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(Circulation. 2002;106:2637.)
© 2002 American Heart Association, Inc.

Editorial

Aortic Valve Replacement for the Asymptomatic Patient With Aortic Regurgitation

A New Piece of the Strategic Puzzle

Jeffrey S. Borer, MD

From the Division of Cardiovascular Pathophysiology and The Howard Gilman Institute for Valvular Heart Diseases, Weill Medical College of Cornell University, New York, NY.

Correspondence to Jeffrey S. Borer, MD, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 East 68th St, New York, NY 10021. E-mail memontal@med.cornell.edu

Key Words: Editorials • valves • contractility • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

For patients with hemodynamically severe aortic regurgitation (AR), the primary remedial therapy is surgical aortic valve replacement (AVR). Timing of surgery, however, is a moving target. Techniques and prosthetic devices continually improve, justifying AVR progressively earlier in the natural history of the disease. Indeed, there is currently a general consensus that surgery for AR is appropriate when congestive symptoms first appear, even if they are mild.¹ This philosophy represents a distinct departure from the accepted standard of a generation ago, when the symptomatic indication for AVR was New York Heart Association functional class III. For asymptomatic patients, AVR remains controversial, except when left ventricular (LV) systolic performance is subnormal at rest as judged from ejection fraction (EF, or the parallel echocardiographic measure of fractional shortening [FS]). This standard was first suggested by Henry et al,^2,3 who began a prospective echocardiographic and clinical assessment of patients with AR in 1972. Henry et al tested two hypotheses: first, that outcome after AVR is dependent on LV systolic performance, and second, that progression to symptoms is predictable when performance is subnormal in asymptomatic patients.

See p 2687

The patients of Henry et al underwent AVR only when symptoms developed.² If, by that time, FS at rest was subnormal, long-term postoperative survival averaged approximately 45% at 4 years after operation, compared with 90% if FS was normal pre-AVR. Although the point estimates were confounded in some of their 49 patients by concomitant mild aortic stenosis or by coronary artery bypass grafting, the importance of . . . [Full Text of this Article]

Related Article:

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

Hari P. Chaliki, Dania Mohty, Jean-Francois Avierinos, Christopher G. Scott, Hartzell V. Schaff, A. Jamil Tajik, and Maurice Enriquez-Sarano
Circulation 2002 106: 2687-2693. [Abstract] [Full Text]