Abstract 3963: Factors Leading to Nonsurgical Management in Severe Aortic Regurgitation Patients With ACC/AHA Class I Indication for Aortic Valve Replacement
Introduction: We investigated the frequency and causes of nonsurgical management of severe aortic regurgitation (AR) patients with ACC/AHA class I indication for aortic valve replacement (AVR) in terms of symptoms or left ventricular (LV) ejection fraction of ≤50%.
Methods and Results: Screening of our AR database yielded 786 patients with severe AR of whom 534 had class I indications for AVR including dyspnea in 92% and LV ejection fraction ≤50% in 48%. The patient characteristics included: age 63±17 years, 59% men, LV ejection fraction 49±20%. Of these patients 316 (59%) did not undergo AVR over a mean follow up of 4.2 years. Patients not undergoing AVR were older (age 67±16 vs 57±18 years, P<0.0001), more likely to be women (51 vs 25%, p<0.0001), and had a greater preponderance of renal insufficiency (29 vs 16% p=0.0004), a lower LV ejection fraction (47±21 vs 52±18%, p=0.0003), a smaller LV size (p<0.0001) and greater mitral and tricuspid regurgitant grades (p=0.02 and <0.0001 respectively). Both groups had similar prevalence of diabetes, coronary artery disease, atrial fibrillation, chronic lung disease, stroke and pulmonary hypertension. Logistic regression analysis showed higher age (p=0.001), lower LV ejection fraction (p<0.0001), female gender (p<0.0001), renal insufficiency (p=0.01), and tricuspid regurgitation (p=0.01) to be the independent risk factors for not performing AVR. The 218 patients undergoing AVR had a significantly better survival compared to the 316 nonsurgical patients independent of age, gender, LV ejection fraction and comorbidities, confirmed further by propensity score analysis (p<0.0001).
Nonsurgical management of severe AR despite a ACC/AHA class I indication for AVR is common (59%).
This is independently predicted by higher age, lower LV ejection fraction, female gender, renal insufficiency, and tricuspid regurgitation.
AVR is associated with a significant independent survival advantage in these patients.