Repair of Aortic Regurgitation in Young Adults

Establishing surgical criteria for aortic valve replacement (AVR) in severe aortic regurgitation in young adults is challenging due to the lack of evidence-based recommendations. We studied indications for AVR in young adults with severe aortic regurgitation and their outcomes, as well as the relati...

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Autores: Barradas-Pires, Ana|||0000-0002-8246-5906, Merás, Pablo, Constantine, Andrew, Costola, Giulia|||0000-0002-7453-7594, de la Cal, Teresa Segura|||0000-0003-0269-5574, Rafiq, Isma, Kempny, Aleksander, Li, Wei, Babu-Narayan, Sonya V.|||0000-0002-1558-8447, Hoschtitzky, J. Andreas, Gatzoulis, Michael A., Rubio, Antonio Martinez, Dimopoulos, Konstantinos|||0000-0003-1300-0504
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:290190
Acceso en línea:https://ddd.uab.cat/record/290190
https://dx.doi.org/urn:doi:10.1161/JAHA.122.029251
Access Level:acceso abierto
Palabra clave:Aortic regurgitation
Aortic valve
Aortic Valve Replacement/Transcather Aortic Valve Implantation
Congenital heart disease
Echocardiography
Outcomes
Prognosis
Surgery
Treatment
Young
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spelling Repair of Aortic Regurgitation in Young AdultsSooner Rather Than LaterBarradas-Pires, Ana|||0000-0002-8246-5906Merás, PabloConstantine, AndrewCostola, Giulia|||0000-0002-7453-7594de la Cal, Teresa Segura|||0000-0003-0269-5574Rafiq, IsmaKempny, AleksanderLi, WeiBabu-Narayan, Sonya V.|||0000-0002-1558-8447Hoschtitzky, J. AndreasGatzoulis, Michael A.Rubio, Antonio MartinezDimopoulos, Konstantinos|||0000-0003-1300-0504Aortic regurgitationAortic valveAortic Valve Replacement/Transcather Aortic Valve ImplantationCongenital heart diseaseEchocardiographyOutcomesPrognosisSurgeryTreatmentYoungEstablishing surgical criteria for aortic valve replacement (AVR) in severe aortic regurgitation in young adults is challenging due to the lack of evidence-based recommendations. We studied indications for AVR in young adults with severe aortic regurgitation and their outcomes, as well as the relationship between presurgical echocardiographic parameters and postoperative left ventricular (LV) size, function, clinical events, and valve-related complications. Data were collected retrospectively on 172 consecutive adult patients who underwent AVR or repair for severe aortic regurgitation between 2005 and 2019 in a tertiary cardiac center (age at surgery 29 [22-41] years, 81% male). One-third underwent surgery before meeting guideline indications. Postsurgery, 65% achieved LV size and function normalization. LV ejection fraction showed no significant change from baseline. A higher presurgical LV end-systolic diameter correlated with a lack of LV normalization (odds ratio per 1-cm increase 2.81, P <0.01). The baseline LV end-systolic diameter cut-off for predicting lack of LV normalization was 43 mm. Pre- and postoperative LV dimensions and postoperative LV ejection fraction predicted clinical events during follow-up. Prosthetic valve-related complications occurred in 20.3% during an average 5.6-year follow-up. Freedom from aortic reintervention was 98%, 96.5%, and 85.4% at 1, 5, and 10 years, respectively. Young adult patients with increased baseline LV end-systolic diameter or prior cardiac surgery are less likely to achieve LV normalization after AVR. Clinicians should carefully balance the long-term benefits of AVR against procedural risks and future interventions, especially in younger patients. Evidence-based criteria for AVR in severe aortic regurgitation in young adults are crucial to improve outcomes. 22023-01-0120232023-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/290190https://dx.doi.org/urn:doi:10.1161/JAHA.122.029251reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2901902026-06-06T12:50:31Z
dc.title.none.fl_str_mv Repair of Aortic Regurgitation in Young Adults
Sooner Rather Than Later
title Repair of Aortic Regurgitation in Young Adults
spellingShingle Repair of Aortic Regurgitation in Young Adults
Barradas-Pires, Ana|||0000-0002-8246-5906
Aortic regurgitation
Aortic valve
Aortic Valve Replacement/Transcather Aortic Valve Implantation
Congenital heart disease
Echocardiography
Outcomes
Prognosis
Surgery
Treatment
Young
title_short Repair of Aortic Regurgitation in Young Adults
title_full Repair of Aortic Regurgitation in Young Adults
title_fullStr Repair of Aortic Regurgitation in Young Adults
title_full_unstemmed Repair of Aortic Regurgitation in Young Adults
title_sort Repair of Aortic Regurgitation in Young Adults
dc.creator.none.fl_str_mv Barradas-Pires, Ana|||0000-0002-8246-5906
Merás, Pablo
Constantine, Andrew
Costola, Giulia|||0000-0002-7453-7594
de la Cal, Teresa Segura|||0000-0003-0269-5574
Rafiq, Isma
Kempny, Aleksander
Li, Wei
Babu-Narayan, Sonya V.|||0000-0002-1558-8447
Hoschtitzky, J. Andreas
Gatzoulis, Michael A.
