662 Effect of Left ventricular size and function on outcome following aortic valve repair for aortic insufficiency

Abstract

BackgroundLeft 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.MethodsSince 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. The primary endpoint was prospectively defined as a composite of death, AV reoperation, or recurrent AI (> = 2+).ResultsOverall survival was 88 ± 3% at 8 years. During follow-up, 30 patients (10%) developed severe recurrent AI (>2+) and 22 (7.3%) underwent AV reoperation. Patients with preoperative LV dysfunction, and LV dilatation (Fig 1A) had increased risk of the composite endpoint. Multivariable analysis demonstrated that preoperative LVEDD (Hazard Ratio: 1.07 [1.04 - 1.11], P< 0.001) and LVESD (HR - 1.06 [1.03 - 1.10], p65 (Fig 1B) and LVESD>45.ConclusionLV dilatation is an important risk factor following AV repair. Valve repair prior to LV dilatation (LVEDD < 65 mm) is associated with improved long-term outcome. This finding may have implications for the timing of surgery in patients with AI amenable for valve repair. BackgroundLeft 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. 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. MethodsSince 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. The primary endpoint was prospectively defined as a composite of death, AV reoperation, or recurrent AI (> = 2+). 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. The primary endpoint was prospectively defined as a composite of death, AV reoperation, or recurrent AI (> = 2+). ResultsOverall survival was 88 ± 3% at 8 years. During follow-up, 30 patients (10%) developed severe recurrent AI (>2+) and 22 (7.3%) underwent AV reoperation. Patients with preoperative LV dysfunction, and LV dilatation (Fig 1A) had increased risk of the composite endpoint. Multivariable analysis demonstrated that preoperative LVEDD (Hazard Ratio: 1.07 [1.04 - 1.11], P< 0.001) and LVESD (HR - 1.06 [1.03 - 1.10], p65 (Fig 1B) and LVESD>45. Overall survival was 88 ± 3% at 8 years. During follow-up, 30 patients (10%) developed severe recurrent AI (>2+) and 22 (7.3%) underwent AV reoperation. Patients with preoperative LV dysfunction, and LV dilatation (Fig 1A) had increased risk of the composite endpoint. Multivariable analysis demonstrated that preoperative LVEDD (Hazard Ratio: 1.07 [1.04 - 1.11], P< 0.001) and LVESD (HR - 1.06 [1.03 - 1.10], p65 (Fig 1B) and LVESD>45. ConclusionLV dilatation is an important risk factor following AV repair. Valve repair prior to LV dilatation (LVEDD < 65 mm) is associated with improved long-term outcome. This finding may have implications for the timing of surgery in patients with AI amenable for valve repair. LV dilatation is an important risk factor following AV repair. Valve repair prior to LV dilatation (LVEDD < 65 mm) is associated with improved long-term outcome. This finding may have implications for the timing of surgery in patients with AI amenable for valve repair.