Background: Aortic stenosis leads to restricted blood outflow from the left ventricle (LV), causing
chronic pressure overload, ventricular remodeling, and eventually heart failure. Surgical
aortic valve replacement (SAVR) is known to promote reverse remodeling, which involves
physiological and structural adaptation of the heart following the cessation of pressure
overload. This study investigates the impact of SAVR in 112 in reverse remodeling.
Methods: We analyzed patients’ characteristics and performed measurements before surgery,
at 4 to 6 days, 6 months, and 12 months post-SAVR. These included: Heart failure evaluation
via New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) scoring.
Quality of life assessments were performed using the Kansas City Cardiomyopathy and
SF-12. Echocardiographic parameters: aortic flow velocity, regurgitation, aortic valve
area, LV ejection fraction (LVEF), LV and atrial volumes, interventricular septum
and posterior wall thickness, mitral inflow, mitral annulus movement, and TAPSE for
right ventricular function. Biomarkers for myocardial stretch and cardiac damage,
kidney function, liver function, lipid profile, and proteomics of EDTA plasma. Histological
analysis of perioperative LV biopsies for structural and fibrosis characterization.
Results: All patients survived SAVR, with significant reductions in maximal aortic blood flow
velocity observed in both sexes at 4 to 6 days post-surgery. Although female patients
had greater initial LV hypertrophy, they demonstrated faster reverse remodeling than
males. LVEF increased in both sexes. Sex-dependent differences in NT-proBNP levels
were observed during remodeling. SAVR improved NYHA and CCS scores for both sexes,
with women showing higher initial NYHA scores. Analysis of differentially expressed
circulating mRNAs identified pathways related to matrisome, fibroblast activation,
cell–cell contact, and immune response. A principal component analysis revealed distinct
sex-based transcriptomic profiles during reverse remodeling.
Conclusion: SAVR effectively restored normal LV-to-aortic blood flow, reversed cardiac remodeling,
and improved NYHA and CCS scores in both sexes. However, women presented for surgery
at a more advanced age, with greater hypertrophy and were more prone to kidney dysfunction.
This study highlights sex-based differences in the dynamics of reverse remodeling,
suggesting that detailed analysis of echocardiographic parameters and fluid biopsies
may help identify non-responders earlier, allowing for optimized interventions.
