Clinical and Echocardiographic Results of Aortic Valve Replacement in the Failing Ventricle: Do Aortic Stenosis and Aortic Regurgitation Differ?

BACKGROUND We hypothesized that long-term clinical and echocardiographic recovery of the impaired ventricle from pressure (aortic stenosis [AS]) and volume (aortic regurgitation [AR]) overload would be different after aortic valve replacement (AVR).METHODS We compared the results of AVR in patients with a preoperative ejection fraction (EF) of 0.35 or less due to AS, AR, or mixed disease. We constructed a mixed-effects model of EF and left ventricular (LV) end-diastolic diameter (LVEDD) to understand ventricular recovery over the short-(in-hospital), intermediate-(3-6 months), and longer-(>24 months) terms. We sought to identify factors associated with clinical and echocardiographic recovery using multivari-able analysis.RESULTS Between July 2011 and 2017, 136 patients with a preoperative EF of 0.35 or less and severe AS (n = 83), severe AR (n = 18), or mixed AS and AR (n = 35) underwent AVR. There were 2 (1.5%) early deaths in the AS group. Survival at 1, 2, and 5 years did not differ between groups. Baseline EF did not differ between the groups but improved with markedly different trajectory and time course in the AS, AR, and mixed groups over time. LVEDD regressed in all patient cohorts, following a different pattern for AS and AR. Baseline EF and LVEDD predicted the long-term fate of the LV but did not determine survival. We identify factors associated with long-term survival.CONCLUSIONS The pattern of LV recovery appears to be early in AS and delayed in AR. Baseline clinical factors, rather than echocardiographic status of the LV, appear to determine late survival. (Ann Thorac Surg 2022;113:853-8)(c) 2022 by The Society of Thoracic Surgeons

Automated summary

This study compares the clinical and echocardiographic recovery after aortic valve replacement in patients with aortic stenosis, aortic regurgitation, or mixed disease. The pattern of left ventricular recovery appears to be early in aortic stenosis and delayed in aortic regurgitation. Baseline clinical factors, rather than echocardiographic status, seem to determine long-term survival.