Predictors of LV function and survival after Aortic Valve Replacement (AYR) among pediatric patients with isolated chronic aortic regurgitation: A 15-year Philippine Heart Center (PHC) experience.

OBJECTIVES: The aim of the study is to determine the preoperative clinical and echocardiographic parameters that affect outcome of pediatric patients with severe aortic regurgitation.

METHODS: A cohort study was done in all patients 9-19 years old who underwent aortic valve replacement from January 1988 up to December 2003. Comparison of preoperative parameters and surgical outcome was performed between group 1 (patients with preoperative LVeD>80mm) vs. group 2((LVeD<80mm). Another group comparison was also done between group A (preoperative LVEF<50 percent) and
group B (preop LVEF>50 percent). Preoperative determinants of persistent LV dimension of >60mm and LVEF<50 percent post operatively were likewise identified.

RESULTS: There was 1 operative mortality (l.9 percent) among 52 patients who underwent aortic valve replacement. The operative mortality for group 1 and group 2 was 12.5 percent and 0 percent respectively (p=0.3). Of the 51 survivors of AVR, there were 3 late deaths (5.9 percent). Late mortality rate was higher (l6 percent) in group A(LVEF<50 percent) as compared to 4% in patients with LVEF>50 percent. Persistent LV enlargement was more
common in patients with extremely dilated LV preoperatively.

CONCLUSION: Preoperative left ventricular systolic function and left ventricular end-diastolic dimension predict postoperative outcome. Patients with preoperative LV EF<50 percent and LVeD>80mm are considered high risk groups. However, operative and late survival rates are acceptable among these groups, therefore, aortic valve replacement is not contraindicated in these patients.