PM1036: Longitudinal Changes in the Left Ventricular Function After Surgical Prosthetic Aortic Valve Replacement in Patients with Aortic Valve Disease

Background: Surgical placement of a prosthetic aortic valve (AVR) is an acceptable option for palliation of aortic valve disease. There are a few cross-sectional studies in adults reporting a decrease in left ventricle (LV) function in the short-term following AVR. Aortic valve disease leads to chronic increase in afterload and LV volume. Additionally, prosthesis-patient size mismatch and altered hemodynamics due to AVR can impede the recovery of the LV postoperatively. We hypothesized that AVR for aortic valve disease would lead to a progressive decrease in LV function in intermediate term follow up.

Methods: This was a retrospective cross-sectional study of patients with aortic valve dysfunction who underwent AVR. Patients with significant mitral valve disease, mechanical mitral valve, or single ventricle were excluded. Echocardiograms were analyzed at 4 time points: pre-operative (pre-Echo), at discharge (Post Echo1), at 1 year follow up (Post Echo2), and at 5 year follow up (Post Echo3). M mode measurement in parasternal short axis view was obtained to calculate the LV shortening fraction (SF) by standard method. LV volume at end-diastole and end-systole and ejection fraction (EF) were also measured using 5/6 area length method. LV global function was assessed by myocardial performance index (MPI) and LV diastolic function by mitral inflow using standard measurements. Data were analyzed using SPSS and repeated measure ANOVA was used to compare various echo parameters and p-value < 0.05 was considered significant.

Results: Our cohort included 15 subjects, 11 (73%) males with a mean (SD) age of 19.1 (9.0) years at the time of surgery. The primary indications for surgery included aortic valve stenosis in 3 (20%), both aortic stenosis and insufficiency in 7 (46.6 %), and aortic regurgitation in 5 (33.4%) subjects. In the early postoperative period, there was a significant decrease in SF (30.7 ± 11.5 vs 38.3 ± 8.7 p=0.02) compared to pre surgery. However, there was no further decrease in the systolic function at 1 year and 5-year follow-up. Global function as assessed by MPI was not significantly different after the surgery (0.47 ± 0.11 and 0.64 ± 0.38 vs. 0.39 ± 0.21 (pre-Echo), p=NS) (Table 1). Similarly, there was no impact on the LV diastolic function as assessed by E/A ratio after the AVR.

Conclusion: Children and young adults undergoing AVR for aortic valve disease have a decrease in LV function in the early postoperative period. However, there is no further worsening of the LV systolic function in intermediate-term follow-up. Further long-term longitudinal analysis with a larger sample size is required to assess the effect of this surgical procedures on LV function.