Key result
Preoperative NYHA class III/IV in severe AR predicts ~81% higher 10-year mortality versus class I/II.
Why the study?
Whether severe preoperative symptoms negatively influence postoperative survival after surgical correction of severe aortic regurgitation remains controversial.
Does the presence of preoperative NYHA class III or IV symptoms compared to class I or II symptoms worsen survival in patients undergoing surgical correction of severe aortic regurgitation?
Cohort (n=289)
Does the presence of preoperative NYHA class III or IV symptoms compared to class I or II symptoms worsen survival in patients undergoing surgical correction of severe aortic regurgitation?
Hazard Ratio: 1.81
Absolute Event Rate: 45% vs 78%
p-value: p=0.0091
In patients with severe aortic regurgitation, waiting until the development of NYHA class III or IV symptoms before surgical correction is associated with significantly higher operative and long-term mortality compared to operating when symptoms are class I or II.
OBJECTIVES: We sought to determine the independent effect of preoperative symptoms on survival after surgical correction of aortic regurgitation (AR). BACKGROUND: Aortic valve replacement for severe AR is recommended after New York Heart Association functional class III or IV symptoms develop. However, whether severe preoperative symptoms have a negative influence on postoperative survival remains controversial. METHODS: Preoperative characteristics and postoperative survival in 161 patients with functional class I or II symptoms (group 1) were compared with those in 128 patients with class III or IV symptoms (group 2) undergoing surgical repair of severe isolated AR between 1980 and 1989. RESULTS: Compared with group 1, group 2 patients were older (p < 0.0001), were more often female (p = 0.001) and more often had a history of hypertension (p = 0.001), diabetes mellitus (p = 0.029) or myocardial infarction (p = 0.005) and were more likely to require coronary artery bypass graft surgery (p < 0.0001). The operative mortality rate was higher in group 2 (7.8%) than in group 1 (1.2%, p = 0.005), and the 10-year postoperative survival rate was worse (45% +/- 5% [group 2] vs. 78% +/- 4% [group 1], p < 0.0001). Compared with age- and gender-matched control subjects, long-term postoperative survival was similar to that expected in group 1 (p = 0.14) but significantly worse in group 2 (p < 0.0001). On multivariate analysis, functional class III or IV symptoms were significant independent predictors of operative mortality (adjusted odds ratio 5.5, p = 0.036) and worse long-term postoperative survival (adjusted hazard ratio 1.81, p = 0.0091). CONCLUSIONS: In the setting of severe AR, preoperative functional class III or IV symptoms are independent risk factors for excess immediate and long-term postoperative mortality. The presence of class II symptoms should be a strong incentive to consider immediate surgical correction of severe AR.
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Klodas et al. (1997) conducted a cohort in Severe aortic regurgitation (n=289). Preoperative NYHA functional class III or IV symptoms vs. Preoperative NYHA functional class I or II symptoms was evaluated on Long-term postoperative survival (HR 1.81, p=0.0091). Preoperative NYHA class III/IV symptoms in severe aortic regurgitation predicted worse 10-year postoperative survival versus class I/II symptoms (45% vs 78%; adjusted HR 1.81, p=0.0091).