Predictors of Left Ventricular Mass Index One Year after Bioprosthetic Aortic Valve Replacement for Aortic Stenosis

Abstract

Background and Aim of Study.To evaluate predictors of residual left ventricular hypertrophy (LVH) one year after surgical aortic valve replacement (SAVR) in patients with aortic stenosis and clarify the relationship between long-term outcomes and predictors. Methods. We retrospectively reviewed 141 patients who underwent SAVR with a bioprosthetic valve. Left ventricular dimensions and mass index were assessed using serial transthoracic echocardiography. The difference in time course and the pattern of left ventricular mass index (LVMI) regression between patients with and without residual LVH one year after surgery were evaluated. The factors associated with LVMI one year after SAVR and the prognostic impact of these predictors on long-term outcomes were analyzed. Results. Although LVMI one year after surgery showed a significant decrease in patients with and without LVH, greater preoperative LVMI and lesser extent of LVMI decrease resulted in high residual LVMI at one year after SAVR in patients with LVH. The preoperative left ventricular end-diastolic dimension index ( $p=0.027$ ) and preoperative left atrial dimension ( $p=0.001$ ) were significant determinants of LVMI at one year after SAVR. A cut-off value of 30 mm/m2 or greater for the left ventricular end-diastolic dimension index was optimal for predicting high LVMI one year after SAVR. Overall survival was significantly lower with a left ventricular end-diastolic dimension index ≥30 mm/m2 ( $p=0.017$ , Log rank). Conclusions. High preoperative left ventricular end-diastolic dimension index and large left atrial dimension were associated with high LVMI one year after surgical aortic valve replacement. Preoperative left ventricular end-diastolic dimension index of >30 mm/m2 could predict adverse outcomes after surgical aortic valve replacement.