Abstract 12752: Left Ventricular Dysfunction After Aortic Valve Replacement in Mixed Aortic Valve Disease: Are We Operating Too Late?

Abstract

Introduction: The fate of the left ventricle (LV) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) is unknown. Hypothesis/objectives: To determine prevalence and predictors of early and late left ventricular dysfunction (LVD) defined as EF <50% at 1 and 5 years post-AVR. Methods: Patients with moderate-severe MAVD, ejection fraction ≥50%, no documented coronary artery disease, and a minimum of 2-year follow-up after AVR were identified. Moderate-severe MAVD was defined as a combination of ≥moderate aortic stenosis and ≥moderate aortic regurgitation. EF was assessed at 1 and 5 years post-AVR. Results: Patients with MAVD (n=179); age 63±8 years, males 134 (75%); underwent AVR at Mayo Clinic from 1994-2010. Early LVD occurred in 38(21%). Predictors of early LVD were LV mass index/LV end-diastolic dimension (LVMI/LVEDD) >3.1 (hazard ratio [HR] 1.83, confidence interval [CI] 1.59-1.98); relative wall thickness (RWT) >0.46 (HR 2.16, CI 1.21-4.99); and older age per decade (HR 1.62, CI 1.23-3.02). Assessment of LV function was performed in 124 patients at 5 years post-AVR, and late LVD was present in 29 (23%). Predictors of late LVD were LVMI/LVEDD >3.1 (HR 1.77, CI 1.24-2.01) and RWT >0.46 (HR 1.65, CI 1.29-2.24). All-cause mortality occurred in 21 (12%), and was more common in patients with higher preoperative LV mass, P<0.05. Patients with postoperative LVD showed less regression of LV mass after AVR even after controlling for blood pressure, P<0.001. Conclusions: LVD can occur after AVR even in the setting of normal preoperative LV function and absence of coronary artery disease. Preoperative LV mass was predictive of LVD, and should be taken into consideration when determining the timing of AVR. LEGENDS Comparison of the occurrence of LVD and all-cause mortality by preoperative left ventricular mass.% of patients with early LVD (blue), late LVD (red) and death (green) between the patients with LVMI/LVEDD ratio ≤3.1 vs >3.1 (A), and ≤0.46 vs >0.46 (B)