Preoperative ejection fraction determines early recovery of left ventricular end-diastolic dimension after aortic valve replacement for chronic severe aortic regurgitation

• Published in: The Journal of surgical research 2015-06, Vol.196 (1), p.49-55
• Main Authors: Zhang, Zhiwei, PhD, Yang, Junjie, PhD, Yu, Yunsheng, PhD, Huang, Haoyue, PhD, Ye, Wenxue, PhD, Yan, Weiya, MD, Shen, Han, MD, Ii, Masaaki, PhD, Shen, Zhenya, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aortic regurgitation; Aortic Valve - surgery; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Aortic valve replacement; Chronic Disease; Diastole - physiology; Ejection fraction; Female; Heart Valve Prosthesis Implantation; Humans; Left ventricular end-diastolic dimension; Male; Middle Aged; Recovery; Stroke Volume; Surgery; Ventricular Function, Left
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2015.02.069

Abstract Background In patients with chronic severe aortic regurgitation (AR), aortic valve replacement (AVR) has been proved to promote left ventricular (LV) remodeling, especially LV end-diastolic dimension (LVEDD) reduction. However, there is little research whether postoperative LVEDD could return to normal parameter after AVR. The objective of this study was to determine predictors for the recovery of dilated LVEDD early after AVR. Methods The echocardiographic data of 105 patients, who underwent AVR for chronic pure AR between January 2005 and December 2011, were analyzed at the preoperative (3–7 d), early (6–8 mo), and late (2-y) postoperative stages, retrospectively. According to the baseline level, LVEDD >70 mm or LV end-systolic dimension (LVESD) >50 mm or LVESD index >25 mm/m2 were defined as severe LV dilation. Patients were then categorized into two groups (group 1: severe LV dilation; group 2: nonsevere LV dilation). Results In all patients, four-fifth of the reduction in LV dimension occurred at early (6–8 mo) postoperative stage. The patients in both groups had significant decreases in the LVEDD and LVESD early after AVR, with an additional but insignificant reduction at late postoperative stage. The ejection fraction (EF) in both groups significantly increased at either early or late stage. However, the LVEDD and LVESD in group 1 were larger than those in group 2, and the EF in group 1 was lower than that in group 2 at early postoperative stage. By multivariate analysis, we found that the preoperative EF was a good predictor for the recovery of dilated LVEDD early after AVR ( P  = 0.009). Receiver-operating characteristics analysis showed that EF >52% was the best cut-off value for the recovery of LVEDD. Conclusions In patients with chronic pure AR, preoperative EF may be a good predictor for successful recovery of dilated LVEDD early after AVR.