Skip to main content

Advertisement

SpringerLink
Log in

The impact of age on the postoperative response of the diastolic function and left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

We examined the impact of advanced age on left ventricular mass regression and the change in the diastolic function after aortic valve replacement in patients with aortic stenosis.

Methods

The present study included 129 patients who underwent either surgical or transcatheter aortic valve replacement and 1-year postoperative echocardiography. The patient characteristics and echocardiographic findings were compared between patients who were <80 years of age (group Y: n = 69) and those who were ≥80 years of age (group O: n = 60).

Results

Preoperative echocardiography revealed that although the left ventricular mass was similar between the groups, the patients in group O had more severe diastolic dysfunction in comparison to those in group Y. Postoperatively, left ventricular mass regression was significantly greater (p = 0.02) and diastolic dysfunction was less prevalent in group Y (p = 0.02) in comparison to group O. The change in E/e′ was significantly correlated with the left ventricular mass regression in group Y (p = 0.02), but not in Group O (p = 0.21).

Conclusions

The patients in group O were less susceptible to improvements in myocardial remodeling and the diastolic function in comparison to those in group Y. The altered physiological response to aortic valve replacement might help to determine the appropriate timing of surgery in elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686–95.

    Article  CAS  PubMed  Google Scholar 

  2. Tsukui H, Yamazaki K. Contemporary strategy for aortic valve stenosis in octogenarians. Surg Today. 2014;44:992–1003.

    Article  PubMed  Google Scholar 

  3. Sawa Y. Transcatheter aortic valve implantation. Surg Today. 2015;45:527–36.

    Article  PubMed  Google Scholar 

  4. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.

    Article  PubMed  Google Scholar 

  5. Baumgartner H. Aortic stenosis: medical and surgical management. Heart. 2005;91:1483–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Marumoto A, Nakamura Y, Kishimoto Y, Saiki M, Nishimura M. Optimal timing of aortic valve replacement in elderly patients with severe aortic stenosis. Surg Today. 2014;44:84–93.

    Article  PubMed  Google Scholar 

  7. Schulz O, Brala D, Bensch R, Krämer J, Schulz-Menger J, Berghoefer G, et al. Aortic valve replacement in asymptomatic and symptomatic patients with preserved left ventricular ejection fraction. J Heart Valve Dis. 2012;21:576–83.

    PubMed  Google Scholar 

  8. Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, et al. Initial surgical versus conservative strategies in patients with asymptomatic severe aortic stenosis. J Am Coll Cardiol. 2015;66:2827–38.

    Article  PubMed  Google Scholar 

  9. Nakamura T, Toda K, Kuratani T, Miyagawa S, Yoshikawa Y, Fukushima S, et al. Diabetes mellitus impairs left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis. Heart Lung Circ. 2016;25:68–74.

    Article  PubMed  Google Scholar 

  10. Villari B, Vassalli G, Monrad ES, Chiariello M, Turina M, Hess OM. Normalization of diastolic dysfunction in aortic stenosis late after valve replacement. Circulation. 1995;91:2353–8.

    Article  CAS  PubMed  Google Scholar 

  11. Elmariah S. Patterns of left ventricular remodeling in aortic stenosis: therapeutic implications. Curr Treat Options Cardiovasc Med. 2015;17:391.

    Article  PubMed  Google Scholar 

  12. Une D, Mesana L, Chan V, Maklin M, Chan R, Masters RG, et al. Clinical Impact of Changes in Left Ventricular Function After Aortic Valve Replacement: Analysis From 3112 Patients. Circulation. 2015;132:741–7.

    Article  PubMed  Google Scholar 

  13. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.

    Article  CAS  PubMed  Google Scholar 

  14. Maeda K, Kuratani T, Torikai K, Ichibori Y, Nakatani K, Onishi T, et al. Early outcomes in Japanese dialysis patients treated with transcatheter aortic valve implantation. Circ J. 2015;79:2713–9.

    Article  PubMed  Google Scholar 

  15. Nishi H, Toda K, Miyagawa S, Yoshikawa Y, Fukushima S, Kawamura M, Yoshioka D, Saito T, Ueno T, Kuratani T, Sawa Y. Annular dynamics after mitral valve repair with different prosthetic rings: a real-time three-dimensional transesophageal echocardiography study. Surg Today. 2016;46:1083–90.

