High-risk Factors and Long-term Results of Surgical Treatment for Aortic Regurgitation and Large Left Ventricle_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGMing-kui , ZHANGFu-qiang ,  WUQing-yu , LIHong-yin , XUEHui , JINGYong-qiang

Department of Cardiac Surgery, First Hospital of Qinghua University, Beijing 100016, P. R. China;

Corresponding author：

WUQing-yu, Email: wuqingyu@mail.tsinghua.edu.cn

Keywords：

Aortic valve insufficiency; Heart valve prosthesis implantation; Severe dilated left ventricle; Long-term; Follow-up

DOI：

10.7507/1007-4848.20160270

Video：

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Objective To summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle. Methods We retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months. Results Early death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m²), indexed LVESD (28.92±9.08 mm/m²), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively. Conclusion Most of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.

Citation： ZHANGMing-kui, ZHANGFu-qiang, WUQing-yu, LIHong-yin, XUEHui, JINGYong-qiang. High-risk Factors and Long-term Results of Surgical Treatment for Aortic Regurgitation and Large Left Ventricle. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(12): 1146-1149. doi: 10.7507/1007-4848.20160270 Copy

1.	Cho SH, Byun CS, Kim KW, et al. Preoperative indexed left ventri-cular dimensions to predict early recovery of left ventricular func-tion after aortic valve replacement for chronic aortic regurgitation. Circ J, 2010, 74(11): 2340-2345.
2.	Zhang Z, Yang J, Yu Y, et al. Preoperative ejection fraction deter-mines early recovery of left ventricular end-diastolic dimension after aortic valve replacement for chronic severe aortic regurgitation. J Surg Res, 2015, 196(1): 49-55.
3.	Wang Y, Shi J, Li F, et al. Aortic valve replacement for severe aortic regurgitation in asymptomatic patients with normal ejection frac-tion and severe left ventricular dilatation. Interact Cardiovasc Thorac Surg, 2016, 22(4): 425-430.
4.	李新民, 祝岩, 赵科研, 等. 主动脉瓣关闭不全合并心脏射血分数低下的外科治疗. 中国胸心血管外科临床杂志, 2015, 22(7): 657-659.
5.	Saisho H, Arinaga K, Kikusaki S, et al. Long term results and predi-ctors of left ventricular function recovery after aortic valve replace-ment for chronic aortic regurgitation. Ann Thorac Cardiovasc Surg, 2015, 21(4): 388-395.
6.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guide-line for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
7.	Aithoussa M, Moutakiallah Y, Abdou A, et al. Surgery of aortic regurgitation with reduced left ventricular function. Ann Cardiol Angeiol (Paris), 2013, 62(2): 101-107.
8.	Badar AA, Brunton AP, Mahmood AH, et al. The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review. Expert Rev Cardiovasc Ther, 2015, 13(8): 915-922.
9.	Une D, Mesana L, Chan V, et al. Clinical impact of changes in left ventricular function after aortic valve replacement: Analysis from 3112 patients. Circulation, 2015, 132(8): 741-747.
10.	李呈龙, 孟旭, 李岩, 等. 巨大左心室心脏瓣膜病的心源性死亡风险预测. 中华心胸血管外科杂志, 2013, 29(10): 577-580.
11.	Kamath AR, Varadarajan P, Turk R, et al. Survival in patients with severe aortic regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement: results from a cohort of 166 patients with an ejection fraction<or=35%. Circulation, 2009, 120(11 Suppl): S134-138.
12.	Tanoue Y, Oishi Y, Sonoda H, et al. Left ventricular performance after aortic valve replacement in patients with low ejection fraction. J Artif Organs, 2013, 16(4): 443-450.
13.	徐激斌, 唐杨烽, 徐志云, 等. 主动脉瓣关闭不全合并左心室功能不全的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(6): 565-567.
14.	Sénéchal M, Bernier M, Dagenais F, et al. Usefulness of preoperative stroke volume as strong predictor of left ventricular remodeling and outcomes after aortic valve replacement in patients with severe pure aortic regurgitation. Am J Cardiol, 2011, 108(7): 1008-1013.
15.	Buddhe S, Du W, Walters HL 3rd, et al. Predictors of left ventricular remodeling after aortic valve replacement in pediatric patients with isolated aortic regurgitation. Congenit Heart Dis, 2013, 8(2): 167-173.
16.	Brown ML, Schaff HV, Suri RM, et al. Indexed left ventricular dimensions best predict survival after aortic valve replacement in patients with aortic valve regurgitation. Ann Thorac Surg, 2009, 87(4): 1170-1175.
17.	Yiu KH, Ng WS, Chan D, et al. Improved prognosis following renin-angiotensin-aldosterone system blockade in patients undergoing concomitant aortic and mitral valve replacement. Int J Cardiol, 2014, 177(2): 680-682.
18.	Muraoka H, Imamura T, Kinugawa K. Reverse remodeling achieved by combination therapy with high-dose beta blocker and cardiac resynchronization. Int Heart J, 2015, 56(4): 462-465.
19.	Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J, 2013, 34(29): 2281-2329.
20.	Bose A, Upadhyay GA, Kandala J, et al. Does prior valve surgery change outcome in patients treated with cardiac resynchronization therapy? J Cardiovasc Electrophysiol, 2014, 25(11): 1206-1213.
21.	Chan PH, Tse HF. Adoption of cardiac resynchronization therapy in heart failure patients with postcardiac valve surgery or interven-tions? J Cardiovasc Electrophysiol, 2014, 25(11): 1214-1215.

