Effect of aortic valve replacement on left ventricular systolic function, left ventricular mass index reduction and clinical outcome in early post-operative period in patients with aortic stenosis

Background: Aortic stenosis (AS) causes chronic left ventricular pressure overload, resulting in ventricular hypertrophy, remodeling and progressive impairment of ventricular function. Aortic valve replacement (AVR) relieves the pressure overload, but the extent of early ventricular recovery remains clinically important. This study evaluated early changes in left ventricular ejection fraction (LVEF), left ventricular mass (LVM), left ventricular mass index (LVMI), relative wall thickness (RWT), hemodynamic parameters and functional status following surgical AVR. Methods: This prospective observational study included 40 adult patients with AS who underwent isolated surgical AVR at the National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh, from July 2017 to June 2018. Preoperative and early postoperative echocardiographic parameters were compared. Clinical outcomes included NYHA functional class, aortic valve pressure gradient, ICU stay and postoperative complications. Results: The mean age was 39.23±12.41 years; 25 (62.5%) patients were male and 15 (37.5%) were female. Mean LVEF increased significantly from 46.30±7.07% preoperatively to 50.83±6.06% postoperatively (p=0.001). Mean LVM decreased from 407.92±157.05 g to 304.49±132.73 g (p=0.001), while LVMI decreased from 220.32±102.58 to 160.57±86.94 (p=0.001). The mean aortic valve pressure gradient decreased from 54.59±4.41 to 12.37±6.60 mmHg (p<0.0001). NYHA functional class improved from 2.83±0.38 to 1.07±0.25 (p<0.001). RWT decreased from 0.4738±0.074 to 0.4227±0.086 (p<0.003). One patient (2.5%) developed prosthesis-patient mismatch and one (2.5%) developed paravalvular leakage. Two deaths were reported during the study period. Conclusions: Surgical AVR was associated with significant early improvement in left ventricular systolic function, regression of left ventricular mass and LVMI, reduction in transvalvular pressure gradient, and improvement in functional status within four weeks. These findings suggest that relief of aortic obstruction is associated with early favorable ventricular remodeling in patients with AS.