Fate of moderate aortic regurgitation after cardiac surgery

Austin Ward, S. Chris Malaisrie*, Adin Cristian Andrei, Robert O. Bonow, James D. Thomas, Jyothy Puthumana, Duc Thinh Pham, Andrei Churyla, Jane Kruse, Patrick M. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: To determine the prevalence of concomitant aortic regurgitation (AR) in cardiac surgery and the outcomes of treatment options. Methods: Between April 2004 and June 2018, 3289 patients underwent coronary artery bypass, mitral valve, or aortic aneurysm surgery without aortic stenosis. AR was graded none/trivial (score = 0), mild (score = 1+), or moderate (score = 2+). Patients with untreated 2+ AR were compared with those with 0 or 1+ AR, and to those with 2+ AR who had aortic valve surgery. Thirty-day and late survival, echocardiography, and clinical outcomes were compared using propensity score matching. Results: One hundred thirty-eight patients (4.2%) had 2+ AR; and 45 (33%) received aortic valve repair (n = 9) or replacement (n = 36) in the treated group and were compared with 2765 untreated patients with 0 AR and 386 patients with 1+ AR. Valve surgery was more common with anatomic leaflet abnormalities: bicuspid aortic valve (9% vs 0%; P <. 01), rheumatic valve disease (16% vs 3%; P <. 01), and calcification (47% vs 27%; P =. 021). In unadjusted analysis, lower preoperative AR grade was associated with increased 10-year survival (P <. 001). At year 10, progression to more-than-moderate AR among moderate AR patients was 2.6% and late intervention rate was 3.1%. In the untreated 2+ AR group, on last follow-up echocardiogram, 58% had improvement in AR, 41% remained 2+, and only 1% progressed to severe AR. Conclusions: Aortic valve surgery in select patients with concomitant moderate AR can be added with minimal added risk, but untreated AR does not influence long-term survival after cardiac surgery and rarely required late intervention.

Original languageEnglish (US)
Pages (from-to)1784-1792.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number6
StatePublished - Dec 2022


  • aortic insufficiency
  • aortic valve surgery
  • moderate aortic regurgitation
  • valve guidelines

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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