Pre- and Postoperative Predictors of Long-Term Prognosis After Aortic Valve Replacement for Severe Chronic Aortic Regurgitation

• Published in: Circulation Journal 2016/11/25, Vol.80(12), pp.2460-2467
• Main Authors: Amano, Masashi, Izumi, Chisato, Imamura, Sari, Onishi, Naoaki, Sakamoto, Jiro, Tamaki, Yodo, Enomoto, Soichiro, Miyake, Makoto, Tamura, Toshihiro, Kondo, Hirokazu, Kaitani, Kazuaki, Yamanaka, Kazuo, Nakagawa, Yoshihisa
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aortic regurgitation; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Aortic valve replacement; Chronic Disease; Disease-Free Survival; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Left ventricular dysfunction; Long-term follow-up; Male; Middle Aged; Postoperative Period; Preoperative Period; Prognostic predictors; Stroke Volume; Ventricular Function, Left
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-16-0782

Background:There are few data on the long-term prognosis and chronological changes in left ventricular (LV) function after aortic valve replacement (AVR) in patients with severe chronic aortic regurgitation (AR) among the Japanese population.Methods and Results:We retrospectively investigated the long-term prognosis in 80 consecutive patients with severe chronic AR who underwent AVR. Additionally, 65 patients with follow-up echocardiography at 1 year after AVR were investigated to evaluate chronological changes in LV function. The mean follow-up period was 8.9±5.2 years. Freedom from all-cause death and cardiac death at 10 years after AVR was 76% and 91%, respectively. The preoperative ejection fraction (EF) and estimated glomerular filtration rate were independent predictors of all-cause death. Preoperative EF, LV end-systolic diameter, and diabetes might be useful predictors of cardiac death. Among the 65 patients with follow-up echocardiographic data, LV function had normalized at 1 year after AVR in all patients, except for 2 who died of cardiac causes in the long-term after AVR. LV end-diastolic diameter, LV end-systolic diameter, and EF at 1 year after AVR might be useful predictors of long-term cardiac death.Conclusions:In patients with severe chronic AR, preoperative LV dysfunction is remarkably improved at 1 year after AVR. Pre- and postoperative echocardiographic data are important for predicting long-term outcome after AVR. (Circ J 2016; 80: 2460–2467)