Asymptomatic moderate or severe chronic aortic regurgitation was associated with a 34% rate of aortic valve or aorta surgery over a median 11.7 years, with no cardiovascular deaths.
Cohort (n=85)
In patients with asymptomatic, moderate-to-severe aortic regurgitation, regular surveillance is a safe strategy with no cardiovascular mortality observed over a decade, though approximately one-third will require corrective surgery.
Abstract Background Chronic aortic regurgitation (AR) causes increased loading stresses, left ventricular (LV) remodelling and risk of eventual heart failure if untreated. Despite this, many patients with AR remain asymptomatic with stable LV function over considerable time. The challenge is to time intervention with aortic valve replacement (AVR) to prevent irreversible damage while avoiding risks associated with delaying corrective surgery. Aims The study aim was to investigate the long-term clinical outcomes in patients with asymptomatic and hemodynamic significant AR. Methods We prospectively enrolled patients with transthoracic echocardiographic evidence of moderate or severe chronic AR, no symptoms (NYHA-I) and no indication for AVR. Patients underwent echocardiography, cardio-pulmonary exercise tests (CPET), questionnaire and laboratory tests at baseline, 1, 5 and 10 years intervals. Results The cohort comprised 85 patients, aged 44±14 years, 77 (91%) male and with a median follow-up time of 11.7 years. The majority of patients 64 (75%) had bicuspid aortic valves and 45 (53%) received anti-hypertensive medication during follow-up. Adverse medical events documented in patients during follow-up included: No cardiovascular related deaths, 29 (34%) underwent AVR and/or aorta surgery, 12 (14%) were treated for atrial fibrillation, 4 (5%) experienced a transient ischemic attack (TIA), 4 (5%) reported angina pectoris, and 2 (2%) required coronary revascularization. Corrective valve surgery occurred at a median 4.3 years after inclusion. None-operated patients (66 %) as a group remained predominantly asymptomatic and without indication for AVR. Conclusion With regular surveillance, many patients with hemodynamic significant AR remain asymptomatic with stable LV function over a prolonged period. However, patients in this study remained at risk of adverse cardiovascular events and approximately one-third required corrective surgery within five years.
Massey et al. (Sat,) conducted a cohort in asymptomatic and hemodynamic significant aortic regurgitation (n=85). Asymptomatic moderate or severe chronic aortic regurgitation was evaluated on Long-term clinical outcomes including adverse medical events and corrective surgery. Asymptomatic moderate or severe chronic aortic regurgitation was associated with a 34% rate of aortic valve or aorta surgery over a median 11.7 years, with no cardiovascular deaths.