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(Circulation. 2009;120:S134-S138.)
© 2009 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Survival in Patients With Severe Aortic Regurgitation and Severe Left Ventricular Dysfunction Is Improved by Aortic Valve Replacement

Results From a Cohort of 166 Patients With an Ejection Fraction 35%

Ashvin R. Kamath, BA; Padmini Varadarajan, MD; Rami Turk, MD; Unnati Sampat, MD; Reena Patel, MD; Sumit Khandhar, DO; Ramdas G. Pai, MD

From the Loma Linda University Medical Center, Loma Linda, Calif.

Correspondence to Ramdas G. Pai, MD, FRCP (Edin), FACC, Professor of Medicine, Division of Cardiology, 11234 Anderson Street, Room 4414, Loma Linda University Medical Center, Loma Linda, CA 92354. E-mail ramdaspai{at}yahoo.com

Background— Aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular (LV) dysfunction entails a higher surgical risk. Though it may improve symptoms and LV size, it is not known whether it translates into a survival benefit.

Methods and Results— This retrospective cohort study included patients screened from our echocardiographic database between 1993 and 2007 for patients with severe AR and LV ejection fraction (EF) 35%. Charts reviews were conducted for clinical, pharmacological, and surgical information. Mortality data were obtained from the social security death index and analyzed as a function of AVR adjusted for the propensity score. Of the 785 patients with severe AR, 166 patients had severe LV dysfunction defined as an EF 35%: 69% of these were men, age 65±16 years, and LV EF was 23±8%. Kaplan–Meier analysis revealed that performance of AVR (n=53) was associated with a better survival (P=0.001). Adjusted for the propensity score, AVR was associated with a significantly lower mortality hazard (HR 0.59, CI 0.42 to 0.98, P=0.04).

Conclusions— There is a clear reluctance to offer AVR in a large number of patients with severe AR associated with LV dysfunction. However, the performance of AVR in these patients is associated with a mortality benefit supporting the current ACC/AHA guidelines.

Key Words: aortic regurgitation • aortic valve • aortic valve replacement • left ventricular dysfunction • survival