Long term results and predictors of left ventricular function recovery after aortic valve replacement for chronic aortic regurgitation.
OBJECTIVE
In most patients with aortic regurgitation (AR), aortic valve replacement (AVR) improves left ventricular (LV) function, but some patients will not have favorable remodeling. Our objectives were to review long term clinical results of AVR for AR and to examine what factors affect the normalization of LV function after AVR for chronic AR.


METHODS
Between 1989 and 2010, 177 patients underwent isolated AVR for chronic pure AR. The patients were divided into 2 groups based on indexed end-systolic LV diameter (iESD): Group L (iESD) ≥25 mm/m(2)) (130 patients) and Group S (iESD <25 mm/m(2)) (47 patients).


RESULTS
There was no significant difference between groups in late mortality, freedom from cardiac-related death and rehospitalization for heart failure at late follow up after operation. At postoperative follow-up, 16% of patients had not recovered normal LV systolic function. By means of multivariate analysis, iESD and cardiac index (CI) were independent predictors of recovery of LV function and iESD >26.7 mm/m(2) and CI <2.71 l/min/m(2) were the best cut-off values.


CONCLUSIONS
Early and late surgical results of AVR for chronic AR were good, but for the preservation of postoperative normal LV function, AVR for AR patients should be performed before iESD reaches 26.7 mm/m(2).
Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Hiroyuki
H
Saisho
Koichi
K
Arinaga
Satoshi
S
Kikusaki
Yuichiro
Y
Hirata
Kumiko
K
Wada
Tatsuyuki
T
Kakuma
Hiroyuki
H
Tanaka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D015992:Body Mass Index; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left