Impact of residual regurgitation after aortic valve replacement
Open Access
- 16 March 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 42 (3), 486-492
- https://doi.org/10.1093/ejcts/ezs083
Abstract
Mild-to-moderate aortic regurgitation (AR) is not infrequently encountered after standard aortic valve replacement, and reportedly more often following transcatheter aortic valve implantation. Patients are usually managed by observational follow-up, but the clinical significance and natural history of residual AR are unknown. The goal of this study was to determine its impact on the outcome of these patients. Between 1992 and 2011, 3201 consecutive patients underwent isolated standard aortic valve replacement in our institution. Of these, 135 patients (4.2%) were found to have paravalvular leak >1/4. Clinical, intraoperative as well as early and late postoperative outcome variables were studied. Factors associated with residual AR and their impact on survival were assessed by multivariate analysis. Mean follow-up was 4.5 ± 3.4 years. The use of a bioprosthesis, longer cardiopulmonary bypass duration and preoperative atrial fibrillation were associated with a higher risk of presenting residual AR. Survival was negatively affected by commonly identified comorbidities (diabetes, stroke, pulmonary disease, renal failure, peripheral vascular disease) but also by the presence of >1/4 residual AR. Survival in the latter group was lower than for patients with ≤1/4 AR at all time points: 91.4 vs 96.7%, 77.5 vs 82.4% and 44.1 vs 54.5% at 1, 5 and 10 years, respectively (P < 0.01). Postoperative residual AR >1/4 is an independent predictor of postoperative mortality and should be considered in the selection of surgical approach and management strategy for patients in need of standard and transcatheter aortic valve replacement.Keywords
This publication has 21 references indexed in Scilit:
- Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo SurgeryNew England Journal of Medicine, 2010
- Outcome of mild periprosthetic regurgitation detected by intraoperative transesophageal echocardiographyJournal of the American College of Cardiology, 2001
- Natural history of early aortic paraprosthetic regurgitation: A five-year follow-upAmerican Heart Journal, 1999
- Quantitative Doppler assessment of valvular regurgitation.Circulation, 1993
- Colour flow Doppler mapping in the assessment of prosthetic valve regurgitation.Heart, 1989
- Evaluation of aortic insufficiency by Doppler color flow mappingJournal of the American College of Cardiology, 1987
- Normal and abnormal prosthetic valve function as assessed by doppler echocardiographyJournal of the American College of Cardiology, 1986
- Noninvasive evaluation of aortic regurgitation by continuous-wave Doppler echocardiography.Circulation, 1986
- Quantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitationThe American Journal of Cardiology, 1985
- Doppler Echocardiography: Theory, Instrumentation, Technique, and ApplicationMayo Clinic Proceedings, 1985