Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes

Ong, Géraldine; Redfors, Björn; Crowley, Aaron; Abdel‐Qadir, Husam; Harrington, Alana; Liu, Yangbo; Lafrenière-Roula, Myriam; Leong‐Poi, Howard; Peterson, Mark D.; Connelly, Kim A.

doi:10.1111/echo.13750

Cited by 15 publications

(6 citation statements)

References 16 publications

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“…Although it is stated to be safe for adult cardiac surgery, more studies are needed on specific subgroups. Conditions requiring aortic valve replacement (aortic stenosis and aortic regurgitation) should also be subject to a separate assessment in terms of their effects on the left ventricle 3 , 4 . However, there is still a limited number of data associated with the use of DNC in aortic valve replacement 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery

Uçak¹,

Ucak²

2021

Braz J Cardiovasc Surg

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Introduction In this study, we aimed to compare Del Nido cardioplegia (DNC) with blood cardioplegia (BC) in aortic valve replacement. Methods A two-year single-institute retrospective cohort study was accomplished. Subjects who underwent aortic valve replacement surgery were divided into two groups (DNC and BC) and outcomes were compared. Results Preoperative demographics and clinical data of the patients in both groups were similar. The time until cardiac arrest following administration of the first dose of cardioplegia was statistically significantly shorter in the BC group (47.0 sec. 25-103) than in the DNC group (63.0 sec. 48-140) ( P =0.012). Cross-clamping time was longer in the BC group (48.7±12.3 min. vs . 41.5±11.8 min.) ( P =0.041). Cardiopulmonary bypass time was statistically significantly shorter in the DNC group (BC 60.8±18.5 min., DNC 53.7±15.2 min.) ( P =0.046). The rate of postoperative use of intravenous positive inotropic support drugs (dopamine, dobutamine, norepinephrine, etc.) for more than two hours was significantly higher in the BC group (20 [23.5%] in the BC group and nine [17.3%] in the DNC group) ( P =0.035). Creatine kinase myocardial band and troponin I levels were slightly lower in patients receiving DNC, but no statistically significant difference was detected. Conclusion Del Nido cardioplegia is safe and can be used efficiently as an alternative to blood cardioplegia in isolated aortic valve replacement surgery.

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Section: Introductionmentioning

confidence: 99%

Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery

Uçak¹,

Ucak²

2021

Braz J Cardiovasc Surg

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“…46 In patients with severe aortic regurgitation undergoing treatment with either transcatheter aortic valve implantation 47 or aortic valve surgery, LV volume decreased an average of 30% to 35%. 48,49 Therefore, the cardiac structural improvements seen in our patients post-HSCT are within the clinically significant range.…”

Section: Hgbmentioning

confidence: 65%

Reversal of a rheologic cardiomyopathy following hematopoietic stem cell transplantation for sickle cell disease

et al. 2019

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“…AR associated with LV volumes overload and pressure overload, preoperative LVEF and left ventricle systolic dimension presented the pump performance, and left ventricle diastolic dimension presented the severity of volumes overload. Although AVR could correct the hemodynamic disturbance in AR patients, previous reports have suggested that the improvement of left ventricle function after aortic valve replacement early phase was due to the reduction of LV volume overloading [ 13 , 14 ]. In this study, the mean LV diastolic dimension and LV ejection fraction were 70.2 mm and 50.5% in remodeling patients, but they were 80.6 mm and 37.7% for the no remodeling patients.…”

Section: Discussionmentioning

confidence: 99%

Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement

Zhang

Han

et al. 2022

J Cardiothorac Surg

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Background Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a severe dilated left ventricle and dysfunction leads to left ventricle remodeling. But there are rarely reports on the left ventricle reverse remodeling (LVRR) after AVR. This study aimed to investigate the LVRR and outcomes in chronic AR patients with severe dilated left ventricle and dysfunction after AVR. Methods We retrospectively analyzed the clinical datum of chronic aortic regurgitation patients who underwent isolated AVR. The LVRR was defined as an increase in left ventricular ejection fraction (LVEF) at least 10 points or a follow-up LVEF ≥ 50%, and a decrease in the indexed left ventricular end-diastolic diameter of at least 10%, or an indexed left ventricular end-diastolic diameter ≤ 33 mm/m2. The changes in echocardiographic parameters after AVR, survival analysis, the predictors of major adverse cardiac events (MACE), the association between LVRR and MACE were analyzed. Results Sixty-nine patients with severe dilated left ventricle and dysfunction underwent isolated AVR. LV remodeling in 54 patients and no LV remodeling in 15 patients at 6–12 months follow-up. The preoperative left ventricular dimensions and volumes were larger, and the EF was lower in the LV no remodeling group than those in the LV remodeling group (all p < 0.05). The adverse LVRR was the predictor for MACE at follow-up. The mean follow-up period was 47.29 months (range 6 to 173 months). The rate of freedom from MACE was 94.44% at 5 years and 92.59% at 10 years in the remodeling group, 60% at 5 years, and 46.67% at 10 years in the no remodeling group. Conclusions The left ventricle remodeling after AVR was the important predictor for MACE. LV no remodeling may not be associated with benefits from AVR for chronic aortic regurgitation patients with severe dilated LV and dysfunction.

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Evaluation of left ventricular reverse remodeling in patients with severe aortic regurgitation undergoing aortic valve replacement: Comparison between diameters and volumes

Abstract: Compared to the volume-based method, diameter-based LV measurement incorrectly identified LV reverse remodeling post-AVR in 17% of patients with severe AR. Left ventricle (LV) volume may be a better measure to assess LV remodeling post-AVR than LV diameter-based measurements.

Cited by 15 publications

References 16 publications

Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery

Single-Dose Del Nido Cardioplegia vs. Blood Cardioplegia in Aortic Valve Replacement Surgery

Reversal of a rheologic cardiomyopathy following hematopoietic stem cell transplantation for sickle cell disease

Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement

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