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Aortic Regurgitation With Markedly Reduced Left Ventricular Function Is Not a Contraindication for Aortic Valve
Tsuyoshi Kaneko1, Julius I Ejiofor1, Robert C Neely1
1Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
The Annals of Thoracic Surgery
|March 28, 2016
Summary
Aortic valve replacement (AVR) for aortic regurgitation (AR) shows similar outcomes for patients with low ejection fraction (EF) as those with moderate or preserved EF. This study highlights comparable survival rates and improved heart function post-surgery across all groups.
Area of Science:
- Cardiovascular Surgery
- Cardiac Physiology
Background:
- Assesses outcomes and risk factors for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR).
- Compares patients with markedly reduced left ventricular (LV) function (EF ≤35%) to those with moderate (36-50%) and preserved (>50%) LV function.
Purpose of the Study:
- To evaluate the impact of preoperative left ventricular ejection fraction (LVEF) on AVR outcomes.
- To identify risk factors influencing survival after AVR in patients with varying degrees of LV dysfunction.
Main Methods:
- Retrospective analysis of 485 consecutive patients undergoing AVR for severe AR between 2002 and 2013.
- Patients categorized into low EF (≤35%), moderate (36-50%), and preserved (>50%) LVEF groups.
- Cox proportional hazard modeling used to identify predictors of survival.
Main Results:
- Operative mortality was low (1.9%) and similar across all LVEF groups (0% in low EF, 2.1% in moderate, 2.0% in preserved).
- Age, preoperative creatinine, atrial fibrillation, and NYHA class III/IV predicted survival.
- In the low EF group, mean LVEF significantly improved from 30% to 49.5% post-surgery.
Conclusions:
- Patients with markedly reduced LVEF undergoing AVR experience similar postoperative outcomes and survival rates compared to those with moderate or preserved LV function.
- AVR is a viable option for patients with severe AR and severely impaired LV function, leading to significant functional improvement.
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