Clinical evaluation of a prospective protocol for the timing of surgery in chronic aortic regurgitation

• Published in: The American heart journal Vol. 120; no. 3; pp. 649 - 657
• Main Authors: Tornos, M.P., Permanyer-Miralda, G., Evangelista, A., Worner, F., Candell, J., Garcia-del-Castillo, H., Soler-Soler, J.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.1990; Elsevier
• Subjects: Adolescent; Adult; Aged; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Chronic Disease; Echocardiography; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Postoperative Period; Prospective Studies; Radionuclide Ventriculography; Time Factors; Human; Follow up study; Indication; Surgery; Cardiovascular disease; Selection criterion; Aortic valve disease; Aortic regurgitation
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(90)90023-Q

Out of 160 prospectively followed patients with aortic regurgitation, the clinical courses of 53 patients with pure, severe, and chronic aortic regurgitation and without coronary artery disease who were selected for surgery on the basis of predefined criteria is discussed. Surgical criteria were either unequivocal symptoms or documentation of impaired left ventricular dysfunction (defined as angiographic ejection fraction of less than 50% plus and end-systolic volume index greater than 60 ml/m 2). According to preoperative status, patients were divided as follows: 11 asymptomatic patients (group A), 30 patients with moderate (classes II to III) symptoms (group B), and 12 patients with dyspnea at rest and pulmonary edema when first seen (group C). Surgical mortality was one patient (from group C). Late death occurred in four patients (one from group B, three from group C). At the end of follow-up (minimum 1 year, mean 3.6 years) 41 patients were in functional class I, four patients in class II, and one patient in class III. All patients except one in functional classes II and III belonged to group C. Before surgery, patients from groups A and B had similar ventricular dimensions and ejection fractions, whereas patients from group C had larger end-systolic diameters and volumes and lower ejection fractions. End-diastolic and end-systolic diameters decreased significantly at 1 and 2 years after surgery. Patients from group C continued to have dilated hearts as did those patients from groups A and B who had preoperative end-systolic diameters greater than 55 mm. Radionuclide ejection fraction increased in most patients with preoperative values less than 50%, except in those with preoperative values less than 30%. Our results suggest that in asymptomatic patients, surgery can be delayed at least until our criteria for left ventricular dysfunction are reached. Although the postoperative outcome of patients with preoperative severe heart failure was not as good as that of other patients, symptomatic improvement is likely to occur even in cases of severely impaired left ventricular function.