Long-Term Outcomes After Aortic Valve Surgery in Patients With Asymptomatic Chronic Aortic Regurgitation and Preserved LVEF

Alashi, Alaa; Khullar, Tamanna; Mentias, Amgad; Gillinov, A. Marc; Roselli, Eric E.; Svensson, Lars G.; Popović, Zoran B.; Griffin, Brian P.; Desai, Milind Y.

doi:10.1016/j.jcmg.2018.12.021

Cited by 71 publications

(55 citation statements)

References 28 publications

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“…This EF increase was a function of reductions in EDV, ESV, and SV, and might primarily be a marker of reversed LV remodeling in these patients. We also measured GLS, which has previously been shown predictive of mortality, the need for surgery, and LV systolic dysfunction in patients with AR [9,10,24,25]. We found baseline average GLS values in the same range (i.e., around − 19%) as those reported in a recent study of patients with AR, where lower absolute values were found to be associated with increased mortality [9].…”

Section: Systolic LV Functionsupporting

confidence: 70%

“…We also measured GLS, which has previously been shown predictive of mortality, the need for surgery, and LV systolic dysfunction in patients with AR [9,10,24,25]. We found baseline average GLS values in the same range (i.e., around − 19%) as those reported in a recent study of patients with AR, where lower absolute values were found to be associated with increased mortality [9]. However, we did not find an association between GLS and the composite outcome of impaired LV functional and structural recovery following surgery.…”

Section: Systolic LV Functionmentioning

confidence: 99%

“…Despite the emerging potentials of transcatheter valve replacement, the treatment of choice for severe AR is still aortic valve replacement (AVR), with intervention timing based on the presence of symptoms or evidence of increased LV dimensions or systolic dysfunction [4][5][6]. Recent studies indicate that the cutoff values used in current guidelines might need to be reconsidered [7,8], and additional measures such as strain imaging for LV have proven useful [9,10]. Thus, most studies of chronic AR have focused on LV dimensions and systolic function, to intervene while it is still possible to achieve full functional myocardial recovery and optimal life expectancy.…”

Section: Introductionmentioning

confidence: 99%

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Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

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Background The impact of volume overload due to aortic regurgitation (AR) on systolic and diastolic left ventricular (LV) indices and left atrial remodeling is unclear. We assessed the structural and functional effects of severe AR on LV and left atrium before and after aortic valve replacement. Methods Patients with severe AR scheduled for aortic valve replacement (n = 65) underwent two- and three-dimensional echocardiography, including left atrial strain imaging, before and 1 year after surgery. A control group was selected, and comprised patients undergoing surgery for thoracic aortic aneurysm without aortic valve replacement (n = 20). Logistic regression analysis was used to assess predictors of impaired left ventricular functional and structural recovery, defined as a composite variable of diastolic dysfunction grade ≥ 2, EF < 50%, or left ventricular end-diastolic volume index above the gender-specific normal range. Results Diastolic dysfunction was present in 32% of patients with AR at baseline. Diastolic LV function indices and left atrial strain improved, and both left atrial and LV volumes decreased in the AR group following aortic valve replacement. Preoperative left atrial strain during the conduit phase added to left ventricular end-systolic volume index for the prediction of impaired LV functional and structural recovery after aortic valve replacement (model p < 0.001, accuracy 70%; addition of left atrial strain during the conduit phase to end-systolic volume index p = 0.006). Conclusions One-third of patients with severe AR had signs of diastolic dysfunction. Aortic valve surgery reduced LV and left atrial volumes and improved diastolic indices. Left atrial strain during the conduit phase added to the well-established left ventricular end-diastolic dimension for the prediction of impaired left ventricular functional and structural recovery at follow-up. However, long-term follow-up studies with hard endpoints are needed to assess the value of left atrial strain as predictor of myocardial recovery in aortic regurgitation.

