The effect of aortic valve replacement on survival

Area of Science:

• Cardiology
• Cardiac Surgery
• Valvular Heart Disease

Background:

• Isolated aortic valve disease affects numerous patients, necessitating evaluation of treatment efficacy.
• Aortic valve replacement (AVR) is a common intervention for severe aortic valve disease.
• Understanding the long-term survival impact of AVR based on specific valve pathologies and left ventricular (LV) function is crucial.

Purpose of the Study:

• To compare the long-term survival outcomes of operated versus unoperated patients with isolated aortic valve disease.
• To assess the impact of AVR on survival in patients with predominant aortic stenosis (AS) versus aortic insufficiency (AI).
• To investigate the influence of left ventricular (LV) function on survival after AVR in these patient groups.

Main Methods:

• Retrospective study of 252 operated and 47 unoperated patients with isolated aortic valve disease.
• Analysis of preoperative hemodynamic and angiographic data.
• Comparison of survival rates between operated and unoperated cohorts stratified by AS and AI, and LV function.

Main Results:

• Operative mortality for AVR was 7%.
• For aortic stenosis (AS), 3-year survival was 87% in operated vs. 21% in unoperated patients (p < 0.001).
• For aortic insufficiency (AI), 5-year survival was 86% in operated vs. 87% in unoperated patients (NS), though LV dysfunction patients showed a trend towards longer survival with AVR.

Conclusions:

• AVR significantly improves long-term survival in patients with aortic stenosis (AS), irrespective of baseline left ventricular (LV) function.
• AVR does not significantly alter long-term survival in patients with aortic insufficiency (AI), although a trend suggests benefit for those with LV dysfunction.
• Unoperated patients with AI had better long-term survival than unoperated patients with AS.