Aortic regurgitation complicated by extreme left ventricular dilation: long-term outcome after surgical correction

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.

OBJECTIVES: This study sought to determine the outcome of aortic valve replacement for aortic regurgitation complicated by extreme left ventricular dilation. BACKGROUND: Aortic valve replacement has been recommended in aortic regurgitation with extreme left ventricular dilation (diastolic dimension >/= 80 mm), but extreme left ventricular dilation raises concern about irreversible left ventricular dysfunction. METHODS: Thirty-one patients with a preoperative echocardiographic diastolic dimension >/= 80 mm (group 1) undergoing operation for severe isolated aortic regurgitation between 1980 and 1989 were compared with 188 patients with a diastolic dimension <80 mm operated on during the same period (group 2). RESULTS: Preoperatively, extreme left ventricular dilation was seen only in male patients and was associated with a reduced ejection fraction (43 +/- 12% vs. 53 +/- 11% [mean +/- SD], p < 0.0001). The postoperative outcome of group 1 was compared with that of male patients in group 2 (group 2M, n = 144). The operative mortality rates for groups 1 and 2M were 0% and 5.6%, respectively (p = 0.35). Late survival in operative survivors was similar in groups 1 and 2M, but compared with expected survival, an excess mortality was observed for group 1 (p = 0.024). Preoperative ejection fraction, but not diastolic dimension, independently predicted late survival and postoperative ejection fraction. Postoperatively, groups 1 and 2M showed a similar improvement in ejection fraction, but persistent left ventricular enlargement was more frequent in group 1. CONCLUSIONS: Extreme left ventricular dilation due to aortic regurgitation is observed in male patients and is frequently associated preoperatively with a reduced ejection fraction but is not a marker of irreversible left ventricular dysfunction. Operative risk and late postoperative survival are acceptable in these patients, although a late excess mortality, predicted best by preoperative ejection fraction, is observed. Therefore, extreme left ventricular dilation is not a contraindication to operation, which should be performed before left ventricular dysfunction occurs.

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