Left ventricular ejection performance, wall stress, and contractile state in aortic regurgitation before and after aortic valve replacement.

Introduction: The Framingham Studies revealed that diabetes mellitus (DM) predisposed subjects to a two- to eight-fold increase in the risk of developing heart failure (HF). However, there is much less information available about the reverse issue; namely, whether there is an increased risk of developing DM in patients with HF. We sought to determine if reversal or partial reversal of HF through aortic valve replacement (AVR) would improve glycemic control in patients with DM at our institution. Methods: The electronic medical records of 57 consecutive diabetic patients were retrospectively analyzed. These patients had undergone AVR at a medium-sized academic medical center from May 2005 through May 2015, and had glycated hemoglobin (HbA1C) measured before and after the procedure. The variables of interest included HbA1C, and echocardiographic parameters such as left ventricular ejection fraction (LVEF), tricuspid regurgitation velocity (TRV), and right ventricular systolic pressure (RVSP) before and after valve replacement. Results: HbA1C decreased significantly during the first year after replacement, from 7.1% (range 4.4 - 13.0%) before surgery to 6.5% in the first year (P < .05). In addition, the calculated RVSP decreased from 44 mmHg (20 - 79 mmHg) to 37 mmHg (P < .05 from the preoperative value). LVEF and TRV did not change significantly. Reductions in HbA1C and RVSP during the first year were greater in patients who experienced an increase of 5% or more in EF at their first postoperative measurement. Patients with higher baseline HbA1C values had a greater decline in glycated Hb during the first year (P < .01). Conclusion: AVR was associated with a reduction of HbA1C and a decrease in pulmonary artery systolic pressure within one year of the procedure.

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Early haemodynamic and structural impact of transcatheter aortic valve replacement in pure aortic regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1919 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Graziani ◽

E Mencarelli ◽

F Burzotta ◽

L Paraggio ◽

C Aurigemma ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Transcatheter Aortic Valve ◽

Structural Impact ◽

Before And After

Abstract Background Patients with severe aortic regurgitation (AR) are treated by surgery and have variable left-ventricular (LV) “reverse remodelling” after intervention. Transcatheter-aortic-valve replacement (TAVR) might be considered in selected AR patients. Purpose To evaluate the hemodynamic and structural impact of TAVR in patients with pure AR. Methods Consecutive AR patients underwent TAVR in our Institution were identified. Left heart catheterization before and after TAVR and complete echocardiographic assessment before TAVR, after (24–72 hours) TAVR and at follow-up (3–12 months) were systematically performed. Hemodynamic and echocardiographic parameters were compared before and after TAVR. Results Twenty-two patients with severe AR, high surgical risk and advanced heart damage were treated by TAVR using mainly self-expandable prostheses. The procedure was successful in 21 patients (95.5%). An immediate hemodynamic impact of the TAVR procedure was documented by different parameters and included significant decrease in LV end-diastolic pressure (from 26.2 to 20.1 mmHg, P=0.012). Significant reduction in LV size (left ventricular end diastolic diameter (LVEDD): 60.0±8.0 mm vs 54.6±8.1 mm, p=0.002) and mass (left ventricular mass indexed (LVMi): 163.2±58.8 g/m2 vs 140.2±45.6 g/m2, p 0.004) as well as a sharp reduction in systolic-pulmonary-arterial-pressure (48.3±17.6 vs 32.9±7.8 mmHg, p<0.0001) was documented at 24–72 hours. Furthermore, patients with baseline moderate-to-severe mitral and tricuspid regurgitation showed a significant, early, valvular regurgitation reduction. All favourable changes persisted at follow-up. More pronounced LVEDD reduction was predicted by baseline LVEDD (p=0.019). Conclusions In patients with severe AR, TAVR determines a profound impact on heart remodelling, which is early detectable and durable. Impact of TAVR in pure AR Funding Acknowledgement Type of funding source: None

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Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement

Cardiology ◽

10.1159/000490848 ◽

2018 ◽

Vol 140 (4) ◽

pp. 204-212 ◽

Cited By ~ 1

Author(s):

Jeffrey S. Borer ◽

Phyllis G. Supino ◽

Edmund McM. Herrold ◽

Antony Innasimuthu ◽

Clare Hochreiter ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Census Data ◽

Left Ventricular ◽

Postoperative Survival ◽

Left Ventricular Ejection ◽

Survival Prediction ◽

Us Census

Background: Noninvasive measurement of myocardial contractility (end-systolic wall stress-adjusted change in left ventricular ejection fraction from rest to exercise [ΔLVEF – ΔESS]) predicts heart failure, subnormal LVEFrest, and sudden death in asymptomatic patients with chronic severe aortic regurgitation (AR). Here we assess the relation of preoperative ΔLVEF – ΔESS to survival after aortic valve replacement (AVR). Methods: Patients who underwent AVR for chronic, isolated, pure severe AR (n = 66) were followed for 13.0 ± 6.4 event-free years. Preoperative ΔLVEF – ΔESS (from combined echocardiographic and radionuclide cineangiographic data) enabled cohort stratification into 3 terciles (–1 to –11% [normal or mild] contractility deficit, –12 to –16% [moderate], and ≤–17% [severe], identical with segregation in our earlier study) to relate preoperative contractility to postoperative survival and to age- and gender-matched US census data. Results: Since AVR, 22 patients died (average annual risk [AAR] for all-cause mortality for the entire co hort = 3.15%). Preoperative ΔLVEF – ΔESS predicted postoperative survival (p = 0.009, log rank test). By contractility terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than among US census comparators (p < 0.02), but the “mild” tercile was indistinguishable from census data (p = ns). By multivariable Cox regression, survival prediction by pre-AVR ΔLVEF – ΔESS was independent of, and superior to, prediction by age at surgery, gender, preoperative functional class, LVEFrest, LVEFexercise, change in LVEFrest to exercise, and LV diastolic or systolic dimensions (p ≤ 0.01, pre-AVR ΔLVEF – ΔESS vs. other covariates). Conclusion: In severe AR, preoperative contractility predicts post-AVR survival and may be prognostically superior to clinical, geometric and performance descriptors, potentially impacting on patient selection for surgery.

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EARLY OUTCOME AFTER AORTIC VALVE REPLACEMENT ON PATIENTS WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.1.12 ◽

2014 ◽

pp. 74-78

Author(s):

Duc Hien Nguyen ◽

Quang Thuu Le

Keyword(s):

Left Ventricular Ejection Fraction ◽

Aortic Valve ◽

Ejection Fraction ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Severe Left Ventricular Dysfunction ◽

Ventricular Ejection Fraction

Background: Patients with aortic valve disease with severe left ventricular dysfunction usually have poor prognosis, postoperative mortality and morbidity are higher compared to those with normal left pump function. It is controversial in which state is too late for surgical indication on such patients with reduced left ventricular ejection fraction. Methods: From January 2012 to December 2013, 17 patients with aortic valve replacement with LVEF ≤ 40% were included. Results: Mean age was 27.29 ± 11.485 yrs. All AR patients were in severe regurgitation (≥ 3/4). All patients with AS had AR ≥ 2.5/4, severe stenosis with transvalvular gradient around 80mmHg. 64.70% NYHA class III-IV. 100% patients with mechanical valve replacement. ICU stay 7.29 days. No intraaortic baloon pump was needed. Operative mortality was 0%. Conclusion: Aortic valve replacement in patients with severe left ventricular dysfunction, although contains higher risk of mortality and morbidity, this is a method of choice which helps improve symtomps and LV function, and reduce mortality due to conventional therapy. Keyword: Aortic valve replacement; reduced left ventricular ejection fraction

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