Left ventricular performance in aortic valve replacement

We analyzed the mid-term left ventricular (LV) performance after aortic valve replacement (AVR). We measured LV contractility (endsystolic elastance: Ees), afterload (effective arterial elastance: Ea) and efficiency (ventriculoarterial coupling: EayEes; ratio of stroke work and pressure-volume area: SWyPVA) based on transthoracic echocardiography data obtained before, after and approximately 1 year after isolated AVR in 263 patients with aortic stenosis (AS group; ns116), aortic regurgitation (AR group; ns93) or aortic stenosis and regurgitation (ASR group; ns54). The LV volume was calculated by the Teichholz M-mode method. Ees and Ea were approximated as follows: Eessmean blood pressureyminimal LV volume; Eassystolic blood pressurey(maximal LV volume–minimal LV volume). Thereafter, EayEes and SWyPVA were calculated. Arterial blood pressure was measured using manchette methods. Ees and Ea decreased after AVR in the AS group, but increased in the AR group. EayEes and SWyPVA worsened after AVR in the AR group, but improved during a 1-year period after AVR in all groups. Contrasting effects of AVR on LV contractility and afterload between AS and AR were clearly demonstrated. The mid-term LV contractility and efficiency after AVR were excellent and satisfactory. However, LV efficiency worsened early after AVR in AR patients. 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.