Reverse remodelling after aortic valve replacement for chronic aortic regurgitation

Abstract

OBJECTIVES This study aimed to assess the long-term outcomes and investigate the factors related to left ventricular (LV) reverse remodelling after aortic valve replacement (AVR) in patients with chronic aortic regurgitation (AR). METHODS A total of 246 patients who underwent AVR for chronic AR at our institution were included in this retrospective study. Primary end-points included all-cause mortality, cardiac mortality and major adverse cerebral and cardiovascular events. Secondary end-points included cardiac function on echocardiography 1 year after surgery. We explored the predictive factors for reverse remodelling 1 year after surgery. RESULTS The 10-year survival rate was 86.0%, with no cardiac deaths in 93.8% and no major adverse cerebral and cardiovascular events in 79.9% of patients. Postoperative LV function and symptoms were significantly improved 1 year after surgery, but 34 patients (13.8%) did not recover normal function and structure. A significant negative correlation was found between the incidence of cardiac death and major adverse cerebral and cardiovascular events and reverse remodelling. Multivariate logistic regression identified preoperative LV ejection fraction (P = 0.001, odds ratio = 1.057) and LV end-systolic dimension index (P = 0.038, odds ratio = 0.912) as significant predictive factors of reverse remodelling 1 year after surgery. CONCLUSIONS Preoperative LV ejection fraction and LV end-systolic dimension index were predictive factors for reverse remodelling after surgery, which was associated with late outcomes. Earlier surgery may thus help to restore normal LV function and achieve better late outcomes after AVR for AR.

Cardiac remodelling – Part 2: Clinical, imaging and laboratory findings. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology

“…62 In the general population, RR after surgical aortic valve surgery for either stenosis or regurgitation is predicted by a higher preoperative LVEF and lower LVESV, while patients with severe LV dysfunction usually do not experience RR. [144][145][146] A variable degree of RR, affecting LV function, size and mass, has been reported also in patients undergoing transcatheter aortic valve replacement (TAVR), following afterload reduction. 147,148 Even patients with low-flow, low-gradient aortic stenosis may experience RR after TAVR, 63 reasonably until the left ventricle has not been irreversibly damaged by the longstanding elevation of LV afterload.…”

“…In the general population, RR after surgical aortic valve surgery for either stenosis or regurgitation is predicted by a higher preoperative LVEF and lower LVESV, while patients with severe LV dysfunction usually do not experience RR 144–146 . A variable degree of RR, affecting LV function, size and mass, has been reported also in patients undergoing transcatheter aortic valve replacement (TAVR), following afterload reduction 147,148 .…”

Fate of moderate secondary mitral regurgitation in patients undergoing aortic valve replacement for severe aortic regurgitation

“…For instance, Koga-Ikuta et al 13 showed that preoperative LVEF and LVESDi were significant predictors of LV reverse remodeling at 1 year after AVR, identifying an LVEF >49% and an LVESDi ≤33.2 mm/m 2 as optimal cut-off values. 13 In addition, Zhang et al 14 found that preoperative LVEF < 52% was a predictor of poor postoperative LV reverse remodeling. 14 Ideally, in a patient at an advanced age or with limited life expectancy and/or no more than moderate LV dilatation, concomitant MVA at the time of AVR could be avoided, also considering the increasing availability of percutaneous technology.…”

“…A number of studies have been published focusing on predictors of LV reverse remodeling following isolated AVR for isolated AR. For instance, Koga‐Ikuta et al 13 showed that preoperative LVEF and LVESDi were significant predictors of LV reverse remodeling at 1 year after AVR, identifying an LVEF >49% and an LVESDi ≤33.2 mm/m 2 as optimal cut‐off values 13 . In addition, Zhang et al 14 found that preoperative LVEF < 52% was a predictor of poor postoperative LV reverse remodeling.…”

A heart valve dedicated for aortic regurgitation: Review of technology and early clinical experience with the transfemoral Trilogy system

“…Aortic regurgitation (AR) is a common valvular pathology affecting up to 15% of the population, of which 1.6% have moderate to severe AR 1 . It a progressive disease of both the valve and myocardium with worsening regurgitation associated with adverse cardiac remodeling and function‐ left ventricular hypertrophy and dilatation followed by diastolic and systolic dysfunction 2,3 . Patients present with dyspnoea and less often with angina 3–5 .…”