754 - Left Ventricle Remodels with Worsening Function after Surgical Mechanical Aortic Valve Replacement in Young Patients with Aortic Valve Disease

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 754
Publication Number: 754.304

Snigdha Bhatia, Children's Hospital of Michigan, Detroit, MI, United States; Gilda Kadiu, Children’s Hospital of MI, Sterling Heights, MI, United States; Gautam K. Singh, Children's Hospital of Michigan, Detroit, MI, United States; Sanjeev Aggarwal, Children's Hospital of Michigan, Detroit, MI, United States

Presenting Author(s)

Snigdha Bhatia, MD (she/her/hers)

Pediatric Cardiology Fellow (PGY-5)
Children's Hospital of Michigan
Detroit, Michigan, United States

Background: Mechanical aortic valve replacement (AVR) is one of the surgical options for the management of aortic valve disease in pediatric patients. There are a few cross-sectional studies in adults reporting a decrease in left ventricle (LV) function following AVR. Possible mechanisms postulated for incomplete recovery of LV function after AVR include chronic afterload changes, LV myocardial fibrosis, and prosthesis-patient size mismatch.

Objective: We hypothesized that AVR in children and young adults with aortic valve disease may lead to a progressive decrease in LV systolic function.

Design/Methods:

This was a retrospective single-center study of patients with aortic valve dysfunction who underwent AVR between 2000 and 2020. Echocardiograms were analyzed at 4-time points: pre-operative (ECHO1), at discharge (ECHO2), at 1-year follow-up (ECHO3), and at 5-year follow-up (ECHO4). Conventional echocardiographic measures of LV function include shortening fraction (SF) by M mode method and ejection fraction (EF) by 5/6 area length method. For speckle strain analysis vendor-independent software was used (TomTec Imaging) to calculate Global longitudinal strain for endocardium (GLSendo) and myocardium (GLSmyo) from the apical views and global circumferential strain for endocardium (GCSendo) and myocardium (GCSmyo) at papillary muscle levels. Repeated measure ANOVA (SPSS Inc.) was used to compare various echo parameters and a p-value < 0.05 was considered significant.

Results:

Our cohort included 15 subjects, 11 (73%) of whom were males and had a mean (SD) age of 19.1 (9.0) years at the time of surgery. The primary indications for surgery included aortic valve stenosis in 3 (20%), both aortic stenosis and insufficiency in 7 (46.6 %), and aortic insufficiency in 5 (33.3%) subjects. LV end-systolic GLSendo, GLSmyo, GCSendo, GCSmyo showed significant worsening in the postoperative period, compared to baseline prior to AVR (Table 1). The LV dysfunction persisted through the 1 and 5-year follow-up, compared to baseline. There was no significant change in conventional measures such as SF and EF from pre-operative echocardiogram.

Conclusion(s):

Conclusion:

Children and young adults undergoing AVR for aortic valve disease have a decrease in LV function, as assessed by speckle tracking echocardiography, in the early postoperative period, which persists on 5-year follow-up. Further long-term longitudinal analysis with a larger sample size is required to assess the effect of these surgical procedures on LV function.