Eastern Cardiothoracic Surgical Society

Aortic Valve Replacement in Patients with Severe Aortic Insufficiency Improves Symptoms and Ejection Fraction at Late Follow-Up
Matthew R. Schill, Farah Musharbash, Vivek Hansalia, Timothy S. Lancaster, Richard B. Schuessler, Keki R. Balsara, Akinobu Itoh, Hersh S. Maniar, Muhammad Faraz Masood, Michael K. Pasque, Marc R. Moon, Ralph J. Damiano Jr., Spencer J. Melby, Washington University in St. Louis, St. Louis, MO


OBJECTIVE: Surgeons have traditionally felt that severe aortic valve insufficiency (AI) is associated with high operative mortality and poor long-term survival after aortic valve replacement (AVR). This study investigated outcomes after AVR in patients with severe AI.

METHODS: A retrospective review was performed of 807 patients with severe AI who underwent aortic valve replacement at a single institution from 1996 to 2016. Patients with key data missing were excluded from long-term analysis. Long-term survival, echocardiographic and clinical follow-up data were obtained from medical records. Data were analyzed using the paired Student s t-test, the Wilcoxon signed-rank test, and Kaplan-Meier survival analysis.

RESULTS: Operative mortality was 6.5% (49/807). Most patients (678/807, 84.0%) received AVR alone; 129/807 (16.0%) also received aortic root repair. Bypass time and cross-clamp time were 158 69 and 108 49 minutes, respectively. Symptoms and preoperative echocardiography were captured in 689/807 (85.4%) of patients. Clinical and echocardiographic follow-up were available for 454/689 (65.9%) and 417/689 (60.5%) of patients at 4.88 4.66 and 4.93 4.42 years, respectively. NYHA class was improved at late follow-up (Table SA-3-1, p<0.001). EF improved from 48.3% 14.0% to 53.6% 13.7% (p<0.001). The postoperative mean aortic valve gradient was 15.6 9.5 mmHg. One-year survival was 86.9%. Median survival was 12.5 years (Figure SA-3-1).

CONCLUSIONS: AVR for severe AI has acceptable early mortality with significant improvements in both symptoms (as recorded by NYHA class) and left ventricular function at late follow-up.

Table SA-3-1. Demographics and Outcomes

Preoperative Postoperative
Age (Y) 54.5 16.2
Male Gender 554/807 (68.6%)
NYHA Class I 42 232
NYHA CLASS II 81 70
NYHA CLASS III 142 52
NYHA CLASS IV 124 35
EF (%) 48.3 14.0 53.6 13.7
Major Complications 138/807 (17.1%)
Operative MORTALITY 49/807 (6.5%)