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Long-Term Outcomes in Patients With Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction

Amgad Mentias1, Ke Feng1, Alaa Alashi1

  • 1Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Journal of the American College of Cardiology
|November 19, 2016
PubMed

Insights

Severe aortic regurgitation (AR) patients with preserved ejection fraction benefit from aortic valve surgery, improving long-term survival. Surgery is recommended even with mild left ventricular dilation, as mortality risk increases at lower thresholds.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Chronic severe aortic regurgitation (AR) causes significant left ventricular (LV) overload but often remains asymptomatic for extended periods.
  • Understanding long-term outcomes and optimal surgical timing in these patients is crucial for clinical management.

Purpose of the Study:

  • To evaluate long-term survival in contemporary patients with severe AR and preserved left ventricular ejection fraction (LVEF).
  • To assess the impact of aortic valve (AV) surgery on long-term survival in this cohort.
  • To re-evaluate the threshold for LV dimension beyond which mortality significantly increases.

Main Methods:

  • A cohort of 1,417 patients with grade III+ chronic AR and preserved LVEF were studied retrospectively.
  • Clinical data and Society of Thoracic Surgeons (STS) scores were collected; primary endpoint was mortality.
  • Multivariate Cox survival analysis was used to compare outcomes based on AV surgery and indexed LV end-systolic dimension (iLVESD).

Main Results:

  • 66% of patients underwent AV surgery; in-hospital mortality was 2%.
  • AV surgery was associated with improved long-term survival compared to no surgery, irrespective of iLVESD.
  • Survival following AV surgery was comparable to the general population, with most deaths occurring in patients with iLVESD < 2.5 cm/m².

Conclusions:

  • Aortic valve surgery significantly improves long-term survival in patients with severe AR and preserved LVEF at experienced centers.
  • The threshold for increased mortality risk due to LV dimension is lower than previously recognized.
  • Early surgical intervention is beneficial for patients with severe AR and preserved LVEF.
Abstract

Keywords:
aortic valve surgeryindexed left ventricular end-systolic dimensionmortalityoutcomes

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