Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Reduced Left Ventricular Ejection Fraction
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To the Editor:
Chaliki et al1 have presented data in patients with severe aortic regurgitation (AR) with normal left ventricular (LV) ejection fraction (LVEF ≥50%; n=≥73). “Mild” LVEF reduction (35% to 50%; n=134) and “markedly” low LVEF (<35%; n=43) who were operated on between 1980 and 1995.
In February of 1980,2 we documented (in a study not cited by the authors) the outcome of 17 patients with severe AR and LVEF of 0.25 to 0.49 who had aortic valve replacement (AVR) between January 1973 and July 1977. There were no operative deaths. There were 5 late deaths, and of the remaining 12 patients, 5 and 6 were in New York Heart Association functional classes II and I, respectively. We concluded that all patients with severe AR and moderately severe impairment of LV function should be offered AVR with or without coronary artery bypass graft unless there is a specific contraindication to surgery because of the low operative mortality and the improvement in symptoms and in …