Author + information
- Received June 28, 2018
- Revision received December 18, 2018
- Accepted January 7, 2019
- Published online April 8, 2019.
- Li-Tan Yang, MDa,
- Hector I. Michelena, MDa,
- Christopher G. Scott, MSb,
- Maurice Enriquez-Sarano, MDa,
- Sorin V. Pislaru, MDa,
- Hartzell V. Schaff, MDc and
- Patricia A. Pellikka, MDa,∗ (, )@MayoClinic@MayoClinicCV@pattypellikka
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- cDepartment of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Patricia A. Pellikka, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Background Few data exist on the contemporary profiles and outcomes of patients with significant aortic regurgitation (AR).
Objectives This study sought to assess the benefits of aortic valve repair or replacement (AVR) and the prognostic value of left ventricular (LV) dimensions in significant AR.
Methods From 2006 to 2017, consecutive patients with ≥moderate-severe chronic AR without prior heart surgery, myocardial infarction, or overt coronary artery disease were included.
Results Of 748 participants (58 ± 17 years of age; 82% men), 387 (52%) were medically treated, and 361 (48%) had AVR. Of 361 patients having AVR, 334 (93%) met guideline criteria: Class I indications in 284 (79%) patients, which included symptoms in 236, and Class II indications in 50 (14%). The remaining 27 (7%) opted for surgery without Class I or II indications. At a median follow-up of 4.9 years (interquartile range: 2.3 to 8.3 years), 125 (17%) patients had died. Age, comorbidities, baseline symptoms, and higher LV end-systolic dimension index (LVESDi) were associated with all-cause mortality (all p ≤ 0.01). Compared with patients having LVESDi <20 mm/m2, those with LVESDi 20 to 25 mm/m2 (hazard ratio: 1.53; 95% confidence interval: 1.01 to 2.31) and ≥25 mm/m2 (HR: 2.23; 95% confidence interval: 1.32 to 3.77) had increased risks of death. AVR was associated with better survival (p < 0.0001). Patients with Class I indications for surgery had inferior post-operative survival (p < 0.003).
Conclusions Class I indications for surgery, mainly symptoms, are the most common triggers for AVR. Class II indications were associated with better post-operative outcome and thus merit more attention. LVESDi was the only LV parameter independently associated with all-cause mortality and the ideal cutoff seems to be lower than previously recommended.
This work was supported by a grant from the Mayo Clinic. Dr. Enriquez-Sarano has received research grant support from Edwards. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received June 28, 2018.
- Revision received December 18, 2018.
- Accepted January 7, 2019.
- 2019 American College of Cardiology Foundation
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