Abstract 2977: Clinical Outcomes of Aortic Valve Repair in Asymptomatic Patients With Chronic Severe Aortic Valve Regurgitation
Objective: Aim of this study is to assess outcome of aortic valve repair in patients with chronic severe aortic valve regurgitation (AVR) with emphasis on postoperative outcome in asymptomatic patients with normal left ventricular size and function.
Methods: Since February 2003, 128 patients (92 men) with chronic severe AVR underwent valve repair in our institution. Ages ranged from 26 to 82 years (mean 53±15 years). Etiology of valve regurgitation were: functional annular dilation in 34 (26.5%) patients and leaflets prolapse in 94 (73.5%). Twenty-six (20%) patients had bicuspid valve. Repair methods included sub-commissural plasty, cusp free edge plication or reinforcement with Gore-Tex. Concomitant surgical procedure were CABG in 8 (6.2%) patients, mitral valve repair in 5 (4%) and aortic root or ascending aorta replacement in 32 (25%). Sixty-two (48.5%) patients were asymptomatic with normal LV function. Mean follow-up was 36±12 months and was 100% complete.
Results: There was 2 early deaths (1.5%). During follow-up there were 12 (9.4%) late cardiac-related deaths (11 deaths in symptomatic group or patients with subnormal LV function). Actuarial survival rate for asymptomatic vs symptomatic patients were 96.7% vs 81%, respectively (p<0.001). Causes of late deaths were heart failure in 6, sudden death in 4, and malignant arrhythmias in 2. Mean NYHA functional class in asymptomatic vs symptomatic patients were 1.2±0.3 vs 2.4±0.5 (p<0.001). Two (1.6%) of 126 hospital survivors had late re-operation on the aortic valve (mean interval 4.2 years) without mortality. At follow-up, 7 (5.5%) patients have residual mild AR and 2 (1.5%) patients have moderate AR. No other valve-related events were found.
Conclusions: Aortic valve repair can be performed with low risk and excellent late freedom from valve -related morbidity and mortality. Incidence of late recurrence of aortic valve regurgitation is very low that led to re-operation in only 1.6% of patients. Late survival rate is better in asymptomatic patients and is similar to the one expected for general population matched by sex and age. Aortic valve repair appears to be a good surgical option and may be considered for early surgery in asymptomatic patients with normal ejection fraction.