Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation: Implications for Timing of Surgical Intervention

Abstract

The timing of valve repair or replacement in patients with severe aortic valve regurgitation (AR) is controversial. We investigated the effect of left ventricular (LV) function on survival and recovery of LV performance and dimensions after correction of chronic severeAR. We reviewed 530 consecutive patients who underwent aortic valve repair or replacement for severe AR between January 1, 2004, and June 30,2014. The 30-day mortality was 0.75%. In multivariate analysis, older age (hazard ratio [HR]= 1.02, p= 0.03), preoperative LV ejection fraction (EF) <60% (HR= 1.78, p= 0.04), previous myocardial infarction (HR= 2.53, p= 0.01), and previous cardiac operation (HR= 1.82, p= 0.03) were associated with all-cause mortality. Ejection fraction was reduced before hospital discharge but then improved and was greater than preoperative levels at all subsequent intervals. The LV dimensions decreased early postoperatively and continued to decrease thereafter. In multivariate analysis, factors associated with LV dysfunction (EF <60%) 1 year after aortic valve replacement were preoperative LV end-systolic dimension ≥40 mm (odds ratio [OR]= 5.39, p < 0.01) and previous myocardial infarction (OR= 3.62, p= 0.04). Preoperative LV dysfunction (EF <60%) had an adverse effect on overall survival after correction of chronic severe AR. Because survival is improved in patients with greater preoperative LVEF and because reverse LV remodeling is more complete with smaller LV dimensions, surgical intervention should be considered promptly in patients with chronic severe AR and deterioration of these indicators during echocardiographic surveillance.