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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2008 August;21(4):189-93
Impact of preoperative left ventricular fibrosis on the mid-term outcome and brain natriuretic peptide after aortic valve replacement
Sakamoto Y. 1, Hashimoto K. 1, Okuyama H. 1, Ishii S. 1, Taguchi S. 1, Naganuma H. 1, Kagawa H. 1, Morita K. 1, Kanazawa T. 2
1 Department of Cardiovascular Surgery Jikei University School of Medicine, Tokyo, Japan
2 Kuroda hospital, Department of Internal Medicine Tokyo, Japan
Aim. The aim of the study was to investigate the impact of preoperative left ventricular (LV) fibrosis on the mid-term outcome after aortic valve replacement (AVR) and clarify a degree of LV hypertrophy that predicts postoperative reversibility from preoperative LV remodeling. We also investigated the relation between brain natriuretic peptides (BNP) concentration after AVR and preoperative % fibrosis.
Methods. Sixteen patients who underwent single AVR and LV endomyocardial biopsy at the operation were enrolled. The mean follow-up was 7.4±0.6 years. Series of echocardiographic examination were performed preoperatively and postoperatively in all patients. On the day of final echocardiography in this follow-up, BNP concentration was measured in 10 patients.
Results. Preoperative % LV fibrosis was 26.0±9.2%. Left ventricular mass index (LVMI) decreased significantly from 201±92 to 143±79 g/m2 with returning to normal after operation in 9 out of 16 patients. These 9 patients had the LVMI less than 200g/m2 before the operation. There was significant difference in the degree of the preoperative LV fibrosis between the patients with normalization of LVMI after operation and the patients without (22.6 ±7.0% versus 30.4±10.3%, p=0.0456). The BNP concentration at 7.4±0.6 years after operation also demonstrated good correlation with the preoperative LV fibrosis.
Conclusion. Preoperative LVMI less than 200g/m2 can be a reliable predicator of reversible LV remodeling after the valve replacement. The patients with preoperative severe LV fibrosis demonstrated the higher postoperative BNP value even after the AVR and needed more time to recover from LV structural abnormalities.