Longitudinal assessment of left ventricular function and remodelling following surgical replacement of aortic valve in young patients with aortic valve dysfunction: a pilot study.

Abstract

Surgical prosthetic aortic valve replacement has been used for the management of aortic valve dysfunction. Studies in adults after aortic valve replacement report decreased left ventricular function in the early post-operative period. We hypothesised that young adults with aortic valve dysfunction who undergo aortic valve replacement may have incomplete recovery of left ventricular systolic function. This was a retrospective single-centre pilot study of patients with surgical aortic valve replacement at our institution over 20 years. Echocardiograms were analysed pre-operatively, at discharge, 1-year, and 5-year follow-up. Left ventricular systolic function was assessed using fractional shortening and ejection fraction. Speckle tracking measurements were performed for four-chamber longitudinal strain and peak systolic circumferential strain. Repeated-measure ANOVA (SPSS Inc.) was used for analysis. A p-value <0.05 was considered significant. Our cohort included 15 subjects (age 19.1 ± 9.0 years, 73% male). Left ventricular mass indexed to body surface area significantly improved (63.5 ± 25.3 pre-operatively to 41.2 ± 13.1 at 5 years, p = 0.009). Left ventricular longitudinal and circumferential strain measures deteriorated in the early post-operative period compared to pre-aortic valve replacement (-18.2 ± 3.4 versus -11.8 ± 3.3, p = 0.00) and (-25.1 ± 5.4 versus -18.9 ± 5.4, p = 0.06). Longitudinal strain continued to be abnormal at the 1- and 5-year follow-up compared to baseline. Children and young adults undergoing aortic valve replacement for aortic valve dysfunction had a decrease in left ventricular systolic function by strain imaging in the early post-operative period and abnormalities persisted on 5-year follow-up.