Abstract 4786: Aortic Valve Replacement Confers Large Survival Benefit In Severe Aortic Regurgitation Patients With Ejection Fraction <35%: Results From A Cohort of 159 Patients
Background: Aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular (LV) dysfunction is associated with a higher surgical risk. Though it improves symptoms and LV size, it is not clear whether it translates into a survival benefit.
Methods: Our echocardiography database from 1993 to 2007, was screened for patients with severe AR and LV EF ≤ 35%. Patient charts were reviewed for clinical, pharmacological, and surgical data. Mortality data was obtained from the social security death index. Survival was analyzed as a function of AVR.
Results: Of the 785 patients with severe AR, 159 patients had severe LV dysfunction defined as an EF ≤35%: 70% men, age 65 ± 16 years, and LV EF was 23% ± 8%. During follow-up, 53 (33%) patients had AVR. Kaplan-Meier analysis showed that AVR was associated with a better survival (n=53, p=0.001, figure⇓). One and 5-year survival with AVR were 80% vs. 78% respectively compared to 49% vs.40% for those without AVR. Other univariate predictors of higher mortality included greater age (p<0.0001), higher NYHA Class IV (p = 0.0002), coronary artery disease (p = 0.003), renal insufficiency (p<0.0001), pulmonary hypertension (p=0.02), larger LV size and lack of beta-blocker use (p=0.003). Beneficial effect of AVR persisted after adjusting for age, gender and EF using the Cox regression model (HR 0.59, 95% CI 0.42– 0.84, p=0.003). Benefit of AVR was supported by sensitivity analysis.
AVR is associated with a large mortality benefit in severe AR patients with EF ≤35%.
There is a marked reluctance to offer AVR in these patients despite this mortality benefit.