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Predictors of outcome for aortic valve replacement in patients with aortic regurgitation and left ventricular
B A Carabello1, B W Usher, G H Hendrix
1Department of Medicine, Medical University of South Carolina, Charleston 29425.
Insights
Left ventricular function remains crucial for predicting outcomes after aortic valve replacement in aortic regurgitation patients. Improved surgical techniques offer better prognoses even with reduced preoperative ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Medicine
Background:
- Left ventricular function is traditionally key for prognosis in aortic regurgitation.
- Recent studies questioned the predictive value of left ventricular function for aortic valve replacement outcomes.
Purpose of the Study:
- To evaluate the role of left ventricular function indexes in predicting surgical outcomes for aortic regurgitation patients.
- To assess the impact of preoperative left ventricular dysfunction on aortic valve replacement results.
Main Methods:
- Studied 14 patients with aortic regurgitation and preoperative ejection fraction < 0.55 undergoing aortic valve replacement.
- Analyzed preoperative predictors of negative outcome and postoperative ejection fraction.
- Correlated preoperative ventricular function indexes with postoperative ejection fraction.
Main Results:
- 12 of 14 patients showed improved symptoms and normal ejection fraction post-surgery.
- Significant correlation found between postoperative ejection fraction and eight preoperative predictors.
- Preoperative end-systolic dimension (≤60 mm) best predicted postoperative ejection fraction (≥0.55).
Conclusions:
- Preoperative left ventricular function remains an important determinant of aortic valve replacement outcomes in aortic regurgitation.
- Current techniques allow for improved prognosis in patients with reduced ventricular function.
- Aortic valve replacement can lead to significant recovery of left ventricular function.
Abstract:
Although left ventricular function is generally regarded as a key determinant of prognosis in aortic regurgitation, predictors of outcome of aortic valve replacement based on this factor have recently been questioned. This study was performed to examine the role of indexes of left ventricular function in predicting the outcome of surgery in patients with aortic regurgitation and left ventricular dysfunction. Fourteen patients with aortic regurgitation with a preoperative ejection fraction of less than 0.55 (average 0.45 +/- 0.02) who underwent aortic valve replacement were studied. The patients had 82 (58%) of a possible 140 predictors of negative outcome preoperatively, but 12 of the 14 patients had a decrease in symptoms and an increase in ejection fraction into the normal range after operation (average postoperative ejection fraction 0.59 +/- 0.04). Although improvement occurred despite the presence of many negative predictors of outcome, there was a significant correlation between postoperative ejection fraction and eight of the tested preoperative predictors. Preoperative end-systolic dimension correlated best (r = -0.91) with postoperative ejection fraction. An end-systolic dimension of 60 mm correlated with a postoperative ejection fraction of 0.55. The results indicate that preoperative ventricular function is still an important determinant of outcome of aortic valve replacement for aortic regurgitation. However, current medical and surgical techniques permit a better prognosis in the presence of reduced ventricular function than was previously considered possible.