Long-term cardiac remodeling associated with heart failure following left-ventricular valve replacement surgery

Abstract

To investigate long-term cardiac remodeling and prognosis of patients post-left-ventricular valve replacement, and explored related risk factors of heart failure and management strategies.Retrospective cohort of patients with left-ventricular valve replacement between 2005 and 2007. Major adverse cardiac events were recorded, including death, hospitalization, stroke, and New York Heart Association (NYHA) functional classifications. Cardiac remodeling was assessed by comparing pre-operative, post-operative, and follow-up echocardiographic images.Two hundred fifty-seven patients who received left-ventricular mitral, aortic, or double-valve replacement surgery were followed up for 10.4 ± 1.5 years with an all-cause mortality rate 18.7% and an incidence of heart failure that significantly restricted daily life (NYHA III or IV) 21.3%.There were no significant differences in classic cardiac-remodeling variables between baseline and long-term follow-up, such as left-ventricular diameter (47.9 ± 8.3 vs 49.9 ± 8.0 mm, P = .14) and left-ventricular ejection fraction (58.6 ± 9.6% vs 57.0 ± 10.3%, P = .34), whereas there were significant differences in terms of left-atrial anteroposterior diameter (LA) (39.7 ± 9.5 vs 49.0 ± 14.3 mm, P < .001) and tricuspid regurgitation (TR) (1.4 ± 1.0 vs 2.2 ± 1.2, P < .001). Multivariable logistic regression analysis showed that LA ≥ 50 mm (P = .011) and more than moderate tricuspid regurgitation (TR > 2) (P = .012) were associated with poor prognoses for long-term consequences of heart failure. Both LA and TR progressed with the length of time after surgery.LA enlargement and TR after left-ventricular valve replacement surgery were time-dependent events, which represented cardiac remodeling and were closely related to post-operative long-term consequences of heart failure. It is important to be cognizant of and to explore long-term preventive and treatment strategies for adverse cardiac events in patients following left-ventricular valve replacement.

Clinical Equivalence of Trubond® and Ethibond® Braided Polyester Sutures for Valvular Prosthesis Fixation During Aortic or Mitral Valve Replacement: A Single-Blind Randomized Controlled Trial

“…To reduce the symptoms of valvular lesions and VHD-related complications and to prolong the patient’s survival, a surgical valve prosthesis is applied [ 17 ]. Successful valve replacement surgery is often reported to be associated with poor long-term prognosis, as 60.6% chances of survival with AV replacement (after 15 years) and 43.0% survival rates with MV replacement (after 20 years) have been recorded [ 1 ]. Incidence of PVL is a potentially serious complication that occurred in 2-10% and 7-17% of patients after AV and MV replacement, respectively [ 18 ].…”

“…One of the increasing causes of cardiovascular morbidity and mortality is valvular heart disease (VHD) [ 1 ]. The Global Burden of Disease study involving 195 countries found that 12.6 and 18.1 million people were affected by the disease of the calcific aortic valve (AV) and degenerative mitral valve (MV), respectively, between 1990 and 2017 [ 2 ].…”