LVEF pre and post AVR

[Nocturne]

i understand the basic concept of how LVEF is typically impaired as AS progresses, and that it is one of the markers looked at to determine when AVR should take place.

I have also read studies of outcomes from surgeries years past revealed that outcomes were generally better for people who had their AVR at higher levels of LV functioning.

Has this resulted in a change of recommendation as to when to proceed with AVR?

And to what degree is LVEF typically restored after AVR? Is it always considered "impaired" afterwards, or do some patients gain fully normal LVEF?

It is my understanding (and I may be wrong here) that if you wait too long for AVR, LVEF can be permanently impaired.

 

[ashadds]

i understand the basic concept of how LVEF is typically impaired as AS progresses, and that it is one of the markers looked at to determine when AVR should take place.

I have also read studies of outcomes from surgeries years past revealed that outcomes were generally better for people who had their AVR at higher levels of LV functioning.

Has this resulted in a change of recommendation as to when to proceed with AVR?

And to what degree is LVEF typically restored after AVR? Is it always considered "impaired" afterwards, or do some patients gain fully normal LVEF?

It is my understanding (and I may be wrong here) that if you wait too long for AVR, LVEF can be permanently impaired.

It is my understanding that LVEF is a criteria for AVR. I have read resources that say that LVEF recovers after AVR and enters the normal range 55-75 unless its not too impaired.

 

[Superman]

The short answer is that waiting too long can do permanent damage. So you work with your cardiologist and surgeon to best determine the right time.

 

[dick0236]

It is my understanding (and I may be wrong here) that if you wait too long for AVR, LVEF can be permanently impaired.

I think you are absolutely correct. Waiting too long for corrective heart surgery probably will permanently impair your heart and lead to a poor quality of life before causing your earlier than normal death. Like Superman says "you work with your cardio and surgeon to best determine the right time"......and then you "git 'er dun". OHS is only a bump in the road and life goes on afterwords.

 

[neil]

spot on there

 

[epstns]

Agreed. That is the value, I think, of having a close working relationship with your cardio. My EF never went down enough to be of concern, but they did watch it closely at every echo.

 

[Warrick]

i understand the basic concept of how LVEF is typically impaired as AS progresses, and that it is one of the markers looked at to determine when AVR should take place.

I have also read studies of outcomes from surgeries years past revealed that outcomes were generally better for people who had their AVR at higher levels of LV functioning.

Has this resulted in a change of recommendation as to when to proceed with AVR?

And to what degree is LVEF typically restored after AVR? Is it always considered "impaired" afterwards, or do some patients gain fully normal LVEF?

It is my understanding (and I may be wrong here) that if you wait too long for AVR, LVEF can be permanently impaired.

Yes it has resulted in a change in recommendation, when my father had AVR over 30 years ago he could barely walk 10 metres , its a bit like over inflating an inner tube once it's gone too far it won't come back.

I have fully regained normal LVEF and it has returned to normal size which I was told is uncommom but it clearly does happen so there is a chance

The longer you wait the more the damage is irreversable, and the small but significant risk of cardiac arrest increases

 

[MethodAir]

Yes it has resulted in a change in recommendation, when my father had AVR over 30 years ago he could barely walk 10 metres , its a bit like over inflating an inner tube once it's gone too far it won't come back.

I have fully regained normal LVEF and it has returned to normal size which I was told is uncommom but it clearly does happen so there is a chance

The longer you wait the more the damage is irreversable, and the small but significant risk of cardiac arrest increases

Not suggesting anyone delay surgery when they need it, but each case is different. This guy's end diastolic left ventricle size was 10.00 cm with an ejection fraction of 10%. He regained normal size and function:

http://circheartfailure.ahajournals....ntent/7/6/1063

He had normal coronary arteries, his cardiac muscle cells were stretched, not dead. In some cases, the internal structure of the cell can recover over time.

 

[matty]

I had severe lv hypertrophy prior to my valve replacement so was interested in remodelling after aortic valve replacement surgery. This probably does not pertain to you but I also have hypertension. The hypertension was not managed properly at the time of surgery but some reading I did suggested that for optimal remodeling (which I guess is related to improved LVEF) I had to have my hypertension properly managed.
My surgery was about 4 months ago and for the last month I've been cycling to work. I was concerned about this stress on my healing heart but i found this paper which made me feel better;

https://www.ncbi.nlm.nih.gov/pubmed/21404903

Though the above paper does run contrary to what I was told at cardiac rehab, which is that it is best to undertake only light to moderate exercise after avr ?!?! Lots of conflicting information out there but in my case I'm keeping my blood pressure at about 120/80 and doing a lot of walking and cycling with moderate effort to hopefully give my heart it's best chance at remodeling. Will find out September next year at my next echo, fingers crossed.

 

[MethodAir]

I had severe lv hypertrophy prior to my valve replacement so was interested in remodelling after aortic valve replacement surgery. This probably does not pertain to you but I also have hypertension. The hypertension was not managed properly at the time of surgery but some reading I did suggested that for optimal remodeling (which I guess is related to improved LVEF) I had to have my hypertension properly managed.
My surgery was about 4 months ago and for the last month I've been cycling to work. I was concerned about this stress on my healing heart but i found this paper which made me feel better;

https://www.ncbi.nlm.nih.gov/pubmed/21404903

Though the above paper does run contrary to what I was told at cardiac rehab, which is that it is best to undertake only light to moderate exercise after avr ?!?! Lots of conflicting information out there but in my case I'm keeping my blood pressure at about 120/80 and doing a lot of walking and cycling with moderate effort to hopefully give my heart it's best chance at remodeling. Will find out September next year at my next echo, fingers crossed.

The case study mentions heart dilation (not hypertrophy), so different rules may apply. Unfortunately, cardiology tends to have the same exercise recommendations for both.