title: Survival in patients with severe aortic regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement: results from a cohort of 166 patients with an ejection fraction < or =35%.
abstract: BACKGROUND
  Aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular (LV) dysfunction entails a higher surgical risk. Though it may improve symptoms and LV size, it is not known whether it translates into a survival benefit.
  
  
  RESULTS
  This retrospective cohort study included patients screened from our echocardiographic database between 1993 and 2007 for patients with severe AR and LV ejection fraction (EF) < or =35%. Charts reviews were conducted for clinical, pharmacological, and surgical information. Mortality data were obtained from the social security death index and analyzed as a function of AVR adjusted for the propensity score. Of the 785 patients with severe AR, 166 patients had severe LV dysfunction defined as an EF < or =35%: 69% of these were men, age 65+/-16 years, and LV EF was 23+/-8%. Kaplan-Meier analysis revealed that performance of AVR (n=53) was associated with a better survival (P=0.001). Adjusted for the propensity score, AVR was associated with a significantly lower mortality hazard (HR 0.59, CI 0.42 to 0.98, P=0.04).
  
  
  CONCLUSIONS
  There is a clear reluctance to offer AVR in a large number of patients with severe AR associated with LV dysfunction. However, the performance of AVR in these patients is associated with a mortality benefit supporting the current ACC/AHA guidelines.
authors.affiliation: Loma Linda University Medical Center, CA 92354, USA.
authors.forename: Ashvin R
authors.initials: AR
authors.lastname: Kamath
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.forename: Rami
authors.initials: R
authors.lastname: Turk
authors.forename: Unnati
authors.initials: U
authors.lastname: Sampat
authors.forename: Reena
authors.initials: R
authors.lastname: Patel
authors.forename: Sumit
authors.initials: S
authors.lastname: Khandhar
authors.forename: Ramdas G
authors.initials: RG
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D001705:Bioprosthesis; D015331:Cohort Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery