Early myocardial remodeling following surgical aortic valve replacement in patients with aortic valve disease: A single-center experience

Abstract: BACKGROUND: Aortic valve disease leads to eccentric or concentric left ventricular (LV) hypertrophy and changes in the LV function, which results from cellular (hypertrophy) and extracellular matrix expansion (interstitial fibrosis). The goal of aortic valve replacement (AVR) is to alleviate the pressure and volume overload on the LV, allowing myocardial remodelling and regression of LV mass. OBJECTIVES: This study aims to characterize and assess early LV remodelling in patients with severe aortic valve stenosis and/or moderate-to-severe aortic regurgitation after AVR and assess its prognostic impact. MATERIALS AND METHODS: This prospective study of 82 patients with aortic valve disease was conducted in the department of cardiovascular and thoracic surgery between October 2023 and October 2025. All patients undergoing AVR exclusively over 2 years were included in the study. Patients were assessed at 1 week, 6 weeks, 3 months, and 6 months after AVR by transthoracic echocardiography. Peak and mean pressure gradients across the aortic valve, LV ejection fraction, fractional shortening, LV dimensions, and LV mass, along with other hemodynamic parameters, were measured in the pre- and postoperative period. RESULTS: A total of 82 patients with different aortic valve lesions who underwent AVR were evaluated. All but one child (aged 14 years) were adults with a median age of 54 years ± 15.6 years, including 64 males and 18 females. The LV mass index (LVMI) regression occurred over time in all patients who underwent AVR. Mean LVMI decreased to 148.2 ± 54.7 g/m 2 at 1 week, 122.8 ± 44.4 g/m 2 at 6 weeks, 116.4 ± 38.6 g/m 2 at 3 months, and 110.9 g/m 2 at 6 months of AVR from its baseline value of 178.8 ± 56.9 g/m 2 ( P < 0.001). LV end-diastolic dimension improved significantly ( P < 0.001) from preoperative mean value of 52.24 ± 12.17 mm to 42.23 ± 12.25 mm at 1 week, 38.66 ± 12.9 mm at 6 weeks, 36.16 ± 7.24 at 3 months, and 35.17 ± 8.70 at 6 months. Reduction continued significantly up to 6 months in respect to values at 1 week. CONCLUSION: Marked reduction in LV mass and reverse myocardial remodeling was observed after AVR as early as 1 week, and further reduction continued up to 6 weeks. However, regression thereafter was not statistically significant.