Patients
This retrospective observational study included 38 patients with chronic
severe AR and reduced LVEF (LVEF < 50%) for whom surgery had
been indicated. We performed LDSE before surgery at Tokyo Women’s
Medical University Hospital, Japan, from July 2011 to November 2014. The
severity of AR was diagnosed and graded by Doppler and colour Doppler
echocardiography.11Regarding indications for surgery, we followed the American Heart
Association/American Colleague of Cardiology and European Society of
Cardiology guidelines, in which surgery is recommended for all
symptomatic patients and asymptomatic patients presenting severe AR and
impaired function at rest (pre-operative LVEF <
50%).12
13 Patients with acute AR, coronary
artery disease, aortic stenosis, significant mitral stenosis and
regurgitation or previous aortic and mitral valve surgery were excluded.
Of the 38 patients, 31 were included in our final analysis, excluding 3
who did not undergo surgery and 4 who had insufficient echocardiographic
data after surgery.
The clinical parameters, including the New York Heart Association
functional class, were recorded. Echocardiography, including LDSE, was
performed in the pre-operative period, and follow-up echocardiography
was performed in the late post-operative period [within 4.6 (range,
2.7–5.7] years].
For valve origin disease, aortic valve replacement with a bioprosthesis
(15 patients) or a mechanical prosthesis (13 patients) was performed.
For aortic root origin disease, Bentall operation (3 patients) was
performed.
This study was conducted in accordance with the principles of the
Helsinki Declaration. The review board of Tokyo Women’s Medical
University Hospital approved the protocol.