Effect of Contemporary Optimal Medical Therapy on Patients With Reduced Ejection Fraction Who Have Undergone Surgery...

Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) in the presence of reduced left ventricular ejection fraction (LVEF) is associated with greater surgical risk. Long-term outcomes remain poorly described in contemporary cohorts.

Between 2004 and 2019, 122 patients underwent AVR for chronic severe AR with LVEF < 50%. Patients with severely reduced LVEF (< 35%; n = 37) were compared with those with mild to moderately reduced LVEF (35%-50%; n = 85).

Preoperative and intraoperative characteristics were similar in both groups. Operative mortality for the entire cohort was 1.6% (n = 2) and similar across the LVEF spectrum. Postoperatively, optimal medical therapy was achieved in most patients and > 25% of patients with LVEF < 35% benefited from cardiac resynchronization therapy. At latest follow-up, mean LVEF was 42 ± 12% in the severely reduced LVEF group (vs baseline 28 ± 5%; P < 0.001) and 51 ± 9% in the mild to moderately reduced LVEF group (vs baseline 46 ± 4%; P < 0.001). Freedom from cardiovascular death at 10 years was 87.2% in the severe group and 94.7% in the mild to moderate group (P = 0.10). Freedom from heart failure hospitalization at 10 years was higher in the mild to moderate group (96.3%) than in the severe group (88.3%; P = 0.009).

In this contemporary cohort of patients who underwent AVR for chronic severe AR, patients with severely reduced LVEF treated with optimal medical therapy had operative mortality and freedom from cardiovascular death similar to patients with mild to moderately reduced LVEF. Favourable left ventricular remodelling was observed in both groups. Hospitalization for heart failure was < 15% in both groups at 10-year follow-up.