Acquired cardiovascular disease
Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis

https://doi.org/10.1016/j.jtcvs.2012.12.016Get rights and content
Under an Elsevier user license
open archive

Objectives

We sought to understand the factors modulating left heart reverse remodeling after aortic valve replacement, the relationship between the preoperative symptoms and modulators of left heart remodeling, and their influence on long-term survival.

Methods

From October 1991 to January 2008, 4264 patients underwent primary aortic valve replacement for aortic stenosis. Changes in the time course of left ventricular reverse remodeling were assessed using 5740 postoperative transthoracic echocardiograms from 3841 patients.

Results

Left ventricular hypertrophy rapidly declined after surgery, from 137 ± 42 g/m2 preoperatively to 115 ± 27 by 2 years and remained relatively constant but greater than the upper limit of normal. The most important risk factor for residual left ventricular hypertrophy was greater preoperative left ventricular hypertrophy (P < .0001). Other factors included a greater left atrial diameter (reflecting diastolic dysfunction), a lower ejection fraction, and male gender. An increased postoperative transprosthesis gradient was associated with greater residual left ventricular hypertrophy; however, its effect was minimal. Preoperative severe left ventricular hypertrophy and left atrial dilatation reduced long-term survival, independent of symptom status.

Conclusions

Severe left ventricular hypertrophy with left atrial dilatation can develop from severe aortic stenosis, even without symptoms. These changes can persist, are associated with decreased long-term survival even after successful aortic valve replacement, and could be indications for early aortic valve replacement if supported by findings from an appropriate prospective study.

Abbreviations and Acronyms

AV
aortic valve
AVR
AV replacement
LA
left atrial
LV
left ventricular
LVEF
LV ejection fraction
LVMI
LV mass index
TTE
transthoracic echocardiogram

CTSNet classification

18

Cited by (0)

This work was supported by awards from the American Heart Association (to J.M.B.). It was also supported in part by the Donna and Ken Lewis Chair in Cardiothoracic Surgery (to T.M.); the Charles and Lorraine Moore Endowed Chair in Cardiovascular Imaging (to J.T.); the National Space Biomedical Research Institute through NASA NCC 9-58 (to J.T.); the Judith Dion Pyle Endowed Chair in Heart Valve Research (to A.M.G.); the John and Rosemary Brown Endowed Chair in Cardiovascular Medicine (to B.G.); and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (to E.H.B.).

Disclosures: Dr Gillinov is a consultant for Edwards Lifesciences and receives research support from St Jude Medical and Medtronic. The other authors have nothing to disclose with regard to commercial support.