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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Long-Term Outcome of Surgically Treated Aortic Regurgitation

Influence of Guideline Adherence Toward Early Surgery

Servei de Cardiologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain

Manuscript received May 31, 2005; revised manuscript received August 5, 2005, accepted October 17, 2005.

^_* Reprint requests and correspondence: Dr. Pilar Tornos, Servei de Cardiologia, Hospital Universitari Vall d’Hebron, P Vall d’Hebron 119-129, 08035 Barcelona, Spain. (Email: ptornos{at}vhebron.net).

OBJECTIVES: The purpose of this study was to compare postoperative outcome in two groups of patients with chronic severe aortic regurgitation (AR): those operated on early and those operated on late according to the guidelines.

BACKGROUND: The impact of earlier surgery for chronic severe AR as defined in guidelines has not been evaluated.

METHODS: A total of 170 patients with chronic severe AR submitted to aortic valve replacement were prospectively followed up. Patients were divided in two groups depending on the clinical situation at the time of surgery. Group A were 60 patients who were operated on following guidelines advice of earlier surgery, and group B were 110 patients who were operated on late with regard to guideline recommendations.

RESULTS: Follow-up was 10 ± 6 years (1 to 22 years). During follow-up 44 patients died, 7 patients (12%) from group A and 37 (37%) from group B (p = 0.001). The cause of death was non-cardiac in 11 patients, 2 (3%) in group A and 9 (8%) in group B. Cardiac deaths occurred in 33 patients, 5 (9%) from group A and 28 (28%) from group B (p = 0.002). Causes of death differed between groups A and B: heart failure or sudden death were significantly more frequent in group B (20 patients vs. 1 patient, p = 0.001). Overall survival in groups A and B was 90 ± 4% vs. 75 ± 8% at 5 years, 86 ± 5% vs. 64 ± 5% at 10 years, and 78 ± 7% vs. 53 ± 6% at 15 years, respectively (p = 0.009).

CONCLUSIONS: Early operation as defined in the guidelines improves long-term survival in patients with chronic AR.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   AR = aortic regurgitation   EDD = end-diastolic diameter   EF = ejection fraction   ESC = European Society of Cardiology   ESD = end-systolic diameter   LV = left ventricular/ventricle   NYHA = New York Heart Association

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