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Submitted: 30 May 2007
HERDIN Record #: PCHRD052907010503

Predictors of LV function and survival after Aortic Valve Replacement (AYR) among pediatric patients with isolated chronic aortic regurgitation: A 15-year Philippine Heart Center (PHC) experience.

Jhuliet J. Balderas,
Marites R. Flores,
Ma Lourdes S. Casas

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OBJECTIVES: The aim of the study is to determine the preoperative clinical and echocardiographic parameters that affect outcome of pediatric patients with severe aortic regurgitation.

METHODS: A cohort study was done in all patients 9-19 years old who underwent aortic valve replacement from January 1988 up to December 2003. Comparison of preoperative parameters and surgical outcome was performed between group 1 (patients with preoperative LVeD>80mm) vs. group 2((LVeD<80mm). Another group comparison was also done between group A (preoperative LVEF<50 percent) and
group B (preop LVEF>50 percent). Preoperative determinants of persistent LV dimension of >60mm and LVEF<50 percent post operatively were likewise identified.

RESULTS: There was 1 operative mortality (l.9 percent) among 52 patients who underwent aortic valve replacement. The operative mortality for group 1 and group 2 was 12.5 percent and 0 percent respectively (p=0.3). Of the 51 survivors of AVR, there were 3 late deaths (5.9 percent). Late mortality rate was higher (l6 percent) in group A(LVEF<50 percent) as compared to 4% in patients with LVEF>50 percent. Persistent LV enlargement was more
common in patients with extremely dilated LV preoperatively.

CONCLUSION: Preoperative left ventricular systolic function and left ventricular end-diastolic dimension predict postoperative outcome. Patients with preoperative LV EF<50 percent and LVeD>80mm are considered high risk groups. However, operative and late survival rates are acceptable among these groups, therefore, aortic valve replacement is not contraindicated in these patients.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Journal of Cardiology
Frequency
Quarterly
Publication Date
July-September 2005
Volume
33
Issue
3
Page(s)
108-112

Objectives

General objective

To determine the preoperative clinical and echocardiographic parameters that predict outcome and presentation of good left ventricular function after aortic valve replacement among pediatric patients with isolated chronic aortic regurgitation.

Specific objectives

1. To assess the correlation of the preoperative clinical (duration of the disease, functional capacity) and echocardiographic variables( LV dimensions, ejection fraction and fractional shortening) with the postoperative outcome (survival, LV function and improvement of symptoms) among patients who underwent AVR.

2. To evaluate the results of AVR in patients with severely dilated LV( LVeD> 80 mm) and impaired LV ejection fraction.

3. To determine the predictive value of the preoperative variables in terms of persistent LV dilatation (LVeD>60mm) and low ejection fraction(LVEF<50%) despite aortic valve replacement.

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