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.