Repair of Aortic Regurgitation in Young Adults : Sooner Rather Than Later
Barradas-Pires, Ana (Universitat Autònoma de Barcelona. Departament de Medicina)
Merás, Pablo (Hospital Universitario La Paz (Madrid))
Constantine, Andrew (Imperial College London)
Costola, Giulia (Guy's and St Thomas' NHS Foundation Trust)
de la Cal, Teresa Segura (Hospital 12 de Octubre (Madrid))
Rafiq, Isma (Guy's and St Thomas' NHS Foundation Trust)
Kempny, Aleksander (Imperial College London)
Li, Wei (Imperial College London)
Babu-Narayan, Sonya V. (Imperial College London)
Hoschtitzky, J. Andreas (Guy's and St Thomas' NHS Foundation Trust)
Gatzoulis, Michael A. (Imperial College London)
Rubio, Antonio Martinez (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Dimopoulos, Konstantinos (Imperial College London)

Data:	2023
Resum:	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.
Drets:	Aquest 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.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Aortic regurgitation ; Aortic valve ; Aortic Valve Replacement/Transcather Aortic Valve Implantation ; Congenital heart disease ; Echocardiography ; Outcomes ; Prognosis ; Surgery ; Treatment ; Young
Publicat a:	Journal of the American Heart Association. Cardiovascular and cerebrovascular disease, Vol. 12 (september 2023) , ISSN 2047-9980

DOI: 10.1161/JAHA.122.029251
PMID: 37721152

11 p, 1.2 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d’Investigació i Innovació Parc Taulí (I3PT)
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