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

Takashi Murashita, Hartzell V Schaff, Rakesh M. Suri, Richard C. Daly, Zhuo Li, Joseph A. Dearani, Kevin L. Greason, Rick A. Nishimura

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: 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 severe AR. Methods: We reviewed 530 consecutive patients who underwent aortic valve repair or replacement for severe AR between January 1, 2004, and June 30, 2014. Results: 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). Conclusions: 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.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2016

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Aortic Valve Insufficiency
Left Ventricular Function
Stroke Volume
Left Ventricular Dysfunction
Aortic Valve
Survival
Multivariate Analysis
Odds Ratio
Myocardial Infarction
Ventricular Remodeling
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation : Implications for Timing of Surgical Intervention. / Murashita, Takashi; Schaff, Hartzell V; Suri, Rakesh M.; Daly, Richard C.; Li, Zhuo; Dearani, Joseph A.; Greason, Kevin L.; Nishimura, Rick A.

In: Annals of Thoracic Surgery, 2016.

Research output: Contribution to journalArticle

Murashita, Takashi ; Schaff, Hartzell V ; Suri, Rakesh M. ; Daly, Richard C. ; Li, Zhuo ; Dearani, Joseph A. ; Greason, Kevin L. ; Nishimura, Rick A. / Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation : Implications for Timing of Surgical Intervention. In: Annals of Thoracic Surgery. 2016.
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title = "Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation: Implications for Timing of Surgical Intervention",
abstract = "Background: 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 severe AR. Methods: We reviewed 530 consecutive patients who underwent aortic valve repair or replacement for severe AR between January 1, 2004, and June 30, 2014. Results: 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). Conclusions: 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.",
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T1 - Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation

T2 - Implications for Timing of Surgical Intervention

AU - Murashita, Takashi

AU - Schaff, Hartzell V

AU - Suri, Rakesh M.

AU - Daly, Richard C.

AU - Li, Zhuo

AU - Dearani, Joseph A.

AU - Greason, Kevin L.

AU - Nishimura, Rick A.

PY - 2016

Y1 - 2016

N2 - Background: 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 severe AR. Methods: We reviewed 530 consecutive patients who underwent aortic valve repair or replacement for severe AR between January 1, 2004, and June 30, 2014. Results: 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). Conclusions: 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.

AB - Background: 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 severe AR. Methods: We reviewed 530 consecutive patients who underwent aortic valve repair or replacement for severe AR between January 1, 2004, and June 30, 2014. Results: 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). Conclusions: 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.

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