Abstract 3960: Management of Patients With Severe Aortic Regurgitation: Appropriateness of Current Guidelines Criteria
Background: The AHA, ACC and ESC have recently issued guidelines for the management of patients (pts) with severe aortic regurgitation (AR). These guidelines recommend to operate on AR pts when the ascending aorta is >55 mm, when pts are symptomatic and, if asymptomatic, when LV EF is <50% or LV end-systolic dimensions are >50 mm. The remaining pts should be followed-up carefully and sent to surgery once 1 of the above criteria is met. The aim of the study was to evaluate the appropriateness of current guidelines criteria in a large population of AR pts.
Methods: Between 1995 and 2004, 248 pts were identified as having severe AR in the echolab database. Overall and cardiovascular survivals were evaluated in 3 groups: “early surgery” (pts with guidelines criteria undergoing surgery within 3 months of diagnosis, n±140), “watchful waiting” (pts without guidelines criteria being carefully followed-up and operated on once guidelines criteria are met (n=66) and “medical” (pts without guidelines criteria not being followed-up regularly, n=42).
Results: Mean follow-up was 7 years. The overall survival of the “early surgery” and “watchful waiting” groups was similar to that of the age and gender matched Belgian population and was significantly better than in the “medical” group (88%, 82% and 67%, respectively, Log rank p=0.048, Figure⇓). Similarly, cardiovascular survival was better in the “early surgery” and “watchful waiting” groups than in the “medical” group (Log Rank p=0.040).
Conclusion: Our results show that pts with severe AR experience a 15–20% reduction in their 7-year survival and that managing these pts according to current guidelines provides them with a normal life expectancy.