HEART-FAILURE AFTER AORTIC-VALVE REPLACEMENT FOR AORTIC REGURGITATION- PROSPECTIVE 20-YEAR STUDY

Background The objective of this study was to assess the probability o f development of heart failure during a long-term follow-up in patient s submitted for aortic valve replacement for aortic regurgitation on t he basis of preoperative findings. Methods and Results Eighty-seven co nsecutive patients with pure aortic regurgitation and normal coronary arteries ies were submitted for aortic valve replacement acid prospect ively followed up. Clinical examination, echocardiography, and radionu clide election fraction were performed before surgery and at 1, 2, 5, and 10 years after surgery, Operative mortality rate was 2.2% (2 patie nts). The follow-up period was 1 to 12 years (mean 6 years). Overall s urvival rate was 87% at 5 years and 81% at 10 years, During follow-up, 19 patients had heart failure develop, and there were 14 deaths (6 ca used by heart failure). Probability of heart failure was 16% at 5 year s and 24% at 10 years. Age was the single independent preoperative pre dictor of both death and heart Failure. Age >50 years (relative risk [ RR] 10.4), preoperative ejection fraction <40% (RR 10.6), and end-syst olic diameter >50 mm (RR 7.4) were independently related to the postop erative development of heart failure. Conclusions Aortic valve replace ment can be performed safely in patients with severe aortic regurgitat ion by following current recommendations. Age >50, end-systolic diamet er >50 mm, and radionuclide election fraction <40% were independent pr eoperative predictors of postoperative heart failure. The only indepen dent predictor of both postoperative death and heart failure was age > 50 years.