title: Aortic valve repair versus replacement for aortic regurgitation: effects on left ventricular remodeling.
abstract: 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.
authors.affiliation: Heart Lung Center Leiden, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Madelien V
authors.initials: MV
authors.lastname: Regeer
authors.forename: Michel I M
authors.initials: MI
authors.lastname: Versteegh
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000503:physiopathology* / Q000601:surgery*; D001705:Bioprosthesis; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D002306:Cardiac Volume; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling / Q000502:physiology*