Abstract 20028: Preoperative Stroke Volume Accurately Predicts Outcome After Aortic Valve Replacement In Patients With Severe Aortic Regurgitation
ABSTRACT Background In most patients with aortic regurgitation (AR), valve replacement results in favorable left ventricular (LV) remodeling and normalization of LV ejection fraction (LVEF) at distance from surgery. However some patients with severe AR will not remodel favorably and will not normalize their LVEF in that setting. The goal of the present study was to determine whether early remodeling the week after surgery and clinical outcomes (mortality, heart failure hospitalization) could be predicted from preoperative echocardiography analysis.
Methods/Results: Fifty-six consecutive patients with severe chronic AR in absence of coronary disease who underwent aortic valve replacement had their preoperative, early postoperative (mean 5 days) and late postoperative (mean 234 days) echocardiography retrospectively analyzed. LV diameter, LVEF and stroke volume (SV) were measured. Forty-five (80%) patients had positive early LV remodeling defined as a 10% reduction in LV end diastolic diameter (LVEDD) one week after surgery. Preoperative SV (124±31cc vs. 69±14cc, p<0.001), LVEF (47±10% vs. 29±4%, p<0.001) and LVEDD (64±6mm vs. 73±6mm, p>0.001) were all significantly different between patients who respectively did or did not present early LV remodeling. Preoperative SV (r=0.44, p<0.001), LVEF (r=0.34, p=0.01) and LVEDD (r=0.26, p=0.06) correlated with early LV remodeling. All patients with early LV remodeling had a preoperative SV ≥ 97cc, which was the best predictor of late postoperative LVEF ≥45% (sensitivity 90%, specificity 100%). Furthermore, at 6 months, in the absence of early LV remodeling, LVEF was significantly lower than prior to surgery (31% vs. 26%, p=0.03). Patients with preoperative SV ≥97cc had markedly higher 3-years event-free survival (92% vs. 13%, p<0.001).
Conclusions: In patients undergoing aortic valve replacement for severe AR, early remodeling and 3-years event-free survival can be accurately predicted by preoperative SV. All patients with a SV ≥ 97 cc had early LV remodeling and most of them had near normal LVEF at 6 months. In contrast no significant LV remodeling was observed in patients with preoperative SV <97cc, a condition associated with a markedly lower 3-year event-free survival.
- © 2010 by American Heart Association, Inc.