Preoperative factors for early recovery of left ventricular function after aortic valve replacement for chronic aortic regurgitation

Abstract

Aortic valve replacement improves left ventricular(LV) systolic function in patients with chronic aortic regurgitation. Our objective was to determine predictors for normalization of impaired LV systolic function after valve replacement for chronic aortic regurgitation.Between 1997 and 2007, 171 patients underwent aortic valve replacement for severe chronic aortic regurgitation. Of these patients, we examined 79 patients with LV systolic dysfunction or severe LV dilatation preoperatively, who were evaluated by echocardiography at predischarge and early follow-up (mean, 6 months). Mean preoperative ejection fraction was 49%. Mean LV end-systolic and end-diastolic dimensions were 52.3±8.4 mm and 69.6±7.8 mm, respectively. In the early follow-up, 62 of 79 patients exhibited restored normal LV function. LV end-systolic dimension and LV end-diastolic dimension were significantly decreased early after aortic valve replacement (52.3±8.4mm vs. 37.8±6.9mm, and 69.6±7.8mm vs. 51.6±6.4mm, respectively). Operative mortality was 3.7%. Multivariate stepwise regression analysis revealed that preoperative indexed LV end-systolic dimension was independent predictors of restored LV systolic function. The sensitivity and specificity in predicting normalization of LV function were 88% and 92% for indexed LVESD <35.3mm/㎡ and 71% and 86% for indexed LVEDD <44.4mm/㎡.In patients who received a valve replacement for chronic aortic regurgitation, smaller indexed LV systolic dimension was associated with early restoration of LV systolic function