Left Ventricular Diastolic Function After Aortic Valve Replacement for Chronic Aortic Regurgitation.

BACKGROUND: The aim of the present study was to investigate the evolution of left ventricular diastolic function after aortic valve replacement for chronic severe aortic regurgitation.

METHODS: Patients (n = 183) who underwent isolated aortic valve replacement for severe aortic regurgitation were included in this study. Degrees of left ventricular diastolic function were designated, according to the integration of two echocardiographic parameters: left atrial volume index and average E/e' ratio. The impact of preoperative diastolic function on long-term survival and cardiac function was investigated. A subgroup of 104 patients with serial echocardiographic data collected at short-term, midterm, and long-term follow-up was investigated to identify dynamic changes in postoperative diastolic function.

RESULTS: Overall, follow-up data were available for 167 patients at 83.8 ± 29.6 months postoperatively. Serial echocardiographic data showed that left ventricular diastolic dysfunction was identified in 74 patients (71.2%) preoperatively, and 45 patients (43.3%) showed improvement by at least one grade at long-term follow-up. Statistical analyses showed that age was the only significant risk factor for cardiac mortality. Furthermore, preoperative left ventricular end-diastolic volume index, New York Heart Association functional class, and degree of diastolic function were predictive factors for late heart failure. The subgroup analysis identified preoperative left ventricular end-diastolic volume index as the only risk factor for impeded recovery or exacerbation of diastolic function during follow-up.

CONCLUSIONS: In patients with chronic severe aortic regurgitation, left ventricular diastolic dysfunction is highly prevalent and might show gradual improvement after aortic valve replacement. However, such improvement could be hindered by an excessively dilated left ventricle during surgery.