Abstract 2978: Impact of Left Ventricular Size and Function on Outcome Following Aortic Valve Repair
Objectives: Left ventricular (LV) dilation and reduced LV function are known predictors of poor long-term outcome following aortic valve (AV) replacement for aortic insufficiency (AI). We examined their impact on long-term outcome following AV repair.
Methods: Since 1995, 300 patients with significant AI (>=2+) with or without ascending aortic pathology underwent AV repair. Mean LV end diastolic (LVEDD) and end-systolic (LVESD) diameters were 60±9 mm and 41±10 mm respectively and 13% had reduced LV function. Valve repair included aortic root replacement in 42% patients and cusp repair in 68%. Cox Models were used to analyze failure-time data.
Results: Overall survival was 88±3% at 8 years. During follow-up, 30 patients (10%) developed severe recurrent AI (>=3+) and 22 (7.3%) underwent AV reoperation. An additional 54 patients (18%) developed moderate (2+) AI. Preoperative LVEDD (Hazard Ratio - 1.37 per 10mm increase, p<0.001) and LVESD (HR - 1.39 per 10mm increase, p<0.001) were strong independent predictors of the composite endpoint of death, AV reoperation, or recurrent AI (>=2+). Other significant predictors included reduced LV function (HR - 1.6, p=0.05), restrictive cusp disease (HR - 1.99, p=0.01), and a tri-leaflet aortic valve (HR - 1.67, p=0.05). Stratified analysis demonstrated a threshold effect with a significantly higher hazard ratio of events with LVEDD>65 (Fig 1B⇓) and LVESD>45.
Conclusions: LV dilatation is an important risk factor following AV repair. Early surgery, prior to LV dilatation (LVEDD <65 mm) is associated with improved long-term outcome. This finding has important implications for the timing of surgery in patients with AI amenable for valve repair.