CONGRESS ABSTRACT

Background: Severe native aortic regurgitation is characterized by volume overload and structural myocardial changes leading to progressive left ventricular dysfunction. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) may favor left ventricle reverse remodeling (LVRR). Objectives: To evaluate the immediate and mid-term LVRR in patients treated for pure aortic regurgitation and to define the best predictors of LVRR among echocardiographic parameters. Methods: 55 patients undergoing SAVR or TAVI for pure aortic regurgitation for native valve disease or bioprosthetic degeneration were included in this retrospective study. All patients underwent a complete echocardiographic examination before the procedure, in the early postoperative period, and at mid-term follow-up. The Wilcoxon test was used to assess reverse remodeling, multiple logistic regression analyses were performed to find the echocardiographic predictors. Results: LVRR, defined as a reduction in systolic and diastolic diameters and volumes, was observed in both the TAVI and SAVR groups at different times: for the TAVI group, at mid-term follow-up (left ventricle end diastolic diameter: 47 mm [IQR 45-54] from 60 mm [IQR 57-63], p < 0.01; left ventricle end systolic diameter: 32 mm [IQR 28-46], from 45 mm [IQR 36-48], p < 0.01); left ventricle end diastolic volume: 107 ml [IQR 95.5-134], from 145 ml [IQR 116-190], p<0.01; left ventricle end systolic volume: 54 ml [IQR 41-77 ml], from 75 ml [IQR 47-103], p < 0.01), while for the SAVR group, it was already observed at early follow-up (p < 0.01) (left ventricle end diastolic diameter: 45.5 mm [IQR 44-49 mm], from 60 mm [IQR 57-63], p < 0.01; left ventricle end systolic diameter: 33 mm [IQR 29.75-36 mm], from 42 mm [IQR 36.75-46.5], p < 0.01; left ventricle end diastolic volume: 126.5 ml [IQR 101-171.8], from 168.5 ml [IQR 147.2-213], p<0.01; left ventricle end systolic volume 54 ml [IQR 40-88], from 73 ml [IQR 62-98.25], p<0.01) and maintained at mid-term evaluation. An increase in Généreux stages was independently associated with a reduction in the probability of left ventricle reverse remodeling both at early and mid-term follow-up. Conclusions: Our study demonstrated that LVRR occurred in patients with pure aortic regurgitation, both for the TAVI and SAVR groups and that as Généreux stages increase, the probability of LVRR reduces. This is a critical prognostic factor.