Surgery for Aortic Regurgitation now Safer

The outcomes following aortic valve surgery for chronic aortic regurgitation (AR) with severe left ventricular dysfunction (LVD) have shown great improvement, and the procedure is no longer considered a high-risk procedure, concluded a new study.

Researchers at the Cleveland Clinic (OH, USA) studied data on 724 patients who underwent surgery for chronic aortic regurgitation between 1972 and 1999. Of these patients, 88 (12%) had an LV ejection fraction of 30% or less, while the others had higher ejection fractions. Across the entire study time frame, survival was lower among patients with severe LVD than among those with non-severe LVD. For example, estimated survival at one year was 81% versus 92% and at 25 years, 5% versus 12%. Over time, however, there was a dramatic improvement in survival in patients with severe LVD. In-hospital mortality fell from 50% in 1975 to none after 1985, and patients with severe and non-severe LVD treated after that year had equivalent survival. The study was reported in the April 3, 2007, issue of the Journal of the American College of Cardiology.

"Neutralizing risk of severe LVD has improved early and late survival such that aortic valve surgery for chronic AR and cardiomyopathy is no longer a high-risk procedure for which transplantation is the best option,” concluded senior author Dr. Sunil K. Bhudia and colleagues.

"The new study helps undo the old perception that many patients are too high risk for conventional surgery, and can only benefit from a heart transplant,” said Dr. Paul A. Grayburn, from Baylor University (Dallas, TX, USA), the author of an accompanying editorial. "Today we routinely operate on patients with advanced heart disease, and they face a risk that is only a fraction of what was reported years ago--but the public and other doctors are largely unaware of the new results.”


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