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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Long-term survival and functional results after aortic valve replacement in asymptomatic patients with chronic severe aortic regurgitation and left ventricular dysfunction

Division of Cardiology, Department of Clinical and Experimental Medicine, University of Padua Medical School, Padua, Italy

Manuscript received April 14, 2004; accepted June 22, 2004.

^_* Reprint requests and correspondence: Dr. Roldano Scognamiglio, Cattedra e Divisione di Cardiologia, Policlinico Universitario, via Giustiniani 2, I-35128 Padova, Italy (Email: r.scognamiglio{at}unipd.it).

OBJECTIVES: We examined the influence of medical treatment on the results of surgery in terms of long-term survival and functional results in patients with chronic, severe aortic regurgitation (AR).

BACKGROUND: Asymptomatic patients with AR and a reduced left ventricular ejection fraction (LVEF) are at high risk because of a higher-than-expected long-term mortality. The influence of preoperative medical therapy on the outcome after aortic valve replacement (AVR) is not well known.

METHODS: Surgery was indicated for the appearance of a reduced LVEF (<50%). At the time of AVR, there were 134 patients treated with nifedipine (group A), and 132 received no medication (group B).

RESULTS: Operative mortality was similar in the two groups (0.75% vs. 0.76%, p = NS). The LVEF normalized in all of group A, whereas it remained abnormal in 36 group B patients (28%). At 10-year follow-up, LVEF persisted higher in group A (62 ± 5% vs. 48 ± 4%, p < 0.001). Five-year survival was similar in the two groups (94 ± 2% vs. 94 ± 3%, p = NS). Group A showed a 10-year survival not different from expected and significantly higher than that in group B (85 ± 4% vs. 78 ± 5%, p < 0.001), which had a worse survival than expected.

CONCLUSIONS: Unloading treatment with nifedipine in AR allows one to indicate AVR at the appearance of a reduced LVEF with a low operative mortality and an optimal long-term outcome. The concept of surgical correction of AR indicated for reduced LVEF may not be applied to all patients. Indeed, in a large amount of untreated patients, a reduced LVEF preoperatively is not reversed by prompt surgery, indicating irreversible myocardial damage, and 10-year survival is worse than expected.

Abbreviations and Acronyms   AR = chronic, severe aortic regurgitation   AVR = aortic valve replacement   LV = left ventricle/ventricular   LVEDVI = left ventricular end-diastolic volume index   LVEF = left ventricular ejection fraction   LVESVI = left ventricular end-systolic volume index

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