IMPACT OF AORTIC VALVE REPLACEMENT ON LEFT VENTRICULAR REMODELING IN PATIENTS WITH SEVERE AORTIC STENOSIS AND SEVERE LEFT VENTRICULAR DYSFUNCTION

Objective: The aim of this study was to evaluate the effect of aortic valve replacement on left ventricular (LV) function and remodeling among patients with severe aortic stenosis and severe left ventricular dysfunction. Methods: In this retrospective bicentric study extended over a 15-year period, 61 consecutive patients underwent isolated AVR for severe AS associated to reduced LV function. The mean age was 58.21 +/- 12.50 years and 83.60 % were men. 70.50% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF) was 32.9 +/- 5.6. The mean LVEDD and LVESD were respectively 63.6 +/- 9.2 and 50.2 +/- 8.8 mm. The mean calculated logistic EuroScore was 12.2 +/- 4.5. Results: The hospital mortality was 11.5%. Morbidity was marked mainly by low output syndrome in 40.8% of cases. After a median follow-up of 38 months, we have recorded 3 deaths. Almost all survivors were in class I and II of NYHA. The mean LV end-diastolic and end-systolic diameters decreased significantly at late postoperative stage. The mean LV ejection fraction increased significantly from 32.9 +/- 5.6 to 38.2 +/- 9.3 and to 50.3 +/- 9.6 in early and late postoperative stages, respectively. Multivariate linear regression analysis found that increased early postoperative LVEF (beta=0.44, 95% CI [0.14; 0.75], p=0.006) and low mean transprosthesis gradient (beta=-0.72, 95% CI [-1.42; -0.02], p=0.04) were the independent predictors of left ventricular systolic function recovery. Conclusion: Patients with aortic valve stenosis and impaired LV systolic function benefited from AVR as regard improvement of LV function parameters and regression of the LV diameters. This improvement depends mainly on early postoperative LVEF and mean transprosthesis gradient.