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Section: Systolic LV Functionsupporting

confidence: 70%

Section: Systolic LV Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Jenner

Ilami

Petrini

et al. 2021

Cardiovasc Ultrasound

View full text Add to dashboard Cite

show abstract

“…• Alashi et al [48] evaluated 865 patients with ≥3+ chronic AR and preserved LVEF undergoing AV surgery, a baseline LV-GLS value worse than −19% was associated with reduced survival. In a subgroup of patients who returned for 3-and 12-month postoperative follow-up examinations, persistently impaired LV-GLS was associated with increased mortality.…”

Section: Strain Imaging In Aortic Regurgitationmentioning

confidence: 99%

Clinical Applications of Strain Imaging in Aortic Valve Disease

Salcedo¹,

Gill²

2021

Advances in Complex Valvular Disease

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The prevalence of aortic valve disease, particularly aortic stenosis, is increasing in parallel to the aging of the population, making it the most prevalent form of valvular heart disease. Surgery and percutaneous interventions of the aortic valve are conditional to a comprehensive evaluation of the aortic valve and the left ventricle (LV). Favorable results from aortic valve surgery or intervention are influenced by LV ejection fraction (EF), presence and severity of left ventricular hypertrophy (LVH), LV end-systolic volume (LVESV), degree of leaflet calcification, and trans-aortic valve gradients. Deformation imaging, particularly global longitudinal strain, is evolving as a powerful tool in the evaluation of ventricular function in patients with aortic stenosis. GLS is particularly suited to detect subclinical LV dysfunction, before a drop in LV ejection fraction, providing the opportunity to intervene earlier to prevent serious and permanent LV dysfunction. Similar added value has been demonstrated in the application of GLS in the detection of subclinical LV dysfunction in patients with aortic regurgitation. Very little information exists in the use of GLS in patients with mixed aortic valve disease, providing an opportunity for future research in this important group of patients with aortic valve disease.

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“…Left ventricular global longitudinal strain (GLS) has gained much attention in the literature as a method that may improve timing of aortic valve surgery by revealing myocardial dysfunction before irreversible dysfunction has occurred [ 85 ]. A challenge with GLS is that discriminating cut-off values vary widely between studies with values between −19% and −12.5% for AR [ 86 , 87 ] and between −18.2% and −12.1% for AS [ 88 , 89 ]. There is significant overlap between GLS values between individuals who have good or poor outcomes [ 90 ], so GLS cut-off values currently appear to be limited to providing incremental prognostic utility [ 86 ].…”

Section: Ramifications Of Earlier Surgerymentioning

confidence: 99%

Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications

Koerber

Bennetts

Psaltis

2020

JCM

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Timing of aortic valve intervention for chronic aortic regurgitation (AR) and/or aortic stenosis (AS) potentially affects long-term survival. The 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines provide recommendations for the timing of intervention. Subsequent to the guidelines’ release, several studies have been published that suggest a survival benefit from earlier timing of surgery for severe AR and/or AS. The aim of this review was to determine whether patients who have chronic aortic regurgitation (AR) and/or aortic stenosis (AS) have a survival benefit from earlier timing of aortic valve surgery. Medical databases were systematically searched from January 2015 to April 2020 for randomized controlled trials (RCTs) and observational studies that examined the timing of aortic valve replacement surgery for chronic AR and/or AS. For chronic AR, four observational studies and no RCTs were identified. For chronic AS, five observational studies, one RCT and one meta-analysis were identified. One observational study examining mixed aortic valve disease (MAVD) was identified. All of these studies, for AR, AS, and MAVD, found long-term survival benefit from timing of aortic valve surgery earlier than the current guidelines. Larger prospective RCTs are required to evaluate the benefit of earlier surgical intervention.

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Long-Term Outcomes After Aortic Valve Surgery in Patients With Asymptomatic Chronic Aortic Regurgitation and Preserved LVEF

Cited by 71 publications

References 28 publications

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Pre- and postoperative left atrial and ventricular volumetric and deformation analyses in severe aortic regurgitation

Clinical Applications of Strain Imaging in Aortic Valve Disease

Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications

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