Valve replacement in chronic aortic regurgitation. True predictors of survival after extended follow-up

The influence of preoperative clinic, hemodynamic, and surgical procedures on extended long-term prognosis after valve replacement for chronic aortic regurgitation is still unclear.

One hundred ninety-two patients (mean age, 44 years) who underwent valve replacement for chronic aortic regurgitation between 1970 and 1983 were followed for 13 to 26 years (mean follow-up, 13.8 years; surviving patients, 18.7 years). Perioperative mortality was 2.6%; survival rates after 10 and 20 years were 76% and 55%; 65 of 80 deaths were cardiac; 21% of patients were free of cardiac complications after 20 years; and 83 of 100 long-term survivors were in NYHA classes I and II. In a univariate analysis, age at operation (P < 0.0001), higher preoperative NYHA class (P < 0.0001), lower left ventricular (LV) ejection fraction (P = 0.0001), higher end-systolic volume (P = 0.0007), history of endocarditis (P = 0.0004), and additional surgical intervention besides valve replacement (P = 0.004) were the main predictors of late survival. In a multivariate stepwise Cox analysis, age (P = 0.0004), high LV end-systolic volume (P = 0.0004), higher NYHA class (P = 0.01), and previous endocarditis (P = 0.006) were independent predictors.

In chronic aortic regurgitation, symptoms and LV systolic function are the main predictors for extended long-term outcome after valve replacement. Low operative mortality and good extended survival make valve replacement mandatory in mildly or asymptomatic patients when LV systolic function decreases and considerable enlargement of systolic dimensions occur.