Background Alterations in left ventricular (LV) diastolic function following native tissue-preserving aortic valve (AV) procedures have not been systematically investigated. Furthermore, no comparisons have been made between these changes and those observed after prosthetic AV replacement.

Methods From October 2017 to August 2020, 74 patients aged <65 years were referred to our institution for elective AV surgery. Preoperative and postoperative (i.e., discharge, 3-month and 1-year follow-up) transthoracic echocardiography was analyzed.

Results Native tissue-preserving surgery was performed in 55 patients (AV repair: n = 42, Ross procedure: n = 13). The remaining 19 patients underwent prosthetic AV replacement. Preoperatively and at discharge, transvalvular hemodynamics and LV diastolic function were comparable in both groups. At 1-year follow-up, native valve (NV) patients showed significantly lower mean transvalvular gradient (7 ± 5 vs. 9 ± 3 mmHg, p = 0.046) and peak velocity (1.74 ± 0.51 vs. 2.26 ± 0.96 m/s, p = 0.004), and significantly better septal e′ (9.1 ± 2.7 vs. 7.7 ± 2.5 cm/s, p = 0.043) and lateral e′ (14.7 ± 3.1 vs. 11.7 ± 3.7 cm/s, p = 0.001). From preoperatively to 1-year postoperatively, septal and lateral e′ and E/e′ improved markedly after NV preservation (septal e′: +0.7 cm/s, p = 0.075; lateral e′: +2.3 cm/s, p < 0.001; E/e′: −1.5, p = 0.001) but not after AV replacement (septal e′: +0.2 cm/s, p = 0.809; lateral e′: +0.8 cm/s, p = 0.574; E/e′: −1.2, p = 0.347). Significant negative linear correlations between postoperative transvalvular gradients and absolute changes in lateral e′ and E/e′ were detected during follow-up.

Conclusion Preservation of native tissue in AV surgery results in superior transvalvular hemodynamics compared with prosthetic AV replacement. This may induce faster LV reverse remodeling and may explain more pronounced improvement in LV diastolic function.

背景 保留主动脉瓣 (AV) 手术后左心室 (LV) 舒张功能的改变尚未得到系统研究。此外，尚未对这些变化与假体 AV 置换后观察到的变化进行比较。

方法 2017年10月至2020年8月，74例年龄<65岁的患者被转诊到我院进行择期AV手术。分析术前和术后（即出院、3 个月和 1 年随访）经胸超声心动图。

结果 55 名患者进行了自然组织保留手术（AV 修复：n  = 42，Ross 手术：n  = 13）。其余 19 名患者接受了假体 AV 置换术。术前和出院时，两组的跨瓣血流动力学和左心室舒张功能相当。在 1 年随访中，自体瓣膜 (NV) 患者表现出显着较低的平均跨瓣压差（7 ± 5 与 9 ± 3 mmHg，p = 0.046）和峰值速度（1.74 ± 0.51与 2.26 ± 0.96 m/s） ，p = 0.004），并且间隔 e′（9.1 ± 2.7 对比 7.7 ± 2.5 cm/s， p  = 0.043）和侧 e′（14.7 ± 3.1 对比 11.7 ± 3.7 cm/s，p  = 0.001） 明显更好。从术前到术后 1 年，保留 NV 后，间隔和外侧 e′ 和 E/e′ 显着改善（间隔 e′：+0.7 cm/s，p = 0.075；外侧 e′：+2.3 cm/ s  ，p  < 0.001；E/e′：-1.5，p  = 0.001），但在 AV 置换后则不然（隔膜 e′：+0.2 cm/s，p  = 0.809；侧向 e′：+0.8 cm/s，p  = 0.574；E/ e′：-1.2，p  = 0.347）。随访期间检测到术后跨瓣梯度与横向 e' 和 E/e' 的绝对变化之间存在显着的负线性相关性。

结论 与人工 AV 置换术相比，AV 手术中保留原生组织可带来更优越的跨瓣血流动力学。这可能会导致更快的左心室逆重塑，并可能解释左心室舒张功能更明显的改善。