{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T21:34:23Z","timestamp":1769117663671,"version":"3.49.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>\n            Objective\u2003Long-term prognosis of patients with aortic regurgitation (AR) and reduced left ventricular ejection fraction (LVEF) who undergo aortic valve surgery (AVS) is unknown. Due to the congenital origin, bicuspid aortic valve (BAV) morphotype might be associated with a more severe cardiomyopathy. We aimed to evaluate the LVEF recovery after aortic valve replacement (AVR) surgery in patients with AR and reduced preoperative LVEF.<\/jats:p><jats:p>\n            Methods\u2003This retrospective analysis included 1,170 consecutive patients with moderate to severe AR who underwent AVS at our institution between January 2005 and April 2016. Preoperative echocardiography revealed 154 (13%) patients with predominant AR and baseline LVEF\u2009&lt;\u200950%. A total of 60 (39%) patients had a BAV (BAV group), while the remaining 94 (61%) patients had a tricuspid morphotype (tricuspid aortic valve [TAV] group). Follow-up protocol included clinical interview using a structured questionnaire and echocardiographic follow-up.<\/jats:p><jats:p>\n            Results\u2003A total of 154 patients (mean age 63.5\u2009\u00b1\u200912.4 years, 71% male) underwent AVS for AR in the context of reduced LVEF (mean LVEF 42\u2009\u00b1\u20098%). Fifteen (10%) patients had a severely reduced preoperative LVEF\u2009\u2264\u200930%. Mean STS (Society of Thoracic Surgeons) score was 1.36\u2009\u00b1\u20091.09%. Mean follow-up was comparable between both the study groups (BAV: 50\u2009\u00b1\u200940 months vs. TAV: 40\u2009\u00b1\u200938 months, p\u2009=\u20090.140). A total of 25 (17%) patients died during follow-up. Follow-up echocardiography demonstrated similar rate of postoperatively reduced LVEF in both groups (i.e., 39% BAV patients vs. 43% TAV patients; p\u2009=\u20090.638). Cox's regression analysis showed no significant impact of BAV morphotype (i.e., as compared with TAV) on the postoperative LVEF recovery (odds ratio [OR]: 1.065; p\u2009=\u20090.859). Severe left ventricular (LV) dysfunction at baseline (i.e., LVEF\u2009\u2264\u200930%) was a strong predictor for persistence of reduced LVEF during follow-up (OR: 3.174; 95% confidence interval: 1.517\u20136.640; p\u2009=\u20090.002). Survival was significantly reduced in patients with persisting LV dysfunction versus those in whom LVEF recovered (log rank: p\u2009&lt;\u20090.001).<\/jats:p><jats:p>\n            Conclusion\u2003Our study demonstrates that reduced LVEF persists postoperatively in 40 to 45% patients who present with relevant AR and reduced LVEF at baseline. Postoperative LVEF recovery is independent of aortic valve morphotype (i.e., BAV vs. TAV). Severe LV dysfunction (LVEF\u2009\u2264\u200930%) at baseline is a strong predictor for persistence of reduced LVEF in patients with AR and results in significantly reduced long-term survival.<\/jats:p>","DOI":"10.1055\/s-0039-1692664","type":"journal-article","created":{"date-parts":[[2019,7,12]],"date-time":"2019-07-12T23:03:02Z","timestamp":1562972582000},"page":"389-395","source":"Crossref","is-referenced-by-count":8,"title":["Persistence of Reduced Left Ventricular Function after Aortic Valve Surgery for Aortic Valve Regurgitation: Bicuspid versus Tricuspid"],"prefix":"10.1055","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3415-3385","authenticated-orcid":false,"given":"Johannes","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5930-9710","authenticated-orcid":false,"given":"Shiho","family":"Naito","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana","family":"Sequeira Gross","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Massel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermann","family":"Reichenspurner","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evaldas","family":"Girdauskas","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,7,12]]},"reference":[{"issue":"13","key":"ref1","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/S0195-668X(03)00201-X","article-title":"A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease","volume":"24","author":"B Iung","year":"2003","journal-title":"Eur Heart 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Surg"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.athoracsur.2008.12.086","article-title":"Indexed left ventricular dimensions best predict survival after aortic valve replacement in patients with aortic valve regurgitation","volume":"87","author":"M L Brown","year":"2009","journal-title":"Ann Thorac Surg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1007\/s00246-012-0529-8","article-title":"Predicting left ventricular recovery after replacement of a regurgitant aortic valve in pediatric and young adult patients: is it ever too late?","volume":"34","author":"D A Cox","year":"2013","journal-title":"Pediatr Cardiol"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1093\/icvts\/ivv365","article-title":"Aortic valve replacement for severe aortic regurgitation in asymptomatic patients with normal ejection fraction and severe left ventricular dilatation","volume":"22","author":"Y Wang","year":"2016","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/ejcts\/ezx018","article-title":"Early surgery versus conventional treatment for asymptomatic severe aortic regurgitation with normal ejection fraction and left ventricular dilatation","volume":"52","author":"Y Wang","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0894-7317(89)80014-8","article-title":"Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. 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