Key result
Preoperative symptoms in patients undergoing aortic valve repair for severe degenerative AI were associated with 10 late cardiac deaths versus 0 in asymptomatic patients (P=0.04).
Why the study?
Does preoperative symptom status affect long-term survival and valve reintervention in patients undergoing aortic valve repair for severe degenerative aortic insufficiency?
Cohort (n=274)
Does preoperative symptom status affect long-term survival and valve reintervention in patients undergoing aortic valve repair for severe degenerative aortic insufficiency?
Absolute Event Rate: 77.3% vs 100%
p-value: p=0.1
Aortic valve repair for severe degenerative aortic insufficiency in asymptomatic patients is associated with excellent long-term outcomes, supporting early intervention in experienced centers.
Symptomatic patients faced higher late cardiac mortality after repair; leaves open whether early intervention improves survival in asymptomatic severe degenerative AI.
OBJECTIVES: This study evaluated the effect of preoperative symptoms on long-term survival and valve reintervention in patients undergoing aortic valve repair (AVr) for severe degenerative aortic insufficiency (AI). METHODS: Between March 1996 and June 2010, 274 patients underwent AVr for severe AI. Seventy-seven were performed in asymptomatic patients (Group I) and 197 were performed in symptomatic (Group II). Patients in Group I were younger (43.9 ± 15.0 vs 54.1 ± 15.5 years; P < 0.001) with a higher proportion of bicuspid valves (n = 40, 51.9% vs n = 68, 30.4%; P = 0.008). Group II had more patients with impaired left ventricular (LV; n = 36, 18.3% vs n = 5, 6.4%; P = 0.013). The mean follow-ups for Group I and Group II were 43.0 ± 34.0 and 61.3 ± 39.5 months, respectively. RESULTS: There was no in-hospital mortality. Overall, leaflet repair and reimplantation were higher in Group I (P = < 0.001 and P = 0.002, respectively), whereas subcommissural annuloplasty for tricuspid AV was higher in Group II (P = 0.002). Leaflet shaving and plication were performed in more patients in Group I (P = 0.002 for both). There was no difference in early complications, but during follow-up atrial fibrillation was more frequent in Group II (P = 0.03). There were 10 late cardiac deaths, all in Group II (P = 0.04). Overall, 10-year cardiac survival was better in Group I (100 vs 77.3 ± 8.6%) but not significant (P = 0.1). At 10 years, freedom from ≥ AI2+ was 63.2 ± 8.1 vs 56.4 ± 4.5% (P = 0.4), and freedom from AV reintervention was 81.8 ± 7.1 vs 89.0 ± 2.8% (P = 0.36), in Groups I and II, respectively. In the whole cohort, 10-year freedom from AV reintervention was greater in patients with an end-diastolic diameter of <60 mm (90.0 ± 7.6 vs 76.3 ± 5.5%; P = 0.003). Multivariate analysis identified increasing age as the only independent predictor of overall survival (P = 0.03). The incidence of valve-related complications was similar. CONCLUSION: In asymptomatic patients with severe degenerative AI, AVr is associated with excellent long-term outcomes, while symptoms are associated with reduced long-term survival. In dilated LV, freedom from reoperation is lower. If feasible, early AVr is recommended in experienced centres.
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Vohra et al. (2013) conducted a cohort in Severe degenerative aortic insufficiency (n=274). Preoperative symptoms vs. Asymptomatic status was evaluated on 10-year cardiac survival (p=0.1). Preoperative symptoms in patients undergoing aortic valve repair for severe degenerative AI were associated with 10 late cardiac deaths versus 0 in asymptomatic patients (P=0.04).
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