Abstract
Objectives: Establishing surgical criteria for aortic valve replacement (AVR) or repair in severe aortic regurgitation (AR) is challenging and evidence-based recommendations for young adults are lacking. We studied the indications for AVR in a cohort of young adults with severe AR from a tertiary centre, and the associated outcomes. The relation between pre-surgical echocardiographic parameters and post-operative left ventricular (LV) size and function, clinical events, and prosthetic valve-related complications was also investigated.
Methods: Data were collected retrospectively on consecutive adult patients who underwent AVR or repair for severe AR between 2005 and 2019 in a tertiary cardiac centre.
Results: One-hundred-and-seventy-two patients were included (age at surgery 29 [22-41] years, 81% male). One third were operated before meeting standard guideline indications. Normalization of LV size and function was achieved in 65% of patients. No significant change in LV ejection fraction (EF) from baseline to the latest follow-up (p=0.08) was observed. Pre-surgical LV end-systolic diameter (LVESD) was associated with lack of LV normalization post-surgery (OR per 1 cm increase 2.81, 95%CI:1.54 - 5.56, p<0.01). On ROC analysis, the cut-off for baseline LVESD that maximizes sensitivity and specificity for lack of LV normalization post-surgery was 43mm. Pre- and post-operative LV dimensions, and post-operative LVEF were predictors of clinical events during follow-up. Prosthesis-related complications were frequent (20.3%) during a follow-up of 5.6 [2.9-9.2] years. Freedom from aortic re-intervention was 98%, 96.5%, 85.4% at 1, 5 and 10 years, respectively.
Conclusions: Patients with a history of cardiac surgery and/or increased baseline LVESD are less likely to achieve normalization of LV size and function following AVR. Clinicians must carefully balance the potential benefits of AVR on long-term outcomes against the risk of periprocedural complications and the likelihood of future interventions, especially in younger patients.