Recovery of left ventricular function after surgery for aortic and mitral regurgitation with heart failure

Wei-Tsung Lai; I-Chen Chen; Ming-Chon Hsiung; Ting-Chao Lin; Kuan-Chih Huang; Chung-Yi Chang; Jeng Wei

doi:10.1016/j.ijcrp.2024.200329

Recovery of left ventricular function after surgery for aortic and mitral regurgitation with heart failure

Int J Cardiol Cardiovasc Risk Prev. 2024 Sep 2:23:200329. doi: 10.1016/j.ijcrp.2024.200329. eCollection 2024 Dec.

Authors

Wei-Tsung Lai^{1

2}, I-Chen Chen², Ming-Chon Hsiung², Ting-Chao Lin^{2

3}, Kuan-Chih Huang^{4

5}, Chung-Yi Chang², Jeng Wei²

Affiliations

¹ Division of Cardiovascular Medicine, Department of Internal Medicine, China Medical University Hsinchu Hospital, Hsinchu, Taiwan.
² Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.
³ Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taipei, Taiwan.
⁴ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
⁵ Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

Abstract

Background: Severe aortic regurgitation (AR) and mitral regurgitation (MR) can lead to left ventricular (LV) systolic dysfunction; however, there are limited data about recovery of LV after surgery for AR or MR. Little is known to guide the management of combined AR and MR (mixed valvular heart disease [VHD]). This study is sought to investigate the predictors of postoperative LV function recovery in left-sided regurgitant VHD with reduced left ventricular ejection fraction (LVEF), especially for mixed VHD.

Methods: From 2010 to 2020, 2053 adult patients underwent aortic or mitral valve surgery at our center. The patients with valvular stenosis, infective endocarditis, concomitant revascularization, and preoperative LVEF ≥40 % were excluded. A total of 127 patients were included in this study: 22 patients with predominant AR (AR group), 64 with predominant MR (MR group), and 41 with combined AR and MR (AMR group).

Results: The mean preoperative LVEF was 32.4 %, 30.7 %, and 30.2 % (p = 0.44) in the AR, MR, and AMR groups, respectively. The AR group was more likely to have postoperative LVEF recovery. The cut-point of left ventricular end-systolic diameter (LVESD) for better recovery was 49 mm for the MR group and 58 mm for the AMR group.

Conclusion: LV dysfunction due to combined AR and MR has similar remodeling reserve as AR, and better recoverability than MR. Thus, double-valve surgery is recommended before the LVESD is > 58 mm.

Keywords: Aortic regurgitation; Heart failure with reduced ejection fraction; Left ventricular function; Mitral regurgitation; Mixed valvular heart disease; Valve surgery.