Early surgery versus conventional treatment for asymptomatic severe aortic regurgitation with normal ejection fraction and left ventricular dilatation

Abstract

OBJECTIVES: The management of patients with asymptomatic severe aortic regurgitation (AR) remains controversial. The aim of the present study was to assess and compare the clinical results between early surgery and conventional treatment for asymptomatic severe AR in patients with normal left ventricular (LV) systolic function and LV dilatation. METHODS: This retrospective cohort study included 230 consecutive patients with severe AR with left ventricular ejection function (LVEF > 50%) and left ventricular end-diastolic dimension (LVEDD > 70 mm) from 2003 to 2014. A total of 154 patients received early aortic valve replacement (AVR), whereas 76 patients received conventional treatment at the discretion of the surgeon. Overall and cardiovascular survival rates were evaluated between 2 groups with propensity score analysis. RESULTS: The patients had a mean age of 54.3 ± 14.1 years; 60.4% were men. Mean LVEF and LVEDD were 58.3 ± 7.7% and 75.3 ± 5.2 mm, respectively. Kaplan-Meier analysis revealed that early AVR was associated with better 10-year cardiovascular (P = 0.037) survivals in the overall population. In the 62 propensity score-matched pairs, early AVR was still associated with a significantly better 10-year overall survival (P = 0.018). Furthermore, patients who underwent early AVR had significantly improved 3-, 5-and 10-year cardiovascular survival rates of 98.3, 96.2 and 93.6%, respectively, compared with 93.5, 88.3 and 80.0% for those in the conventional treatment group (P = 0.008). CONCLUSIONS: Compared with conservative management, early AVR is associated with an improved long-term outcome in patients with asymptomatic severe AR with LVEF ≥ 50% and LVEDD > 70 mm. These data provide new evidence to strongly support current guidelines, which recommend a strategy of early operative intervention.