title: Late recurrence of left ventricular dysfunction after aortic valve replacement for severe chronic aortic regurgitation.
abstract: BACKGROUND
  Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a decreased ejection fraction (EF) leads to improvement in left ventricular (LV) function, but there are no reports on late recurrence of LV dysfunction over long-term after AVR. This study aimed to identify frequency and predictors of late recurrent LV dysfunction after AVR.
  
  
  METHODS
  We retrospectively investigated 58 consecutive patients undergoing AVR for severe chronic AR and with follow-up echocardiography for >5years after AVR. Late recurrence of LV dysfunction was defined as an EF of <50% late after AVR and a 10% reduction in the EF compared with that observed at 1year after AVR.
  
  
  RESULTS
  The mean follow-up period was 10.3±5.2years. The preoperative EF was <50% in 21 (36%) patients, but it was normalized at 1year after AVR in all patients except for one. However, late recurrence of LV dysfunction developed in 7 (12%) of the 58 patients. These patients showed significantly higher LV end-diastolic and end-systolic diameters before and at 1year after AVR, a lower EF and relative wall thickness before AVR, a higher LV mass index at 1year after AVR, and a higher incidence of preoperative and postoperative atrial fibrillation than those without late recurrence.
  
  
  CONCLUSIONS
  Late recurrent LV dysfunction may occur after AVR for severe chronic AR despite EF being once normalized. Early surgery proceeding remarkable LV enlargement and maintaining sinus rhythm are important for LV function over the long-term after AVR.
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Amano
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan. Electronic address: izumi-ch@tenriyorozu.jp.
authors.forename: Chisato
authors.initials: C
authors.lastname: Izumi
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Sari
authors.initials: S
authors.lastname: Imamura
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Naoaki
authors.initials: N
authors.lastname: Onishi
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Yodo
authors.initials: Y
authors.lastname: Tamaki
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Enomoto
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kaitani
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
authors.affiliation: Department of Cardiology, Tenri Hospital, Tenri, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D004452:Echocardiography / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: Aortic regurgitation; Aortic valve replacement; Late recurrence of left ventricular dysfunction; Long-term follow-up