation (AR) is associated with superior prognosis. The outcomes of valve‐sparing aortic root replacement techniques on LV performance have not been compared with LV reverse remodeling in AVR. The present evaluation compared the extent of long‐term LV reverse remodeling in patients with aortic root pathology and/or AR who underwent aortic valve repair (AVr) with patients who underwent AVR. Methods A total of 226 patients (54.7 ± 14.3 years, 63% male) with AR or aortic root pathology who underwent AVr (n = 135) or AVR with the Freestyle® stentless aortic root bioprosthesis [Medtronic, Inc.; Minneapolis, Minnesota] (n = 91) were included in the present retrospective evaluation. LV volumes and ejection fraction were assessed preoperatively, postoperatively (before hospital discharge) and during follow‐up. Results Baseline characteristics were comparable between patient groups, except for higher prevalence of bicuspid aortic valve anatomy among AVR patients (38% vs. 16%, p < 0.001). In addition, patients undergoing AVR had significantly larger LV end‐diastolic and end‐systolic volumes than their counterparts. After a median follow‐up of 46 months (interquartile range: 17 to 78 months), both groups of patients showed a significant and sustained reduction in LV end‐diastolic and end‐systolic volumes, with significantly larger reduction in patients undergoing AVR. Ejection fraction decreased significantly postoperatively and improved later during follow‐up similarly in both groups. The incidence of significant AR at long‐term follow‐up was comparable among groups (AVr: 8% vs. AVR: 7%). Conclusions LV reverse remodeling occurs after AVR and AVr, reaching comparable LV volumes and function after a median of four years of follow‐up. doi: 10.1111/jocs.12457 (J Card Surg 2015;30:13–19)