Effect of aortic valve replacement on left ventricular function in chronic aortic regurge

ABSTRACT

The purpose of this study is to evaluate the effect of aortic valve replacement [AVR] on left ventricular function in patients with chronic rheumatic aortic regurge [AR]. This prospective selected study was conducted in the Department of Cardiothoracic Surgery, Mansoura University Hospitals from January 2005 to March 2007 including follow up period. The study involved 50 patients with chronic rheumatic AR for whom AVR was done. Group I [N = 25 patients] with FF > gt 50%. Group II [N= 25 patients] with EF patients were subjected to pre-operative full history taking and physical examination, routine full lab examination was performed in all patients. Echocardiography was performed pre-operatively, 3 weeks, months and after one year of surgery. Aortic valve replacement was done using Mechanical bileaflet prosthetic valves [St.Jude and amp Carbomedics] which was implanted randomly in both groups of patients. Preoperatively, Both groups were similar regarding age, gender, clinical presentation and NYHA functional class without any statistically significant difference Postoperatively, NYPLA functional class improved significantly in both groups [p value 0.001]. LVESD was reduced in both groups, however this reduction was significant only in groups I at 3 weeks [p value 0.023]. The end of follow-up period, this reduction was significant in both groups [p value 0.001]. LVEDD was reduced in both groups, although it was more significant in group I [p value 0.001]. [EF% showed initial drop in both groups early postoperatively. However, after 3 months and at 1 year, it showed significant improvement in both groups which was more significant in group I value 0.006]. The mean ICU stay was 2.6 days in groups I Vs 8 days in group II .The mean hospital stay was 9.2 days in group IVs 16 days in group II. Aortic valve replacement has a beneficial effect on left vermicular diameters and function in patients with chronic rheumatic aortic regurge which is more obvious in patients with EF > 50% at the time of surgical intervention. So early surgery is recommended in these patients to provide faster and more significant recovery of the myocardial pump performance. Also, it is associated with shorter hospital and ICU stay and lower incidence of morbidity and mortality