Left ventricular reverse remodeling after aortic valve surgery for acute versus chronic aortic regurgitation.

ABSTRACT

AIMS: Extent of left ventricular (LV) reverse remodeling after aortic valve repair or replacement (AVR) may differ between patients operated for acute aortic regurgitation (AR) and chronic AR. The aim of this study was to compare changes in LV volumes and function between patients with acute and chronic AR who underwent AVR. METHODS AND RESULTS: A total of 98 patients (54±15 years, 61% men) with acute (n=21) or chronic AR (n=77) were included in the present retrospective evaluation. LV volumes, LV ejection fraction, and global longitudinal strain indexed for LV end-diastolic volume (GLSi) were assessed preoperatively and after a median follow-up of 28 months (interquartile range 17-66 months). Patients with acute AR tended to have smaller preoperative LV end-diastolic volume compared with chronic AR (156±15 vs 183±6 mL; P=.070). Both in patients with acute and chronic AR, significant LV reverse remodeling with sustained reduction in LV volumes occurred during follow-up with a significant smaller LV end-diastolic volume in acute AR compared with chronic AR (106±8 vs 128±5 mL; P=.032). Preoperative and postoperative LV ejection fractions were not significantly different between groups. In contrast, GLSi was better in patients with acute AR compared with chronic AR before AVR (-1.34±0.20 vs -0.96±0.07%/10 mL; P=.042) and during follow-up (-1.65±0.16 vs -1.29±0.07%/10 mL; P=.017). CONCLUSIONS: After AVR, LV reverse remodeling occurs both in patients with acute and chronic AR. However, LV end-diastolic volume was more reduced and GLSi was more preserved during follow-up in acute AR than in chronic AR.