Aortic Valve Surgery in Patients with Congestive Heart Failure

Increasing numbers of the very elderly are undergoing aortic valve procedures. We describe the short and long-term survivorship for this cohort. We conducted a cohort study of 8,796 consecutive patients undergoing aortic valve surgery without (48.0%; AVR) or with (52.0%) concomitant coronary artery bypass graft (CABG) surgery (AVR-CABG) between November 10, 1987 through June 30, 2006. Patient records were linked to the Social Security Administration’s Death Master File. Survivorship was stratified by age strata and concomitant CABG surgery. During 44,,435 person years of follow-up, there were 3,236 deaths. Among AVR, there were 3,939 patients <80 yrs, 463 patients 80 – 84 yrs, and 174 patients 85 + yrs (29 patients ≥90 yrs). Among AVR-CABG patients, there were 3,312 patients <80 yrs, 656 patients 80 – 84 yrs, and 252 patients 85+ yrs (22 patients ≥90 yrs). Increasing age among patients undergoing isolated AVR was associated with female gender, more vascular disease and congestive heart failure, procedural urgency, while less diabetes. Increasing age among AVR-CABG patients was associated with female gender, left main stenosis, procedural urgency, more congestive heart failure, while less diabetes and lower ejection fraction. Median survivorship was better for patients undergoing AVR: 11.8 yrs (<80 yrs), 6.7 yrs (80 – 84 yrs), 6.1 yrs (85+yrs) than patients undergoing AVR-CABG: 9.3 yrs (<80 yrs), 6.3 yrs (80 – 84 yrs), and 5.6 yrs (85+ yrs), though this effect diminished with age. Octogenarians undergoing aortic valve surgery have a surprisingly favorable survivorship, with more than half of these patients still alive 6 years after their procedure. Concomitant CABG surgery diminishes this survivorship only slightly. Percent of Patients Surviving by Age Group, Procedure and Time Period

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P5992Why aortic valve disease may persist after surgery? A joint basic science - Clinical effort

European Heart Journal ◽

10.1093/eurheartj/ehz746.0713 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Petersen ◽

B Kloth ◽

N Grammatika-Pavlidou ◽

T Eschenhagen ◽

H Reichenspurner ◽

...

Keyword(s):

Heart Failure ◽

Energy Transfer ◽

Aortic Valve ◽

Aortic Valve Disease ◽

Resonance Energy Transfer ◽

Resonance Energy ◽

Valve Surgery ◽

Valve Disease ◽

Myocardial Tissue ◽

Aortic Valve Surgery

Abstract Background Diseases of the aortic valve are a common reason for heart surgery. Aortic stenosis (AS) is associated with pressure and aortic regurgitation (AR) with a volume overload of the left ventricle (LV). Over time both pathologies lead to systolic and diastolic heart failure, while progressive downregulation of β-adrenoceptors occurs. While LV re-remodeling occurs in the majority of patients after aortic valve surgery, LV dysfunction persists in one fourth of such patients and leads to a terminal heart failure. We aimed to investigate whether differential remodeling in the protein kinase A (PKA) dependent inotropic response in myocytes and myocardial tissue obtained from patients undergoing aortic valve surgery is associated with the LV re-remodeling after surgery. Methods Preoperatively, pro BNP levels were measured and left ventricular strain analysis via echocardiography was performed. Interventricular septal biopsy was obtained intraoperatively in 10 patients who underwent aortic valve surgery. In-vitro contractility was analyzed in myocardial tissue paced with 4 Hz at 37 °C. Freshly isolated cells were transduced with an adenovirus expressing a cytosolic Förster resonance energy transfer (FRET) based cAMP biosensor (Epac1-camps). After 48 hours of culture, Föster-resonance energy transfer (FRET) was used for the first time to measure cAMP in 60 isolated human ventricular myocytes. Isoprenaline (10 nM – 10 μM) was used for β-adrenoceptor activation and forskolin (10 μmol) to activate adenylyl cyclase directly. Results We found a significantly downregulated β-adrenergic sensitivity in cardiomyocytes of patients with aortic valve disease, although contractile response to forskolin was maintained. Furthermore, we found a clear association between reduced sensitivity to isoprenaline (i.e., high EC50 values) and low maximum effect size to isoprenaline in myocardial tissue of patients with aortic valve disease, pointing out relevant β-adrenoceptor dysfunction. There were no significant differences in basal myocardial force between tissue samples of patients with AR and AS. Conclusion Collectively, our data show a profound remodelling in the cAMP/PKA pathway in patients with aortic valve disease. These disturbances may have an impact on the postoperative ventricular function and possibly on the long-term LV re-remodelling after aortic valve surgery.

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