CLINICAL OUTCOME OF SEVERE ASYMPTOMATIC CHRONIC AORTIC REGURGITATION - A LONG-TERM PROSPECTIVE FOLLOW-UP-STUDY

One hundred one patients with asymptomatic chronic severe aortic regur gitation and normal ejection fraction were monitored for up to 10 year s (mean 55.4 +/- 33.5 months). Predefined surgical indications were th e development of cardiac symptoms or the documentation of impaired bas al left ventricular function. During the follow-up period there were n o cardiac deaths; 14 patients needed surgery, 8 because of development of symptoms and 6 because of left ventricular impairment. The risk of surgery was 12% at 5 years and 24% at 10 years. Baseline end-systolic diameter >50 mm and radionuclide ejection fraction <60% were independ ent predictors or either cardiac symptoms or left ventricular dysfunct ion. In patients needing surgery, a pattern of progressive left ventri cular dilatation was demonstrated. There were no deaths during surgery , and echocardiographic and radionuclide parameters normalized in the first year of follow-up. Our data confirm that the prognosis of severe aortic regurgitation in patients with no symptoms is good and that th e occurrence of asymptomatic left ventricular dysfunction is an uncomm on event. Surgery can be safely postponed until the appearance of card iac symptoms or the documentation of left ventricular dysfunction at r est.