1. Cho SH, Byun CS, Kim KW, et al. Preoperative indexed left ventri-cular dimensions to predict early recovery of left ventricular func-tion after aortic valve replacement for chronic aortic regurgitation. Circ J, 2010, 74(11): 2340-2345.
2. Zhang Z, Yang J, Yu Y, et al. Preoperative ejection fraction deter-mines early recovery of left ventricular end-diastolic dimension after aortic valve replacement for chronic severe aortic regurgitation. J Surg Res, 2015, 196(1): 49-55.
3. Wang Y, Shi J, Li F, et al. Aortic valve replacement for severe aortic regurgitation in asymptomatic patients with normal ejection frac-tion and severe left ventricular dilatation. Interact Cardiovasc Thorac Surg, 2016, 22(4): 425-430.
4. 李新民, 祝岩, 赵科研, 等. 主动脉瓣关闭不全合并心脏射血分数低下的外科治疗. 中国胸心血管外科临床杂志, 2015, 22(7): 657-659.
5. Saisho H, Arinaga K, Kikusaki S, et al. Long term results and predi-ctors of left ventricular function recovery after aortic valve replace-ment for chronic aortic regurgitation. Ann Thorac Cardiovasc Surg, 2015, 21(4): 388-395.
6. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guide-line for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
7. Aithoussa M, Moutakiallah Y, Abdou A, et al. Surgery of aortic regurgitation with reduced left ventricular function. Ann Cardiol Angeiol (Paris), 2013, 62(2): 101-107.
8. Badar AA, Brunton AP, Mahmood AH, et al. The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review. Expert Rev Cardiovasc Ther, 2015, 13(8): 915-922.
9. Une D, Mesana L, Chan V, et al. Clinical impact of changes in left ventricular function after aortic valve replacement: Analysis from 3112 patients. Circulation, 2015, 132(8): 741-747.
10. 李呈龙, 孟旭, 李岩, 等. 巨大左心室心脏瓣膜病的心源性死亡风险预测. 中华心胸血管外科杂志, 2013, 29(10): 577-580.
11. Kamath AR, Varadarajan P, Turk R, et al. Survival in patients with severe aortic regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement: results from a cohort of 166 patients with an ejection fraction<or=35%. Circulation, 2009, 120(11 Suppl): S134-138.
12. Tanoue Y, Oishi Y, Sonoda H, et al. Left ventricular performance after aortic valve replacement in patients with low ejection fraction. J Artif Organs, 2013, 16(4): 443-450.
13. 徐激斌, 唐杨烽, 徐志云, 等. 主动脉瓣关闭不全合并左心室功能不全的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(6): 565-567.
14. Sénéchal M, Bernier M, Dagenais F, et al. Usefulness of preoperative stroke volume as strong predictor of left ventricular remodeling and outcomes after aortic valve replacement in patients with severe pure aortic regurgitation. Am J Cardiol, 2011, 108(7): 1008-1013.
15. Buddhe S, Du W, Walters HL 3rd, et al. Predictors of left ventricular remodeling after aortic valve replacement in pediatric patients with isolated aortic regurgitation. Congenit Heart Dis, 2013, 8(2): 167-173.
16. Brown ML, Schaff HV, Suri RM, et al. Indexed left ventricular dimensions best predict survival after aortic valve replacement in patients with aortic valve regurgitation. Ann Thorac Surg, 2009, 87(4): 1170-1175.
17. Yiu KH, Ng WS, Chan D, et al. Improved prognosis following renin-angiotensin-aldosterone system blockade in patients undergoing concomitant aortic and mitral valve replacement. Int J Cardiol, 2014, 177(2): 680-682.
18. Muraoka H, Imamura T, Kinugawa K. Reverse remodeling achieved by combination therapy with high-dose beta blocker and cardiac resynchronization. Int Heart J, 2015, 56(4): 462-465.
19. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J, 2013, 34(29): 2281-2329.
20. Bose A, Upadhyay GA, Kandala J, et al. Does prior valve surgery change outcome in patients treated with cardiac resynchronization therapy? J Cardiovasc Electrophysiol, 2014, 25(11): 1206-1213.
21. Chan PH, Tse HF. Adoption of cardiac resynchronization therapy in heart failure patients with postcardiac valve surgery or interven-tions? J Cardiovasc Electrophysiol, 2014, 25(11): 1214-1215.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

High-risk Factors and Long-term Results of Surgical Treatment for Aortic Regurgitation and Large Left Ventricle

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