Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: impact of preoperative left ventricular function.

Abstract

Our results indicate that preoperative left ventricular systolic function continues to influence postoperative prognosis and suggest that the discordant conclusions of previous studies probably resulted from interpretive differences and differences in patient selection.

Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular Function

“…The usual operative mortality rate reported for AVR ranges from 1% to 7%. 4,7,8,15 Our study undeniably shows excessive operative mortality rates among patients with markedly low EF, but it is not overwhelming, particularly for patients not requiring associated procedures (7.7%). Most importantly, our data indicate that a majority of patients remain free of heart failure 10 years after AVR.…”

“…6 The very definition of thresholds for defining a marked reduction of left ventricular (LV) function in patients with severe AR is unknown, and little is known about the outcome of patients with such severe reduction because previous studies included few patients with markedly reduced EF. 5,7,8 It is unclear how to identify a high-risk group in the setting of severe AR, thus making the treatment and outcome of such patients unclear. For these patients, uncertainty remains regarding treatment options and whether to recommend vasodilator therapy or cardiac transplantation rather than AVR and recent guidelines underscore the need for new data on long-term outcome.…”

“…The most recent guidelines have underscored 6 the relative consensus that a low EF generally appears to affect outcome. 7 However, these guidelines also emphasized gaps in knowledge regarding patients with markedly reduced LV function and the difficulty in making recommendations because of this lack of data. 6 A major finding of our study is that patients with markedly low EF (Ͻ35%) and severe AR constitute a high-risk group even after successful surgery.…”

“…Even excluding operative mortality rates, the risk ratio to expected mortality rate is 3.2 versus 1.4 in Nl EF. For late morbidity after AVR, earlier studies have provided either no 4,7,15 or limited information. 8,16 Even in studies with data on morbidity, specific information is not available about patients with markedly reduced EF.…”

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…This can progress to the extent that the full benefit of surgical correction of the regurgitant lesion, in terms of recovery of LV function and improved survival, can no longer be achieved. 244,[247][248][249][250][251][252][253][254][255][256] A large number of studies have identified LV systolic function and end-systolic size as the most important determinants of survival and postoperative LV function in patients undergoing AVR for chronic AR. 235, Studies of predictors of surgical outcome are listed in Table 13.…”