Evaluation of Left Ventricular Functions after Aortic Valve Replacement in a Specific Young Male Patient Population with Pure Aortic Insufficiency or Aortic Stenosis: 5-Years Follow-up

Objective: Aortic insufficiency (AI) can lead to left ventricular (LV) remodeling characterized by dilation and increased LV mass. This remodeling can cause altered mitral valve coaptation and functional mitral regurgitation (FMR). While there is growing evidence that aortic valve replacement (AVR) for aortic stenosis promotes sufficient ventricular reverse remodeling that FMR improves or resolves, this effect is not well characterized for patients with AI. Methods: All cases of AVR for AI that were performed at a single center between January 2003 and December 2015 were reviewed. Cases with any concomitant procedures, any degree of aortic stenosis, any evidence of ischemic etiology, absence of mitral regurgitation, or significant primary mitral pathology were excluded from analysis. The primary outcome was change in FMR after isolated AVR. Secondary outcomes included change in LV ejection fraction (EF), left atrial (LA) dimension, and change in end-diastolic and –systolic LV dimensions. Two-tailed paired t-test was used to evaluate for difference between the two time points. Results: Over the course of 13.4 years, 31 cases of isolated aortic valve replacement for pure aortic insufficiency with concurrent functional mitral regurgitation were identified. 54.8% (17/31) of cases had some evidence of bacteremia or aortic vegetations at time of surgery, with 41.9% (13/31) of cases completed urgently. Postoperatively, FMR was improved in 74.2% (23/31) of the patients, and decreased by a mean 1.0 ± 0.8 grades (1.6 ± 0.8 vs 0.6 ± 0.7, p < 0.001). There was no significant change in LV EF (50.5 ± 13.4 vs. 50.2 ± 12.9, p = 0.892) or LA dimension (42.5 ± 7.2 vs 40.7 ± 5.9, p = 0.341), but there were significant reductions in the dimension of the LV at end-diastole (56.7 ± 7.1 vs 47.7 ± 8.5, p < 0.001) and end-systole (38.5 ± 9.7 vs 34.0 ± 8.3, p = 0.011). Conclusions: Significant reduction in ventricular size and subsequent improvement in functional mitral regurgitation is expected after isolated aortic valve replacement for pure aortic insufficiency.

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Aortic Valve Replacement for Severe Aortic Stenosis or Aortic Insufficiency with Advanced Left Ventricular Dysfunction

Surgical Treatment for Advanced Heart Failure ◽

10.1007/978-1-4614-6919-3_5 ◽

2013 ◽

pp. 49-61

Author(s):

S. Chris Malaisrie ◽

Patrick M. McCarthy

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Severe Aortic Stenosis ◽

Aortic Insufficiency ◽

Left Ventricular

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Severe aortic stenosis without left ventricular hypertrophy: prevalence, predictors, and short-term follow up after aortic valve replacement.

Heart ◽

10.1136/hrt.76.3.250 ◽

1996 ◽

Vol 76 (3) ◽

pp. 250-255 ◽

Cited By ~ 33

Author(s):

C. Seiler ◽

R. Jenni

Keyword(s):

Aortic Valve ◽

Left Ventricular Hypertrophy ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Ventricular Hypertrophy ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Short Term

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Regression of Left Ventricular Mass after Implantation of the Sutureless 3f Enable Aortic Bioprosthesis

Texas Heart Institute Journal ◽

10.14503/thij-13-3943 ◽

2015 ◽

Vol 42 (2) ◽

pp. 117-123

Author(s):

Giovanni Concistrè ◽

Antonio Miceli ◽

Federica Marchi ◽

Francesca Chiaramonti ◽

Mattia Glauber ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Left Ventricular Mass ◽

Valve Replacement ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Mass ◽

The Mean

Left ventricular hypertrophy in aortic stenosis is considered a compensatory response for the maintenance of systolic function but a risk factor for cardiac morbidity and death. We investigated the degree of left ventricular mass regression after implantation of the sutureless Medtronic 3f Enable® Aortic Bioprosthesis. We studied 19 patients who, from May 2010 through July 2011, underwent isolated aortic valve replacement with the 3f Enable bioprosthetic valve, with clinical and echocardiographic follow-up at 6 months. The mean age was 77.1 ± 5.1 years (range, 68–86 yr); 14 patients were women (73.7%); and the mean logistic EuroSCORE was 15.4% ± 11.8%. Echocardiography was performed preoperatively, at discharge, and at 6 months' follow-up. The left ventricular mass was calculated by means of the Devereux formula and indexed to body surface area. The left ventricular mass index decreased from 146.1 ± 47.6 g/m2 at baseline to 118.1 ± 39.8 g/m2 at follow-up (P=0.003). The left ventricular ejection fraction did not change significantly. The mean transaortic gradient decreased from 57.3 ± 14.2 mmHg at baseline to 12.3 ± 4.6 mmHg at discharge and 12.2 ± 5.3 mmHg at follow-up (P <0.001), and these decreases were accompanied by substantial clinical improvement. No moderate or severe paravalvular leakage was present at discharge or at follow-up. In isolated aortic stenosis, aortic valve replacement with the 3f Enable bioprosthesis results in significant regression of left ventricular mass at 6 months' follow-up. However, this regression needs to be verified by long-term echocardiographic follow-up.

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Four year follow up of aortic valve replacement for isolated aortic stenosis: a link between reduction in pressure overload, regression of left ventricular hypertrophy, and diastolic function

Heart ◽

10.1136/heart.86.3.309 ◽

2001 ◽

Vol 86 (3) ◽

pp. 309-316 ◽

Cited By ~ 42

Author(s):

I Ikonomidis

Keyword(s):

Aortic Valve ◽

Left Ventricular Hypertrophy ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Diastolic Function ◽

Valve Replacement ◽

Ventricular Hypertrophy ◽

Pressure Overload ◽

Left Ventricular

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A national study of the outcome after treatment of critical aortic stenosis in the neonate

Cardiology in the Young ◽

10.1017/s1047951120002036 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1321-1327

Author(s):

Cecilia Kjellberg Olofsson ◽

Katarina Hanseus ◽

Jens Johansson Ramgren ◽

Mats Johansson Synnergren ◽

Jan Sunnegårdh

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

National Study ◽

Term Survival ◽

Critical Aortic Stenosis

AbstractObjective:This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention.Methods:All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement.Results:Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%).Conclusions:Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

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