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Predictors of long-term survival after valve replacement for chronic aortic regurgitation; is M-mode echocardiography

R Corti1, C Binggeli, M Turina

  • 1Division of Cardiology, University Hospital, Zurich, Switzerland.

European Heart Journal
|May 15, 2001
PubMed

Insights

Pre-operative echocardiography is valuable for predicting long-term survival in patients with aortic valve regurgitation, complementing clinical and angiographic data for better surgical decisions and risk stratification.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Diagnostic Imaging

Background:

  • The prognostic value of pre-operative and follow-up echocardiography in chronic severe aortic regurgitation surgery remains debated.
  • Direct comparisons between M-mode echocardiography and clinical/angiographic data for prognosis are limited.

Purpose of the Study:

  • To evaluate the prognostic significance of pre-operative and post-operative echocardiographic parameters in patients undergoing surgery for chronic severe aortic regurgitation.
  • To compare the predictive value of echocardiography with clinical and angiographic data for long-term survival.

Main Methods:

  • Analysis of clinical, echocardiographic, and angiographic data from 125 patients operated on for aortic regurgitation between 1975 and 1983.
  • Long-term follow-up (13.3+/-6.4 years) with univariate and multivariate survival analyses.
  • Comparison of pre-operative parameters (age, NYHA class, ventricular volumes, ejection fraction, end-systolic dimension, shortening fraction) and post-operative changes.

Main Results:

  • Ten and 20-year survival rates were 77% and 48%, respectively.
  • Pre-operative predictors of survival included age, NYHA class, angiographic volumes, ejection fraction, and M-mode echocardiographic end-systolic dimension and shortening fraction.
  • Multivariate analysis identified angiographic end-systolic volume index, age, and pre-operative NYHA class as independent predictors. A post-operative end-diastolic dimension reduction >20% significantly improved late survival (74% vs. 44% at 20 years).

Conclusions:

  • Long-term survival after aortic valve replacement for chronic regurgitation is primarily determined by age, pre-operative NYHA class, and left ventricular systolic function.
  • Echocardiography, despite a slightly lower predictive value than angiography, is sufficient for clinical decision-making.
  • Post-operative echocardiography aids in assessing left ventricular function recovery and risk stratification.
Abstract

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