Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunction.

Abstract

OBJECTIVES:

Among patients undergoing aortic valve surgery for chronic aortic regurgitation (AR), we sought to: 1) compare survival among those with and without severe left ventricular dysfunction (LVD); 2) identify risk factors for death, including LVD and date of operation; and 3) estimate contemporary risk for cardiomyopathic patients.

BACKGROUND:

Patients with chronic AR and severe LVD have been considered high risk for aortic valve surgery, with limited prognosis. Transplantation is considered for some.

METHODS:

From 1972 to 1999, 724 patients underwent surgery for chronic AR; 88 (12%) had severe LVD. They were propensity matched to patients with nonsevere LVD to compare hospital mortality, interaction of operative date with severity of LVD, and late survival. Propensity score-adjusted multivariable analysis was performed for all 724 patients to identify risk factors for death.

RESULTS:

Survival was lower (p = 0.04) among patients with severe LVD than among matched patients with nonsevere LVD (30-day, 1-, 5-, and 25-year survival estimates were 91% vs. 96%, 81% vs. 92%, 68% vs. 81%, and 5% vs. 12%, respectively). However, survival of patients with severe LVD improved dramatically across the study time frame (p = 0.0004): hospital mortality decreased from 50% in 1975 to 0% after 1985, and time-related survival in patients with severe LVD operated on since 1985 became equivalent to that of matched patients with nonsevere LVD (p = 0.96).

CONCLUSIONS:

Neutralizing risk of severe LVD has improved early and late survival such that aortic valve surgery for chronic AR and cardiomyopathy is no longer a high-risk procedure for which transplantation is the best option.

• Authors: Sunil K Bhudia, Patrick M McCarthy, Ganesh S Kumpati, Joe Helou, Katherine J Hoercher, Jeevanantham Rajeswaran, Eugene H Blackstone
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 49 Issue 13 Pg. 1465-71 (Apr 03 2007) ISSN: 1558-3597 [Electronic] United States
• PMID: 17397676 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Aged
• Aortic Valve Insufficiency (complications, mortality, surgery)
• Chronic Disease
• Female
• Humans
• Male
• Middle Aged
• Risk Factors
• Severity of Illness Index
• Survival Rate
• Treatment Outcome
• Ventricular Dysfunction, Left (complications, mortality)