The effect of left ventricular characters to short-term (in-hospital) and mid-term clinical outcome after aortic valve replacement due to chronic aortic regurgitation

Author : A. R. Lubis, A. M. Soesanto, D. Firman, A. Bono
Upload Date : 19-04-2018

Background: The optimal timing of aortic valve replacement is still challenging. The patients often come to hospital in end-stage clinical performance with alteration in left ventricular (LV) geometry due to compensatory mechanism to volume and pressure overload in long-term period.  This study sought to determine the effect of left ventricular characters (diameter of the left ventricle, end diastolic diameter (EDD), end systolic diameter (ESD), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI)) to in-hospital morbidity and mortality following aortic valve replacement (AVR) in patients with chronic aortic regurgitation and postoperative mid-term outcome.

Methods: 168 patients with chronic aortic regurgitation underwent AVR selected according to inclusion and exclusion criteria. Outcomes (morbidity and mortality) were observed during hospitalization and 1- year until 5-years after surgery. Mid-term outcomes consisted of NYHA functional class, re-hospitalization and redo operation.

Results:There was no significant difference to in-hospital morbidity and mortality for each of LV characters (p>0.05). Other factors which influenced in-hospital morbidity were glomerular filtration rate (GFR) (p<0.001), age (p=0.001), history of coronary artery diseases and COPD (p=0.033), history of cerebrovascular disease (p=0.027). There was an immediate reverse remodelling from echocardiography predischarge. Mid-term morbidity was influenced by postoperative arrhythmia event (p=0.009), an improvement in NYHA functional class was founded after one year post surgery. In-hospital mortality was influenced by age (p=0.001) and GFR (p<0.001). There were no other factors which influenced 1-year until 5-years mortality following aortic valve replacement.Other findings, 2 patients with significant LV dilatation                (EDD >100 mm) and 7 patients with LVEF <20 % have good clinical outcome after surgery.                               

Conclusion:Left ventricular characters including left ventricular diameter (EDD, ESD), LVEF, LVMI did not influence in-hospital morbidity and mortality following aortic valve replacement and 1-year until 5-years postoperative outcome in patients with chronic aortic regurgitation.

KEYWORDS : morbidity,mortality, regurgitation, left ventricle, surgery,clinical outcome

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