(1) Artesis-Plantijn University College of Antwerp, Belgium
(2) University of Antwerp, Belgium
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AVR in patients with calcified aortic valve stenosis relieves the left ventricle from pressure overload. Yet, congestive heart failure (CHF) is one of the complications observed, even years after the operation. The main questions are: why do patients still develop CHF? Which types of CHF can be expected? Which predictors are known?
It has become clear that decrease in ejection fraction, which is the most commonly used parameter, occurs late in the course of aortic valve stenosis, when damage to the left ventricle has already been inflicted on this cardiac cavity. Several more sensitive imaging and Doppler parameters can demonstrate this damage earlier in the course of CAVS. This damage proves to be irreversible, at least in part. This explains the appearance of heart failure after aortic valve replacement. Although this type of heart failure is “diastolic” in nature”, a continuum with the systolic type probably exists, at least in patients with aortic valve stenosis.
Damage to the left ventricle in patients with aortic valve stenosis can go unnoticed if only ejection fraction is used as parameter. Detection of more subtle changes, even in asymptomatic patients with severe aortic valve stenosis might lead to early replacement and hence less postoperative heart failure.