title: Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgery.
abstract: OBJECTIVE
  The purpose of this study was to compare postoperative outcome in two groups of patients with chronic severe aortic regurgitation (AR): those operated on early and those operated on late according to the guidelines.
  
  
  BACKGROUND
  The impact of earlier surgery for chronic severe AR as defined in guidelines has not been evaluated.
  
  
  METHODS
  A total of 170 patients with chronic severe AR submitted to aortic valve replacement were prospectively followed up. Patients were divided in two groups depending on the clinical situation at the time of surgery. Group A were 60 patients who were operated on following guidelines advice of earlier surgery, and group B were 110 patients who were operated on late with regard to guideline recommendations.
  
  
  RESULTS
  Follow-up was 10 +/- 6 years (1 to 22 years). During follow-up 44 patients died, 7 patients (12%) from group A and 37 (37%) from group B (p = 0.001). The cause of death was non-cardiac in 11 patients, 2 (3%) in group A and 9 (8%) in group B. Cardiac deaths occurred in 33 patients, 5 (9%) from group A and 28 (28%) from group B (p = 0.002). Causes of death differed between groups A and B: heart failure or sudden death were significantly more frequent in group B (20 patients vs. 1 patient, p = 0.001). Overall survival in groups A and B was 90 +/- 4% vs. 75 +/- 8% at 5 years, 86 +/- 5% vs. 64 +/- 5% at 10 years, and 78 +/- 7% vs. 53 +/- 6% at 15 years, respectively (p = 0.009).
  
  
  CONCLUSIONS
  Early operation as defined in the guidelines improves long-term survival in patients with chronic AR.
authors.affiliation: Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. ptornos@vhebron.net
authors.forename: Pilar
authors.initials: P
authors.lastname: Tornos
authors.forename: Antonia
authors.initials: A
authors.lastname: Sambola
authors.forename: Gaietà
authors.initials: G
authors.lastname: Permanyer-Miralda
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Zamira
authors.initials: Z
authors.lastname: Gomez
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome