Clinical and echocardiographic results of AVR in the failing ventricle: do AS and AR differ?

Abstract Background We hypothesized that long-term clinical and echocardiographic recovery of the impaired ventricle from pressure (AS) and volume (AR) overload would be different following aortic valve replacement (AVR). Methods We compared the results of AVR in patients with a pre-operative ejection fraction (EF) of 0.35 or less due to AS, AR or mixed disease. We constructed a mixed-effects model of EF and left ventricular end diastolic diameter (LVEDD) to understand ventricular recovery over the short (in-hospital), intermediate (3-6 month) and longer (>24 months) terms. We sought to identify factors associated with clinical and echocardiographic recovery using multivariable analysis. Results Between July 2011 and 2017, 136 patients with pre-operative EF of 0.35 or less and severe AS (83), severe AR (18) or mixed AS and AR (35) underwent AVR. There were 2 early deaths in the AS group (1.5%). Survival at 1, 2 and 5 years did not differ between groups. Baseline EF did not differ between the groups but improved with markedly different trajectory and time course in AS, AR and mixed groups over time. LVEDD regressed in all patient cohorts, following a different pattern for AS and AR. Baseline EF and LVEDD predicted long term fate of the LV but did not determine survival. We identify factors associated with long term survival. Conclusions The pattern of LV recovery appears to be early in AS and delayed in AR. Baseline clinical factors, rather than echocardiographic status of the LV, appear to determine late survival.