title: Long-term survival and functional results after aortic valve replacement in asymptomatic patients with chronic severe aortic regurgitation and left ventricular dysfunction.
abstract: OBJECTIVE
  We examined the influence of medical treatment on the results of surgery in terms of long-term survival and functional results in patients with chronic, severe aortic regurgitation (AR).
  
  
  BACKGROUND
  Asymptomatic patients with AR and a reduced left ventricular ejection fraction (LVEF) are at high risk because of a higher-than-expected long-term mortality. The influence of preoperative medical therapy on the outcome after aortic valve replacement (AVR) is not well known.
  
  
  METHODS
  Surgery was indicated for the appearance of a reduced LVEF (<50%). At the time of AVR, there were 134 patients treated with nifedipine (group A), and 132 received no medication (group B).
  
  
  RESULTS
  Operative mortality was similar in the two groups (0.75% vs. 0.76%, p = NS). The LVEF normalized in all of group A, whereas it remained abnormal in 36 group B patients (28%). At 10-year follow-up, LVEF persisted higher in group A (62 +/- 5% vs. 48 +/- 4%, p < 0.001). Five-year survival was similar in the two groups (94 +/- 2% vs. 94 +/- 3%, p = NS). Group A showed a 10-year survival not different from expected and significantly higher than that in group B (85 +/- 4% vs. 78 +/- 5%, p < 0.001), which had a worse survival than expected.
  
  
  CONCLUSIONS
  Unloading treatment with nifedipine in AR allows one to indicate AVR at the appearance of a reduced LVEF with a low operative mortality and an optimal long-term outcome. The concept of surgical correction of AR indicated for reduced LVEF may not be applied to all patients. Indeed, in a large amount of untreated patients, a reduced LVEF preoperatively is not reversed by prompt surgery, indicating irreversible myocardial damage, and 10-year survival is worse than expected.
authors.affiliation: Division of Cardiology, Department of Clinical and Experimental Medicine, University of Padua Medical School, via Giustiniani 2, I-35128 Padua, Italy. r.scognamiglio@unipd.it
authors.forename: Roldano
authors.initials: R
authors.lastname: Scognamiglio
authors.forename: Christian
authors.initials: C
authors.lastname: Negut
authors.forename: Monica
authors.initials: M
authors.lastname: Palisi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fasoli
authors.forename: Sergio
authors.initials: S
authors.lastname: Dalla-Volta
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*
chemical_list: D014665:Vasodilator Agents; D009543:Nifedipine