Related Experiment Videos
[Prognostic value of preoperatively determined end-systolic left ventricular diameter in patients with chronic aortic
Insights
Patients with chronic aortic regurgitation (AR) and enlarged left ventricles (end-systolic dimension > 55 mm) may not require immediate aortic valve replacement. Echocardiography shows significant improvement in ventricular dimensions post-surgery, suggesting a better prognosis than previously thought.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Context:
- Chronic aortic regurgitation (AR) can lead to left ventricular (LV) dilation and dysfunction.
- Previous studies suggested poor outcomes for AR patients with LV end-systolic dimension (ESD) > 55 mm and fractional shortening (FS) < 25%.
Purpose:
- To evaluate the long-term outcomes of patients with chronic AR and preoperative LV dilation undergoing aortic valve replacement.
- To assess if a preoperative end-systolic dimension (ESD) > 55 mm predicts reduced postoperative survival in AR patients.
Summary:
- A retrospective analysis of 33 AR patients without coronary artery disease who underwent aortic valve replacement was performed.
- Patients were divided into two groups based on preoperative ESD: ≤ 55 mm (Group A) and > 55 mm (Group B).
- No perioperative or late deaths occurred in either group. Both groups showed significant improvement in NYHA functional class and LV end-diastolic dimension postoperatively. Group B (ESD > 55 mm) also demonstrated a significant decrease in LV end-diastolic dimension three years post-surgery.
Impact:
- The findings suggest that AR patients with preoperative ESD > 55 mm may have a better long-term prognosis than previously assumed.
- These results indicate that aortic valve replacement can lead to significant reverse remodeling and functional improvement even in patients with marked preoperative LV dilation.
- The study challenges the a priori recommendation for aortic valve replacement in asymptomatic patients with AR and significant LV dilation (ESD > 55 mm), suggesting a more nuanced approach is warranted.
Abstract:
Serial echocardiographic studies of Henry et al. (Circulation 61, 471 [1980]) in patients with chronic aortic regurgigation (AR) indicate that preoperative left ventricular end-systolic dimension (ESD) greater than 55 mm and fractional shortening (FS) less than 25% may identify patients with reduced postoperative survival. We retrospectively analyzed the onedimensional echocardiograms of 33 patients with AR without coronary artery disease who underwent operation from 1977 to 1981. Twenty-three patients with ESD less than or equal to 55 mm (group A, mean age 48 +/- 10 years) were followed 36 +/- 14 months postoperatively, ten patients with ESD greater than 55 mm (group B, eight patients with FS less than 25%; mean age 48 +/- 12 years) 40 +/- 10 months. In both groups there were no perioperative or late deaths. In group A the average preoperative NYHA functional class decreased from 2.6 to 1.4 postoperatively, in group B from 3.0 to 1.5 (A vs. B: NS). Preoperative FS was 35 +/- 8% in group A and 22 +/- 3% in group B, preoperative ESD 44 +/- 5 mm in group A and 62 +/- 7 in group B. Three years after operation, end-diastolic dimension was 54 +/- 8 mm compared with 68 +/- 5 mm preoperatively in group A (p less than 0.001) and 61 +/- 11 mm compared to 79 +/- 8 mm preoperatively in group B (p less than 0.001). According to these data, a significant postoperative decrease of end-diastolic dimension can be expected in most patients with AR and ESD greater than 55 mm. The long-term prognosis of this subgroup is not so impaired as to recommend aortic valve replacement to asymptomatic patients a priori.