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

Amgad Mentias, Ke Feng, Alaa Alashi, L. Leonardo Rodriguez, A. Marc Gillinov, Douglas R. Johnston, Joseph F. Sabik, Lars G. Svensson, Richard A. Grimm, Brian P. Griffin, Milind Y. Desai

Research output: Contribution to journalArticle

Abstract

Background 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.

Original languageEnglish (US)
Pages (from-to)2144-2153
Number of pages10
JournalJournal of the American College of Cardiology
Volume68
Issue number20
DOIs
StatePublished - Nov 15 2016
Externally publishedYes

Keywords

  • aortic valve surgery
  • indexed left ventricular end-systolic dimension
  • mortality
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Mentias, A., Feng, K., Alashi, A., Rodriguez, L. L., Gillinov, A. M., Johnston, D. R., Sabik, J. F., Svensson, L. G., Grimm, R. A., Griffin, B. P., & Desai, M. Y. (2016). Long-Term Outcomes in Patients With Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction. Journal of the American College of Cardiology, 68(20), 2144-2153. https://doi.org/10.1016/j.jacc.2016.08.045