TY - JOUR
T1 - Fate of moderate aortic regurgitation after cardiac surgery
AU - Ward, Austin
AU - Malaisrie, S. Chris
AU - Andrei, Adin Cristian
AU - Bonow, Robert O.
AU - Thomas, James D.
AU - Puthumana, Jyothy
AU - Pham, Duc Thinh
AU - Churyla, Andrei
AU - Kruse, Jane
AU - McCarthy, Patrick M.
N1 - Publisher Copyright:
© 2021 The American Association for Thoracic Surgery
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - aortic insufficiency
KW - aortic valve surgery
KW - moderate aortic regurgitation
KW - valve guidelines
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U2 - 10.1016/j.jtcvs.2020.12.114
DO - 10.1016/j.jtcvs.2020.12.114
M3 - Article
C2 - 33610367
AN - SCOPUS:85101306606
SN - 0022-5223
VL - 164
SP - 1784-1792.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -