OPTIMIZING TIMING OF SURGICAL-CORRECTION IN PATIENTS WITH SEVERE AORTIC REGURGITATION - ROLE OF SYMPTOMS

Objectives. We sought to determine the independent effect of preoperat ive symptoms on survival after surgical correction of aortic regurgita tion (AR). Background. Aortic valve replacement for severe AR is recom mended after Men York Heart Association functional class III or IV sym ptoms develop, However, whether severe preoperative symptoms have a ne gative influence an postoperative survival remains controversial. Meth ods. Preoperative characteristics and postoperative survival in 161 pa tients with functional class I or II symptoms (group 1) mere compared with those in 128 patients with class III or IV symptoms (group 2) und ergoing surgical repair of severe isolated AR between 1980 and 1989. R esults. Compared with group 1, group 2 patients were older (p < 0.0001 ), were more often female (p = 0.001) and more often had a history of hypertension (p = 0.001), diabetes mellitus (p (0.029) or myocardial i nfarction (p = 0.005) and mere more likely to require coronary artery bypass graft surgery (p < 0.0001). The operative mortality rate mas hi gher in group 2 (7.8%) than in group 1 (1.2%, p = 0.005), and the 10-y ear postoperative survival rate was worse (45% +/- 5% [group 2] vs, 78 %; +/- 4% [group 1], p < 0.0001). Compared with age-and gender-matched control subjects, long-term postoperative survival was similar to tha t expected in group 1 (p = 0.14) but significantly worse in group 2 ip < 0.0001), On multivariate analysis, functional class III or IV sympt oms mere significant independent predictors of operative mortality (ad justed odds ratio 5.5, p = 0.036) and worse long-term postoperative su rvival (adjusted hazard ratio 1.81, p = 0.0091). Conclusions. In the s etting of severe AR, preoperative functional class III or IV symptoms are independent risk factors for excess immediate and long term postop erative mortality. The presence of class II symptoms should be a stron g incentive to consider immediate surgical correction of severe AR. (C ) 1997 by the American College of Cardiology.