    Article  PubMed  Google Scholar 

  16. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1–23.

    Article  PubMed  Google Scholar 

  17. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.

    Article  CAS  PubMed  Google Scholar 

  18. Emery WT, Jadavji I, Choy JB, Lawrance RA. Investigating the European Society of Cardiology Diastology Guidelines in a practical scenario. Eur J Echocardiogr. 2008;9:685–91.

    Article  PubMed  Google Scholar 

  19. Gavina C, Falcão-Pires I, Pinho P, Manso MC, Gonçalves A, Rocha-Gonçalves F, et al. Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis. Eur J Cardiothorac Surg. 2016;49:952–9.

    Article  PubMed  Google Scholar 

  20. Seo JS, Jang MK, Lee EY, Yun SC, Kim DH, Song JM, et al. Evaluation of left ventricular diastolic function after valve replacement in aortic stenosis using exercise Doppler echocardiography. Circ J. 2012;76:2792–8.

    Article  PubMed  Google Scholar 

  21. Maruyama Y. Aging and arterial-cardiac interactions in the elderly. Int J Cardiol. 2012;155:14–9.

    Article  PubMed  Google Scholar 

  22. Villari B, Vassalli G, Schneider J, Chiariello M, Hess OM. Age dependency of left ventricular diastolic function in pressure overload hypertrophy. J Am Coll Cardiol. 1997;29:181–6.

    Article  CAS  PubMed  Google Scholar 

  23. Ding WH, Lam YY, Pepper JR, Kaya MG, Li W, Chung R, et al. Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis. Int J Cardiol. 2010;141:24–31.

    Article  PubMed  Google Scholar 

  24. Kato M, Yamamoto K. Clinical characteristics of elderly patients with aortic stenosis. J Echocardiogr. 2015;13:134–40.

    Article  PubMed  Google Scholar 

  25. Owen A, Henein MY. Challenges in the management of severe asymptomatic aortic stenosis. Eur J Cardiothorac Surg. 2011;40:848–50.

    PubMed  Google Scholar 

  26. Kim SJ, Samad Z, Bloomfield GS, Douglas PS. A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement. Am Heart J 2014;168:150-9.e1-7.

  27. Howell NJ, Keogh BE, Ray D, Bonser RS, Graham TR, Mascaro J, et al. Patient-prosthesis mismatch in patients with aortic stenosis undergoing isolated aortic valve replacement does not affect survival. Ann Thorac Surg. 2010;89:60–4.

    Article  PubMed  Google Scholar 

  28. Flameng W, Meuris B, Herijgers P, Herregods M-C. Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valve. Ann Thorac Surg. 2006;82:530–6.

    Article  PubMed  Google Scholar 

  29. Dayan V, Vignolo G, Soca G, Paganini JJ, Brusich D, Pibarot P. Predictors and outcomes of prosthesis-patient mismatch after aortic valve replacement. JACC Cardiov Imag 2016 [Epub ahead of print].

  30. Fairbairn TA, Steadman CD, Mather AN, Motwani M, Blackman DJ, Plein S, et al. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart. 2013;99:1185–91.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Crouch G, Bennetts J, Sinhal A, Tully PJ, Leong DP, Bradbrook C, et al. Early effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: insights from cardiovascular magnetic resonance imaging. J Thorac Cardiovasc Surg. 2015;149:462–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, 565-0871, Japan

    Teruya Nakamura, Koichi Toda, Toru Kuratani, Shigeru Miyagawa, Yasushi Yoshikawa, Satsuki Fukushima, Shunsuke Saito & Yoshiki Sawa

Authors
  1. Teruya Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koichi Toda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toru Kuratani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shigeru Miyagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasushi Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satsuki Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shunsuke Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshiki Sawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshiki Sawa.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest in association with the present study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakamura, T., Toda, K., Kuratani, T. et al. The impact of age on the postoperative response of the diastolic function and left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis. Surg Today 47, 770–776 (2017). https://doi.org/10.1007/s00595-016-1458-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-016-1458-6

Keywords

Search

Navigation