Abstract 3964: Regression in Left Ventricular Mass After Aortic Valve Replacement for Chronic Aortic Regurgitation is Unrelated to Prosthetic Valve Size
Objective: Our objectives were to examine the predictors of left ventricular (LV) mass regression following aortic valve replacement (AVR) for chronic aortic valve regurgitation (AR) and to determine the influence of valve size on extent of LV reverse remodeling.
Methods: We selected patients who had AVR for ≥moderate AR who had complete preoperative and follow-up echocardiograms with measurement of LV mass. Patients were excluded who had ≥moderate aortic valve stenosis, concomitant coronary artery bypass grafting, or mitral valve procedures. The 90 study patients were stratified by presence or absence of prosthesis-patient mismatch (PPM) defined as <0.85cm2/m2 and into terciles of preoperative LV mass index (LVMi).
Results: Patients’ mean age was 55±17 years and 21% were female. The mean preoperative LVMi was 150±45g/m2. Thirteen patients had PPM (14%) and were similar to patients who did not have PPM except for a greater body surface area, more mechanical valves, and smaller valve sizes in those with PPM (P<0.05). Patients with mildly (n=44, mean LVMi 126±15g/m2), moderately (n=31, mean LVMi 168±11g/m2), or severely (n=15, mean LVMI 241±34g/m2) increased preoperative LVMi, were similar except for lower ejection fractions and larger end-diastolic dimensions and ventricular wall thicknesses in the severely enlarged group (P<0.001). At a mean follow-up of 3.2±2.4 years, the average reduction in LVMi was 50±38g/m2; late mass regression was unrelated to labeled valve size, PPM, or measured indexed effective aortic valve area. A greater preoperative LVMi (P<0.001) was an independent predictor of greater LV mass regression. However, despite the greatest LV mass regression, patients with severe preoperative LVMi did not return to normal LVMi measurements (mean 142±25g/m2).
Conclusions: LV mass regression after AVR for chronic AR is unrelated to indexed prosthetic valve area. Although often incomplete, regression is greatest in patients with the largest preoperative LVMi. Early operation should be considered in order to maximize LV remodeling and normalize LV mass.