The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review

Abstract

A systematic search of Medline, EMBASE and CINAHL electronic databases was performed. Original research articles reporting all-cause mortality following surgery in patients with aortic regurgitation and severe left ventricular systolic dysfunction (LVSD) were identified. Nine of the 10 eligible studies were observational, single-center, retrospective analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year and 68 to 84% at 5 years. Three studies described an improvement in mean left ventricular ejection fraction (LVEF) following aortic valve replacement (AVR) of 5-14%; a fourth study reported an increase in mean left ventricular ejection fraction (LVEF) of 9% in patients undergoing isolated AVR but not when AVR was combined with coronary artery bypass graft and/or mitral valve surgery. Three studies demonstrated improvements in functional New York Heart Association (NYHA) class following AVR. Additional studies are needed to clarify the benefits of AVR in patients with more extreme degrees of left ventricular systolic dysfunction (LVSD) and the potential roles of cardiac transplantation and transaortic valve implantation.

Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

“…Higher-risk patients are far less likely to undergo AVR based on their clinical risk profiles, with a reduced left ventricular ejection fraction decreasing the likelihood of intervention by more than 2-fold (23,24). This is in spite of the established benefit of AVR in terms of improvement in systolic function and reverse remodeling of the left ventricle (25,26). As such, data suggests that a minimally invasive approach, with its enhanced recovery, may be a viable alternative in this high-risk population (9,10).…”