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Long-term outcomes after aortic valve surgery in patients with aortic regurgitation with preserved ejection fraction and left ventricular dilation

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Abstract

Objectives

This study aims to assess the long-term outcomes and prognostic predictors of asymptomatic patients with severe aortic regurgitation (AR) accompanied by left ventricular ejection fraction (LVEF) ≥ 55% and left ventricular end-diastolic diameter (LVEDD) > 65 mm undergoing aortic valve replacement (AVR).

Methods

We retrospectively studied 291 consecutive asymptomatic patients with severe AR accompanied by LVEF ≥ 55% and LVEDD > 65 mm undergoing AVR from January 2000 to December 2013. The long-term outcomes and prognostic predictors were evaluated.

Results

There were 2 (0.7%) in-hospital deaths caused by multiple organ failure. The overall survival rate was 95.2% at 5 years, 89.9% at 10 years, 85.9% at 15 years, and 85.9% at 20 years. The left ventricular end-systolic volume index (LVESVi) was an independent predictor of overall mortality, with 59 ml/m2 being the best cut-off value. The left ventricular (LV) dimension decreased within 1 year after surgery and sustained thereafter. There were 15.5% of patients had incomplete LV reverse remodeling. LVESVi was an independent predictor of incomplete LV reverse remodeling, with 56 ml/m2 being the best cut-off value.

Conclusions

AVR can be performed with an acceptable outcome in patients with severe AR accompanied by LVEF ≥ 55% and LVEDD > 65 mm. The LVESVi has the best predictive value for prognosis and the cut-off value is 59 ml/m2, and has the best predictive value for incomplete LV reverse remodeling and the cut-off value is 56 ml/m2.

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Acknowledgements

This study was supported by the National Natural Scientific Foundation of China (No.81770383).

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Author notes

  1. Xingli Fan and Xiangyang Xu contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People’s Republic of China

    Xingli Fan & Yongbing Chen

  2. Department of Cardiovascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, 200433, People’s Republic of China

    Xingli Fan, Xiangyang Xu, Boyao Zhang, Jie Lu, Ye Ma, Yangfeng Tang & Lin Han

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  1. Xingli Fan
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Fan, X., Xu, X., Zhang, B. et al. Long-term outcomes after aortic valve surgery in patients with aortic regurgitation with preserved ejection fraction and left ventricular dilation. Gen Thorac Cardiovasc Surg 71, 51–58 (2023). https://doi.org/10.1007/s11748-022-01849-9

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