Effect of persistence of left ventricular hypertrophy and left atrial dilatation after aortic valve replacement on early outcomes and survival: a prospective study

Authors

  • Hari Krishna Murthy P. Department of Cardiothoracic Surgery, S.V.R.R.G.G. Hosacpital, Tirupati, Andhra Pradesh, India
  • Abha Chandra Department of Cardiothoracic Surgery, S.V.R.R.G.G. Hosacpital, Tirupati, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20194442

Keywords:

Aortic stenosis, Aortic valve replacement, Aortic regurgitation

Abstract

Background: The objective of the study was to evaluate the early outcomes and survival in patients with severe aortic stenosis associated with concentric left ventricular hypertrophy following aortic valve replacement.

Methods: This is a prospective study done at SVIMS, Tirupati, from June 2014 to September 2015 evaluating out comes and survival in patients undergoing primary isolated aortic valve replacement (AVR) for severe aortic stenosis, severe aortic stenosis with mild aortic regurgitation and severe aortic stenosis with moderate aortic regurgitation.

Results: A total of 40 cases 26 males and 14 females aged 18 to 60 years (mean age, 48.5±13.4 years) underwent elective AVR. Left ventricular end diastolic diameter (p=0.008) at 6 months, a statistically highly significant difference in left ventricular mass  preoperatively, at discharge, at 3rd and 6th month follow up. The difference in mean left ventricular mass index (LVMI) had declined from 244.425 to 141.100 at 6 months, showing a statistically highly significant difference in LVMI preop, at discharge, at 3rd month and at 6th month follow up.

Conclusions: Patients with preoperative increase in LVMI, with large left atrial diameter carries a strong predictor of postoperative mortality for patients undergoing aortic valve surgery. We also conclude that there will be significant regression of LVMI following successful AVR. But, the decrease in LVMI is maximum during early three months and it is minimal though significant in the later course of follow up. 

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References

Villa E, Troise G, Cirillo M, Brunelli F, Margherita Tomba D, Mhagna Z, et al. Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. Cardiovascular Ultrasound. 2006;4:25.

Astor BC, Kaczmarek RG, Hefflin B, Daley WR. Mortality after aortic valve replacement: results from a nationally representative database. Ann Thoracic Surg. 2000;70:1939-45.

Petrov G, Regitz-Zagrosek V. Regression of Myocardial Hypertrophy after Aortic Valve Replacement Faster in Women, Circulation. 2010;122:S23-S28.

Douglas PS, Otto CM, Mickel MC, Labovitz A, Reid CL, Davis KB. Gender differences in left ventricle geometry and function in patients undergoing balloon dilatation of the aortic valve for isolated aortic stenosis: NHLBI Balloon Valvuloplasty Registry. Br Heart J. 1995;73(6):548-54.

Pereira JJ, Lauer MS, Bashir M, Afridi I, Blackstone EH, Stewart WJ, et al. Survival after aortic valve replacement for severe aortic stenosis with low transvalvelar gradients and severe left ventricular dysfunction. J Am Coll Cardiolol. 2002;39:1356-63.

Kurtz CE, Otto CM. Aortic stenosis: clinical aspects of diagnosis and management, with 10 illustrative case reports from a 25-year experience. Am J Med Sci. 2010;89(5):349-79.

Beach JM, Mihaljevic T. Ventricular hypertrophy and left atrial dilatation persistant are associated with reduced survival after valve replacement for aortic stenosis J Thoracic Cardiovascular Surg. 2014;147:362-9.

Carabello BA, Paulus WJ. Aortic stenosis. Lancet. 2009;373:956-66.

Kannel W, Cobb J. Left ventricular hypertrophy and mortality: Results from the Framingham Study. Cardiology. 1992; vol.81, pg:291-298.

Benjamin E, Levy D. Why is left ventricular hypertrophy so predictive of morbidity and mortality? Am J Med Sci. 1999;317:168-75.

Mehta RH, Bruckman D, Das S. Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgery. J Thorac Cardiovascular Surg 2001;122:919-28.

Amar A. Youssef, Implications of left ventricular mass index on early postoperative outcome in patients undergoing aortic valve replacement. J Am College Cardiolol. 2013;1:131-4.

Fuster RG, Montero JA, Gil O. Left ventricular mass index in aortic valve surgery: a new index for early valve replacement. Eur J Cardiothoracic Surg. 2003;23:696-702.

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Published

2019-09-26

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Original Research Articles