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Published on: December 11, 2017
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
Summary
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.
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