JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Vol. III, n 2, December 2016
Pages: 267-274
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Impact of Aortic Valve Replacement on Left Ventricular Remodeling in Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction
Author: Abderrahmane Bakkali, Imad Jaabari, Rochde Sayah, Koulekey Dadji, Mahdi Ait Houssa, Mohamed Laaroussi
Category: JMSR Cardiovascular Disease
Abstract:
Objective: The aim of this study was to evaluate the effect of aortic valve replacement on left ventricular function and remodeling among patients with severe aortic stenosis and severe left ventricular dysfunction.
Methods: In this retrospective bicentric study extended over a 15-year period, 61 consecutive patients underwent isolated AVR for severe AS associated to reduced LV function. The mean age was 58.21 ± 12.50 years and 83.60 % were men. 70.50% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF) was 32.9 ± 5.6.The mean LVEDD and LVESD were respectively 63.6 ± 9.2 and 50.2 ± 8.8 mm. The mean calculated logistic EuroScore was 12.2 ±4.5.
Results: The hospital mortality was 11.5%. Morbidity was marked mainly by low output syndrome in 40.8% of cases. After a median follow-up of 38 months we have recorded 3 deaths. Almost all survivors were in class I and II of NYHA. The mean LV end-diastolic and end-systolic diameters decreased significantly at late postoperative stage. The mean LV ejection fraction increased significantly from 32.9 ± 5.6 to 38.2 ± 9.3 and to 50.3 ± 9.6 in early and late postoperative stages, respectively. Multivariate linear regression analysis found that increased early postoperative LVEF (β= 0.44, 95% CI [0.14; 0.75], p=0.006) and low mean transprosthesis gradient (β=-0.72, 95% CI [-1.42; -0.02], p= 0.04) were the independent predictors of left ventricular systolic function recovery.
Conclusion: Patients with aortic valve stenosis and impaired LV systolic function benefited from AVR as regard improvement of LV function parameters and regression of the LV diameters .This improvement depends mainly on early postoperative LVEF and mean transprosthesis gradient.
Keywords: Aortic Valve Replacement, Left Ventricular Dysfunction, Severe Aortic Stenosis.
References:
1. Piestrzeniewicz K, Luczak K, Maciejewski M, et al. Clinical outcome, echocardiographic assessment, neurohormonal and collagen turnover markers in low-flow severe aortic stenosis with high transvalvular gradient. Pol Arch Med Wewn. 2014; 124: 19-26.
2. Vahanian A, Baumgartner H, Bax J, et al .Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology. ESC Committee for Practice Guidelines Guidelines on the management of valvular heart disease: The Task Force on theManagement of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28: 230-268.
3. Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: the Task Force on the management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28: 230-68.
4. Connolly HM, Oh JK, Drszulok TA, Osborn SL, Roger VL, Hodge DO. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction: prognostic indicators. Circulation 1997; 95: 2395-400.
5. Cannolly HM, Oh JK, Schaff HV, Roger VL, Osborn SL, Hodge DO, et al. Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction. Results of aortic valve replacement in 52 patients. Circulation 2000; 101: 1940-1946.
6. Badiani S ,Van Zalen J, Treibel TA, Bhattacharyya S, Moon JC Guy Lloyd. Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging. Curr. Cardiol. Rep (2016) 18: 80.
7. Carabello BA, Green LH, Grossman W, Cohn LH, Koster JK, Collins JJ. Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation. 1980; 62; 42-8.
8. Smith N, McAnulty JH, Rahimtoola SH. Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement. Circulation 1978; 58:255-64.
9. Harpole DH, Jones RH. Serial assessment of ventricular performance after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg. 1990; 99: 645-50.
10. Clavel MA, Fuchs C, Burwash IG, Mundigler G, Du mesnil JG, Baumgarter H, et al. Predictors of outcomes in low-flow, low-gradient aortic stenosis. Results of the multicenter TOPAS Study. Circulation. 2008; 118 (Suppl 1):234-242.
11. Nishimura RA, Grantham JA, Connolly HM, Schaff HV, Higano ST,Holmes DR Jr. Low-output, lowgradient aortic stenosis in patientswith depressed left ventricular systolic function: the clinical utility ofthe dobutamine challenge in the catheterization laboratory. Circulation.2002; 106: 809-813. doi: 10.1161/01.CIR.0000025611.21140.34.
12. Sharma UC, Barenbrug P, Pokharel S, Dassen WRM, Pinto YM, Maessen JG. Systemic review of the outcome of aortic valve replacement in patients with aortic stenosis. Ann ThoracSurg2004; 78: 9095.
13. Monrad ES, Hess OM, Murakomi T, Nonogi H, Corin WJ and Krayenbuell HP. Time course of regression of left ventricular hypertrophy after aortic valve replacement. Circulation; 77: 1345-1355, 1988.
14. Villari B, Vassali G, Betocchi S, Briguori C, Chiriello M andHess OM. Normalization of left ventricular nonuniformitylate after valve replacement for aortic stenosis. Am J. Cardiol; 78: 66-71, 1996.
15. Vaquette B, Corbineau H, Laurent M, Lelong B, Langanay T, De Place C, and al. Valve replacement in patients with critical aortic stenosis and depressed left ventricular function: predictors of operative risk, left ventricular function recovery, and long term outcome. Heart. 2005; 91: 1324-1329.
16. Jung SH, Lee JW, Gon Je H, Choo SJ, Chung CH, Song H. Surgical outcomes and post-operative changes in patients with significant aortic stenosisand severe left ventricle dysfunction. J Korean Med Sci 2009; 24:812-7.
17. Carabello BA. Ventricular function in aortic stenosis: how low can you go? J Am CollCardiol 2002; 39: 1364-5.
18. Collinson J, Henein M, Flather M, Pepper JR, Gibson DG. Valve replacement for aortic stenosis in patients with poor left ventricular function: comparaison of early changes with stented and stentless valves. Circulation 1999; 100(Suppl II): II1-II-5.
19. Pereira JJ, Lauer MS, Bashir M, Afridi I, Blackstone EH, Stewart WJ, McCarthy PM, Thomas JD, Asher CR. Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction JACC 2002 (39) 8:1356-63.
20. Querejeta R, Varo N, Lopez B, et al. Serum carboxy-terminal propeptide of procollagen type I is a marker of myocardial fibrosis in hypertensive heart disease. Circulation 2000; 101: 1729-35.
21. Pardo Mindan FJ, Panizo A. Alterations in the extracellular matrix ofthe myocardium in essential hypertension. Eur Heart J 1993; 14 Suppl J: 12-4.
22. Une D, Mesana L, Chan V, Maklin M, Chan R, Masters R.G et al. Clinical impact of changes in left ventricular function after aortic valve replacement: analysis from 3112 patients. Circulation 2015; 132:741-747.
23. Wiedemann D, Bonaros N and Kocher A(2011). Aortic Valve Surgery and Reduced Ventricular Function, Aortic Valve Surgery, Prof. Noboru Motomura (Ed.), DOI: 10.5772/20542. Available from: http://www.intechopen.com/books/aorticvalve-surgery/aortic-valve-surgery-and-reducedventricular-function
24. Ruel M, Al-Faleh H, Kulik A, Chan KL, Mesana TG, Burwash IG. Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regression. J Thorac Cardiovasc Surg. 2006 May;131(5):1036-44.
25. Kulik A, Burwash IG, Kapila V, Mesana TG, Ruel M. Long-term outcomes after valve replacement for low-gradient aortic stenosis: impact of prosthesispatient mismatch. Circulation. 2006; 114: I553-8.
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