Jocelyn M Beach1, Tomislav Mihaljevic2, Jeevanantham Rajeswaran3, Thomas Marwick4, Samuel T Edwards1, Edward R Nowicki5, James Thomas4, Lars G Svensson5, Brian Griffin4, A Marc Gillinov5, Eugene H Blackstone6. 1. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio. 2. Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. Electronic address: mihaljt@ccaduae.ae. 3. Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 4. Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 5. Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 6. Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Abstract
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/m(2) 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.
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/m(2) 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.
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Authors: Jocelyn M Beach; Tomislav Mihaljevic; Lars G Svensson; Jeevanantham Rajeswaran; Thomas Marwick; Brian Griffin; Douglas R Johnston; Joseph F Sabik; Eugene H Blackstone Journal: J Am Coll Cardiol Date: 2013-02-26 Impact factor: 24.094
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Authors: Lars G Svensson; Saila T Pillai; Jeevanantham Rajeswaran; Milind Y Desai; Brian Griffin; Richard Grimm; Donald F Hammer; Maran Thamilarasan; Eric E Roselli; Gösta B Pettersson; A Marc Gillinov; Jose L Navia; Nicholas G Smedira; Joseph F Sabik; Bruce W Lytle; Eugene H Blackstone Journal: J Thorac Cardiovasc Surg Date: 2015-11-10 Impact factor: 5.209