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Prognostic Markers and Long-Term Outcomes After Aortic Valve Replacement in Patients With Chronic Aortic Regurgitation

Authors
 Min-Seok Kim  ;  Jung Hwan Kim  ;  Hyun-Chel Joo  ;  Sak Lee  ;  Young-Nam Youn  ;  Seung Hyun Lee 
Citation
 JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol.9(24) : e018292, 2020-12 
Journal Title
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Issue Date
2020-12
MeSH
Aftercare ; Aged ; Aortic Valve Insufficiency / surgery* ; Blood Flow Velocity / physiology ; Case-Control Studies ; Echocardiography / methods* ; Echocardiography, Doppler, Pulsed / methods ; Female ; Heart Valve Prosthesis Implantation / adverse effects* ; Heart Valve Prosthesis Implantation / methods ; Heart Valve Prosthesis Implantation / mortality* ; Humans ; Male ; Middle Aged ; Mitral Valve / diagnostic imaging ; Postoperative Period ; Preoperative Period ; Prognosis ; Retrospective Studies ; Risk Factors ; Stroke Volume / physiology ; Survival Rate / trends ; Systole / physiology ; Ventricular Dysfunction, Left / diagnostic imaging ; Ventricular Dysfunction, Left / physiopathology ; Ventricular Function, Left / physiol
Keywords
aortic valve replacement ; left ventricular dysfunction ; long‐term follow‐up
Abstract
Background The objectives of the present study were (1) to evaluate the echocardiographic prognostic factors associated with improved left ventricular (LV) systolic function after aortic valve replacement, and (2) to compare the long-term outcomes after aortic valve replacement in chronic aortic regurgitation (AR) patients with or without LV dysfunction. Methods and Results A total of 280 patients who underwent aortic valve replacement because of chronic aortic regurgitation were studied. Patients with reduced LV systolic function (LV ejection fraction [LVEF] <50%; group reduced LVEF [rEF]; N=80) were compared with those with preserved LV systolic function (LVEF ≥50%; group preserved LVEF; N=200). Postoperative clinical outcomes, overall survival, and freedom from cardiac death were compared. Postoperative echocardiographic examinations were reviewed, and changes in echocardiographic parameters were analyzed. The parameters related to LVEF improvement or normalization were evaluated, and risk factors affecting long-term survival were identified. Follow-up was complete in 100% of patients, with a median follow-up of 104.8 months. Overall and cardiac mortality-free survival rates at postoperative 10 years were 80.1% and 92.9% and 87.3% and 97.2% in groups rEF and preserved LVEF, respectively (P=0.036 and P=0.058, respectively). LVEF tended to decrease in the early postoperative period but improved thereafter in both groups. Preoperative early diastolic transmitral flow velocity/mitral annular tissue velocity ratio was a parameter of postoperative improvement or normalization of LVEF in all patients (area under the curve, 0.719; P=0.003) and in group rEF patients (area under the curve, 0.726; P=0.011) with a cutoff value of 12.73. Preoperative early diastolic transmitral flow velocity/mitral annular tissue velocity ratio also was the parameter of overall survival in all patients (hazard ratio [HR], 1.08; P=0.001) and in group rEF patients (HR, 1.08; P=0.005). Conclusions Long-term outcomes and survival after aortic valve replacement were related to preoperative LV function in patients with chronic aortic regurgitation. Preoperative early diastolic transmitral flow velocity/mitral annular tissue velocity ratio was correlated with the postoperative improvement or normalization of LVEF and long-term survival, especially in group rEF patients.
Files in This Item:
T202006189.pdf Download
DOI
10.1161/JAHA.120.018292
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min-Seok(김민석)
Kim, Jung Hwan(김정환)
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182549
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