Background: Surgical intervention for asymptomatic aortic regurgitation (aAR) should be performed while the le ventricular (LV) functional reserve is maintained. However, data on the optimal timing for surgery in pediatric patients with aAR are scarce. erefore, this study aimed to clarify the optimal timing for surgical intervention in patients with aAR in consideration of the LV functional reserve.
Methods:irty-three patients with aAR who were 18 years old and underwent aortic valve repair at Shizuoka Children s Hospital were enrolled. We retrospectively examined their medical charts and echocardiography records. Results: For patients in whom the preoperative echocardiographic assessment of LV geometry showed either an indexed le ventricular end-systolic dimension (ESDI) of 31 mm/m 2 or an indexed end-diastolic dimension (EDDI) of 51 mm/m 2 , LV dimension improved to the normal range (ESDI 25 mm/m 2 and EDDI 40 mm/ m 2 ) at 3 years a er surgery while maintaining an LV ejection fraction (EF) of ≥50 in 80 and 77 of the patients, respectively. Hazard ratios for not recovering to the normal LV geometry or EF a er the surgery were as follows: preoperative ESDI ≥31 mm/m 2 : 1.60 (95 con dent interval [CI]: 0.6 4.3, p 0.3), preoperative EDDI ≥51 mm/m 2 : 1.96 (95 CI: 0.6 5.2, p 0.3), preoperative EF 50 : 3.37 (95 CI: 0.8 14.6, p 0.1). Death and aortic valve reoperation were not noted during the observation period. Conclusion: An ESDI of ≥31 mm/m 2 or EDDI ≥51 mm/m 2 can be useful indicators for determining the optimal timing for surgical intervention in patients with aAR who are younger than 18 years.
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