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

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• 作者：Amgad Mentias ; MD ; Ke Feng ; MD ; Alaa Alashi ; MD ; L. Leonardo Rodriguez ; MD ; A. Marc Gillinov ; MD ; Douglas R. Johnston ; MD ; Joseph F. Sabik ; MD ; Lars G. Svensson ; MD ; PhD ; Richard A. Grimm ; MD ; Brian P. Griffin ; MD ; Milind Y. Desai ; MD ; ^{desaim2@ccf.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：aortic valve surgery ; indexed left ventricular end-systolic dimension ; mortality ; outcomes
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：15-22 November 2016
• 年：2016
• 卷：68
• 期：20
• 页码：2144-2153
• 全文大小：792 K

文摘

Chronic severe aortic regurgitation (AR) imposes significant volume and pressure overload on the left ventricle (LV), but such patients typically remain in an asymptomatic state for a very long time.

Objectives

This study sought to examine long-term outcomes in a contemporary group of patients with grade III+ chronic AR and preserved left ventricular ejection fraction (LVEF) and the value of aortic valve (AV) surgery on long-term survival. We also wanted to reassess the threshold of LV dimension, beyond which mortality significantly increases.

Methods

The authors studied 1,417 such patients (mean 54 ± 16 years of age, 75% men) seen between 2002 and 2010. Clinical data were obtained and Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality.

Results

Mean STS score was 5.5% ± 8%, and mean LVEF was 57 ± 4%, whereas 1,228 patients (87%) were asymptomatic, and 93 patients (7%) had indexed LV end-systolic dimension (iLVESD) ≥2.5 cm/m². At 6.6 ± 3 years, 933 patients (66%) underwent AV surgery (36% isolated AV surgery, 16% concomitant coronary bypass, and 58% aortic replacement), and 262 patients (19%) died. In-hospital postoperative mortality was 2% (0.6% in isolated AV surgery). On multivariate Cox survival analysis, compared to the group of iLVESD <2.5 cm/m² and no AV surgery, the 2 groups of iLVESD <2.5 cm/m² with AV surgery and iLVESD ≥2.5 cm/m² with AV surgery were associated with improved survival (hazard ratios: 0.62 and 0.42, respectively; both p < 0.01). Survival of patients who underwent AV surgery was similar to that of an age- and sex-matched U.S. population with 96% of deaths occurring in those with iLVESD <2.5 cm/m².

Conclusions

At a high-volume experienced center, patients with grade III or greater AR and preserved LVEF demonstrated significantly improved long-term survival following AV surgery. The risk of death significantly increased at a lower LV dimension threshold than previously described.