title: Effect of ejection fraction on left ventricular remodeling in aortic insufficiency.
abstract: BACKGROUND
  Due to ventricular compensatory mechanisms, patients with severe aortic regurgitation are generally asymptomatic. Severe left ventricular dysfunction develops annually in 20% of non-operated cases, and the prognosis in those cases is poor. Although surgery is recommend in patients with left ventricular dysfunction, surgeons are wary. We investigated the changes in ventricular and effort capacity after surgery in patients with normal and abnormal left ventricular function.
  
  
  METHODS
  We retrospectively examined the data of patients with aortic regurgitation who underwent aortic valve replacement in our clinic between 1993 and 2013. Those who had previous cardiac surgery, chemotherapy, radiotherapy, renal dysfunction, diabetes mellitus, or preoperative arrhythmias were excluded. The 113 patients were divided into 2 groups according to ejection fraction.
  
  
  RESULTS
  In patients with ejection fraction <50%, interventricular septal thickness, posterior wall thickness, and left ventricular mass were significantly greater than in the ejection fraction ≥50% group (p < 0.01). No significant differences in intensive care unit stay and hospitalization were determined. No mortality was observed. Ejection fraction and effort capacity increased significantly after aortic valve replacement in both groups, and interventricular septal thickness, posterior wall thickness, and left ventricular mass decreased in both groups.
  
  
  CONCLUSIONS
  Significant left ventricular functional improvements can be achieved after aortic valve replacement in patients with severe aortic regurgitation who develop left ventricular dysfunction. Despite the reported higher surgical mortality in this patient group, surgical treatment offers a survival benefit. We recommend surgical treatment in patients with severe aortic regurgitation who develop left ventricular dysfunction.
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey md.dnzgny@gmail.com.
authors.forename: Deniz
authors.initials: D
authors.lastname: Gunay
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Yucel
authors.initials: Y
authors.lastname: Ozen
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Davut
authors.initials: D
authors.lastname: Cekmecelioglu
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Sabit
authors.initials: S
authors.lastname: Sarikaya
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Eray
authors.initials: E
authors.lastname: Aksoy
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Murat Bulent
authors.initials: MB
authors.lastname: Rabus
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D055815:Young Adult
keywords: Aortic valve insufficiency; Echocardiography; Heart valve prosthesis implantation; Treatment outcome; Ventricular dysfunction; left