Rubio, Antonio Martinez
Dimopoulos, Konstantinos|||0000-0003-1300-0504
author Barradas-Pires, Ana|||0000-0002-8246-5906
author_facet Barradas-Pires, Ana|||0000-0002-8246-5906
Merás, Pablo
Constantine, Andrew
Costola, Giulia|||0000-0002-7453-7594
de la Cal, Teresa Segura|||0000-0003-0269-5574
Rafiq, Isma
Kempny, Aleksander
Li, Wei
Babu-Narayan, Sonya V.|||0000-0002-1558-8447
Hoschtitzky, J. Andreas
Gatzoulis, Michael A.
Rubio, Antonio Martinez
Dimopoulos, Konstantinos|||0000-0003-1300-0504
author_role author
author2 Merás, Pablo
Constantine, Andrew
Costola, Giulia|||0000-0002-7453-7594
de la Cal, Teresa Segura|||0000-0003-0269-5574
Rafiq, Isma
Kempny, Aleksander
Li, Wei
Babu-Narayan, Sonya V.|||0000-0002-1558-8447
Hoschtitzky, J. Andreas
Gatzoulis, Michael A.
Rubio, Antonio Martinez
Dimopoulos, Konstantinos|||0000-0003-1300-0504
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Aortic regurgitation
Aortic valve
Aortic Valve Replacement/Transcather Aortic Valve Implantation
Congenital heart disease
Echocardiography
Outcomes
Prognosis
Surgery
Treatment
Young
topic Aortic regurgitation
Aortic valve
Aortic Valve Replacement/Transcather Aortic Valve Implantation
Congenital heart disease
Echocardiography
Outcomes
Prognosis
Surgery
Treatment
Young
description Establishing surgical criteria for aortic valve replacement (AVR) in severe aortic regurgitation in young adults is challenging due to the lack of evidence-based recommendations. We studied indications for AVR in young adults with severe aortic regurgitation and their outcomes, as well as the relationship between presurgical echocardiographic parameters and postoperative left ventricular (LV) size, function, clinical events, and valve-related complications. Data were collected retrospectively on 172 consecutive adult patients who underwent AVR or repair for severe aortic regurgitation between 2005 and 2019 in a tertiary cardiac center (age at surgery 29 [22-41] years, 81% male). One-third underwent surgery before meeting guideline indications. Postsurgery, 65% achieved LV size and function normalization. LV ejection fraction showed no significant change from baseline. A higher presurgical LV end-systolic diameter correlated with a lack of LV normalization (odds ratio per 1-cm increase 2.81, P <0.01). The baseline LV end-systolic diameter cut-off for predicting lack of LV normalization was 43 mm. Pre- and postoperative LV dimensions and postoperative LV ejection fraction predicted clinical events during follow-up. Prosthetic valve-related complications occurred in 20.3% during an average 5.6-year follow-up. Freedom from aortic reintervention was 98%, 96.5%, and 85.4% at 1, 5, and 10 years, respectively. Young adult patients with increased baseline LV end-systolic diameter or prior cardiac surgery are less likely to achieve LV normalization after AVR. Clinicians should carefully balance the long-term benefits of AVR against procedural risks and future interventions, especially in younger patients. Evidence-based criteria for AVR in severe aortic regurgitation in young adults are crucial to improve outcomes.
publishDate 2023
dc.date.none.fl_str_mv 2
2023-01-01
2023
2023-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/290190
https://dx.doi.org/urn:doi:10.1161/JAHA.122.029251
url https://ddd.uab.cat/record/290190
https://dx.doi.org/urn:doi:10.1161/JAHA.122.029251
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
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https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
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