期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 12, 期 18, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.122.029251
关键词
aortic regurgitation; aortic valve; congenital heart disease; outcomes; surgery; young
This study investigates the indications and outcomes of aortic valve replacement (AVR) in young adults with severe aortic regurgitation, as well as the relationship between presurgical echocardiographic parameters and postoperative left ventricular size and function. The results show that a higher presurgical left ventricular end-systolic diameter is associated with a lack of left ventricular normalization after AVR. Pre- and postoperative left ventricular dimensions and postoperative left ventricular ejection fraction predict clinical events during follow-up.
Background: Establishing surgical criteria for aortic valve replacement (AVR) in severe aortic regurgitation in young adults is challenging due to the lack of evidence-based recommendations. We studied indications for AVR in young adults with severe aortic regurgitation and their outcomes, as well as the relationship between presurgical echocardiographic parameters and postoperative left ventricular (LV) size, function, clinical events, and valve-related complications. Methods and Results: Data were collected retrospectively on 172 consecutive adult patients who underwent AVR or repair for severe aortic regurgitation between 2005 and 2019 in a tertiary cardiac center (age at surgery 29 [22-41] years, 81% male). One-third underwent surgery before meeting guideline indications. Postsurgery, 65% achieved LV size and function normalization. LV ejection fraction showed no significant change from baseline. A higher presurgical LV end-systolic diameter correlated with a lack of LV normalization (odds ratio per 1-cm increase 2.81, P<0.01). The baseline LV end-systolic diameter cut-off for predicting lack of LV normalization was 43mm. Pre- and postoperative LV dimensions and postoperative LV ejection fraction predicted clinical events during follow-up. Prosthetic valve-related complications occurred in 20.3% during an average 5.6-year follow-up. Freedom from aortic reintervention was 98%, 96.5%, and 85.4% at 1, 5, and 10years, respectively. Conclusions: Young adult patients with increased baseline LV end-systolic diameter or prior cardiac surgery are less likely to achieve LV normalization after AVR. Clinicians should carefully balance the long-term benefits of AVR against procedural risks and future interventions, especially in younger patients. Evidence-based criteria for AVR in severe aortic regurgitation in young adults are crucial to improve outcomes.
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