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Valve-sparing Root Reimplantation In Patients With Left Ventricular Dysfunction
William L. Patrick, Jake L. Rosen, Joseph E. Bavaria, John J. Kelly, Andrew Freas, Sania Ahmed, Siddharth Yarlagadda, Joshua C. Grimm, Wilson Y. Szeto, Nimesh D. Desai.
University of Pennsylvania, Philadelphia, PA, USA.

OBJECTIVE:
Recent evidence suggests that left ventricular (LV) systolic dysfunction predicts late AI following valve-sparing root reimplantation (VSRR). If true, this may influence guidelines towards earlier intervention in patients with preserved LV function for whom VSRR is indicated. We evaluated the hypothesis that LV dysfunction predicts late AI following VSRR.
METHODS:
We performed a retrospective analysis of patients undergoing elective VSRR at a single intuition between 2000 and 2021. Patients with an indexed left ventricular internal diameter during systole (iLVIDS) of ≥2cm/m2were categorized as having LV dysfunction. The primary outcomes were AI grade >2 and re-intervention. Unadjusted cumulative incidences of the primary and secondary outcomes were compared using a Log-rank test and adjusted using a Cox-proportional hazards model. Where appropriate, the competing risk of death was accounting for. A multilevel mixed-effects ordered logistic regression was performed to asses increases in AI grade overtime.
RESULTS: There were 295 patients, of whom 52 had LV dysfunction. All patients were discharged with AI grade ≤1. There was no unadjusted difference in the incidence of AI at 10 years between those with compared to without LV dysfunction (10%, 95% CI <1% to 22% vs. 7%, 95% CI 2% to 12%; p = 0.73) (Figure). After adjustment and accounting for the competing risk of death LV dysfunction was unassociated with an increased risk of AI at 10 years (HR 0.88, 95% CI 0.21 to 3.67, p = 0.88). After accounting for correlation between repeated measures, LV dysfunction was not associated with an increasing odds of AI overtime (OR = 1.12, 95% CI 0.54 to 2.31, p = 0.77). No patients in the LV dysfunction group have undergone re-intervention.
CONCLUSIONS:
In patients with LV dysfunction VSRR was not associated with late AI grade >2 or re-operation.


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