P3653Aortic regurgitation in the young - Is it time to rethink the guidelines?

• Published in: European heart journal 2019-10, Vol.40 (Supplement_1)
• Main Authors: Barradas Pires, A, Costola, G, Meras, P, Constantine, A, Rafiq, I, Gatzoulis, M A, Dimopoulos, K
• Format: Article
• Language: English
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz745.0510

Abstract Background Establishing surgical indication for aortic valve replacement or repair (AVR) in the setting of severe aortic regurgitation (AR) can be challenging in young patients. Current guidelines state patients should be operated based on symptoms, presence of left ventricular (LV) dysfunction (Ejection Fraction, EF ≤50%) or severely LV dilatation (LV end diastolic diameter, LVEDD ≥70mm or LV end systolic diameter, LVESD ≥50mm) 1. Purpose Our goal was to study the change of the LV size and function in a cohort of young adults with severe AR after surgery and relate this to pre-operative ventricular characteristics. Methods We reviewed all patients who underwent AVR in our centre between 2013 and 2018. The echocardiographic data was collected prior to, pre discharge and at 6–12 months after surgery. A ROC analysis was used to determinate the discriminative power of baseline LV diameters in predicting normalization of LV size pre discharge. Normal values were considered as per the guidelines3. Results A total of 75 adult patients were included: mean age 25±10.5 years, 64% male. The majority (61%) had a bicuspid valve, 17% an autograft (previous Ross procedure), 10% developed AR after a VSD was closed, 6% had an arterial switch procedure, 3% a truncal valve and 3% Tetralogy of Fallot. 10% went for a Ross procedure, 60% received a bioprosthetic and 30% a mechanical aortic valve. The majority (61%) were completely asymptomatic. The vast majority (88%) were operated with LVEDD ≤70mm (mean 60±6.9mm), 84% had a LVESD ≤50mm and 80% had an LVEF >50%. A significant reduction in LVEDD occurred within a few days from surgery: mean reduction 9.2±6.2mm, p