Prevalence of heart failure with preserved ejection fraction after surgical aortic valve replacement

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Abstract Background The prevalence of heart failure (HF) is increasing as the population ages, leading to increased hospitalizations and mortality rates. Despite advances in improving outcomes in HF, the disease often remains undiagnosed. Similarly, prevalence of aortic valvular disease is rising, leading to a growing number of surgical or transcatheter aortic valve replacement (SAVR/TAVR) procedures. However, even after successful SAVR, left ventricular structural changes do not fully reverse and patients often present with persistent symptoms. Aim We sought to evaluate prevalence of HF with preserved ejection fraction (HFpEF) in patients undergoing SAVR. Methods A retrospective registry was established to include patients who underwent successful SAVR between January 2003 and March 2024. Inclusion criteria were complete clinical and echocardiographic evaluation six months postoperatively. Exclusion criteria were previous cardiac surgery, concomitant coronary artery bypass grafting, and TAVR. HF was diagnosed according to current European Society of Cardiology guidelines. Results In total, 320 patients underwent successful SAVR. Mean age was 63.1 years (±13.3) and 189 patients (59.1%) were male. The indication for surgery was aortic stenosis in 174 patients (54.4%), aortic regurgitation in 58 patients (18.1%) and combined valve disease in 88 patients (27.5%). Six months after SAVR, 34.4% of patients were still in New York Heart Association (NYHA) class ≥ II (Figure). HFpEF was diagnosed in 77 patients (24.1%) and HF with reduced ejection fraction in 36 patients (11.3%). Significant predictors of HFpEF were patient age (OR 1.04, p=0.002), body-mass-index (BMI; OR 1.06, p=0.019), and aortic stenosis as an indication for surgery (OR 2.19, p=0.006). Preoperative NYHA class was also identified as an independent predictor (OR 1.73, p = 0.049). Conclusion Despite successful SAVR, 34.4% were still symptomatic and 24.1% of patients met the diagnostic criteria for HFpEF six months after surgery. Significant predictors of HFpEF diagnosis after SAVR were age, BMI, aortic stenosis and higher preoperative NYHA class. These results highlight the need for continued surveillance in this patient population and suggest the potential benefit of early initiation of medical therapy in patients at risk.Figure

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