Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function

Hari P Chaliki, Dania Mohty, Jean Francois Avierinos, Christopher G. Scott, Hartzell V Schaff, A. Jamil Tajik, Maurice E Sarano

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

Background - Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known. Methods and Results - The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35%, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35% to 50%, MedEF, n=134) and those with normal left ventricular function (EF ≥50%, Nl EF, n=273). The operative mortality rate was higher with LoEF (14%) than with MedEF and Nl EF (6.7% and 3.7%, respectively, P=0.02). At 10 years, 41%±9% of LoEF patients had survived compared with 56%±5% and 70%±3% of MedEF and Nl EF patients, respectively (P<0.0001). Congestive heart failure occurred at 10 years in 25%±9% with LoEF compared with 17%±4% and 9%±2% with MedEF and NL EF, respectively (P<0.003). Postoperative EF improved by 4.9%±13.8% in the LoEF group and by 4%±11.9% in the MedEF group compared with -2.3%±10.9% in the Nl EF group (P<0.002 and P<0.0001, respectively). Conclusions - Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.

Original languageEnglish (US)
Pages (from-to)2687-2693
Number of pages7
JournalCirculation
Volume106
Issue number21
DOIs
StatePublished - Nov 19 2002

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Aortic Valve Insufficiency
Aortic Valve
Left Ventricular Function
Stroke Volume
Heart Failure
Mortality
Left Ventricular Dysfunction
Recurrence
Survival

Keywords

  • Aorta
  • Regurgitation
  • Surgery
  • Survival
  • Valves

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function. / Chaliki, Hari P; Mohty, Dania; Avierinos, Jean Francois; Scott, Christopher G.; Schaff, Hartzell V; Tajik, A. Jamil; Sarano, Maurice E.

In: Circulation, Vol. 106, No. 21, 19.11.2002, p. 2687-2693.

Research output: Contribution to journalArticle

Chaliki, Hari P ; Mohty, Dania ; Avierinos, Jean Francois ; Scott, Christopher G. ; Schaff, Hartzell V ; Tajik, A. Jamil ; Sarano, Maurice E. / Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function. In: Circulation. 2002 ; Vol. 106, No. 21. pp. 2687-2693.
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abstract = "Background - Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known. Methods and Results - The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35{\%}, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35{\%} to 50{\%}, MedEF, n=134) and those with normal left ventricular function (EF ≥50{\%}, Nl EF, n=273). The operative mortality rate was higher with LoEF (14{\%}) than with MedEF and Nl EF (6.7{\%} and 3.7{\%}, respectively, P=0.02). At 10 years, 41{\%}±9{\%} of LoEF patients had survived compared with 56{\%}±5{\%} and 70{\%}±3{\%} of MedEF and Nl EF patients, respectively (P<0.0001). Congestive heart failure occurred at 10 years in 25{\%}±9{\%} with LoEF compared with 17{\%}±4{\%} and 9{\%}±2{\%} with MedEF and NL EF, respectively (P<0.003). Postoperative EF improved by 4.9{\%}±13.8{\%} in the LoEF group and by 4{\%}±11.9{\%} in the MedEF group compared with -2.3{\%}±10.9{\%} in the Nl EF group (P<0.002 and P<0.0001, respectively). Conclusions - Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.",
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T1 - Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function

AU - Chaliki, Hari P

AU - Mohty, Dania

AU - Avierinos, Jean Francois

AU - Scott, Christopher G.

AU - Schaff, Hartzell V

AU - Tajik, A. Jamil

AU - Sarano, Maurice E

PY - 2002/11/19

Y1 - 2002/11/19

N2 - Background - Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known. Methods and Results - The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35%, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35% to 50%, MedEF, n=134) and those with normal left ventricular function (EF ≥50%, Nl EF, n=273). The operative mortality rate was higher with LoEF (14%) than with MedEF and Nl EF (6.7% and 3.7%, respectively, P=0.02). At 10 years, 41%±9% of LoEF patients had survived compared with 56%±5% and 70%±3% of MedEF and Nl EF patients, respectively (P<0.0001). Congestive heart failure occurred at 10 years in 25%±9% with LoEF compared with 17%±4% and 9%±2% with MedEF and NL EF, respectively (P<0.003). Postoperative EF improved by 4.9%±13.8% in the LoEF group and by 4%±11.9% in the MedEF group compared with -2.3%±10.9% in the Nl EF group (P<0.002 and P<0.0001, respectively). Conclusions - Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.

AB - Background - Left ventricular dysfunction is an indication for aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR). However, the postoperative outcome of patients with severe AR and a markedly low ejection fraction (EF) is not known. Methods and Results - The study group consisted of a total of 450 patients who had AVR for isolated AR between 1980 and 1995. Patients with markedly reduced left ventricular function (EF <35%, LoEF, n=43) were compared with those with moderate reduction in left ventricular function (EF 35% to 50%, MedEF, n=134) and those with normal left ventricular function (EF ≥50%, Nl EF, n=273). The operative mortality rate was higher with LoEF (14%) than with MedEF and Nl EF (6.7% and 3.7%, respectively, P=0.02). At 10 years, 41%±9% of LoEF patients had survived compared with 56%±5% and 70%±3% of MedEF and Nl EF patients, respectively (P<0.0001). Congestive heart failure occurred at 10 years in 25%±9% with LoEF compared with 17%±4% and 9%±2% with MedEF and NL EF, respectively (P<0.003). Postoperative EF improved by 4.9%±13.8% in the LoEF group and by 4%±11.9% in the MedEF group compared with -2.3%±10.9% in the Nl EF group (P<0.002 and P<0.0001, respectively). Conclusions - Patients with severe AR and markedly low EF incur excess operative mortality rates, postoperative mortality rates, and congestive heart failure after AVR. However, postoperative EF improves markedly, and most patients enjoy a long postoperative survival without recurrence of heart failure after AVR; thus they should not be denied the benefits of AVR.

KW - Aorta

KW - Regurgitation

KW - Surgery

KW - Survival

KW - Valves

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