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

Abstract

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.

Quantitative assessment of aortic regurgitation by Doppler echocardiography: Usefulness of the comparison of aortic and pulmonary flows

“…Interestingly, the Cleveland group demonstrated in a large contemporary cohort that patients with severe and moderate-to-severe AR benefit from earlier surgery. 18 Therefore, the identification of patients with grade 3 or more AR is crucial as they need either close follow-up or valve surgery. In agreement with ASE recommendations, a RF greater than 40% indicated an AR at least moderate to severe (grade 3 and 4 AR) with high sensitivity and specificity.…”

“…13 In clinical practice, aortic valve replacement is discussed in patients with grade 3 and 4 AR. 18 For such patients, surgical decision making is based on symptoms, LV enlargement and systolic function, associated aortic root disease, indication for coronary artery bypass graft and/or mitral valve surgery, and finally the surgical risks are considered. 19 The measurement of pulmonary outflow tract diameter and pulmonary VTI is a major issue as this measurement is not routinely performed during basic examination.…”

Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography

“…Similar to above, for each patient undergoing AVR, the analysis time was modeled so that only the person‐time after AVR was included in surgical group. The functional relationship between Zva, LV‐GLS and risk of death was assessed using a parametric multiphase hazard model 39. The best fitting model was obtained when Zva and LV‐GLS were modeled using quadratic splines with 5 knots at 10th, 25rd, 50th, 75th, and 90th percentile values of Zva and LV‐GLS.…”

Aortic regurgitation: are we operating too late?

“…In a recent large study of 1,417 patients treated at a high-volume experienced center, asymptomatic/minimal symptomatic patients with ≥ III+ AR and preserved LVEF demonstrate significantly improved longer-term survival following AV surgery which approximates that of a normal age-gender-matched US population (8).…”