title: The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review.
abstract: A systematic search of Medline, EMBASE and CINAHL electronic databases was performed. Original research articles reporting all-cause mortality following surgery in patients with aortic regurgitation and severe left ventricular systolic dysfunction (LVSD) were identified. Nine of the 10 eligible studies were observational, single-center, retrospective analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year and 68 to 84% at 5 years. Three studies described an improvement in mean left ventricular ejection fraction (LVEF) following aortic valve replacement (AVR) of 5-14%; a fourth study reported an increase in mean left ventricular ejection fraction (LVEF) of 9% in patients undergoing isolated AVR but not when AVR was combined with coronary artery bypass graft and/or mitral valve surgery. Three studies demonstrated improvements in functional New York Heart Association (NYHA) class following AVR. Additional studies are needed to clarify the benefits of AVR in patients with more extreme degrees of left ventricular systolic dysfunction (LVSD) and the potential roles of cardiac transplantation and transaortic valve implantation.
authors.affiliation: University of Glasgow, Glasgow, UK.
authors.forename: Athar A
authors.initials: AA
authors.lastname: Badar
authors.forename: Alan P T
authors.initials: AP
authors.lastname: Brunton
authors.forename: Ammad H
authors.initials: AH
authors.lastname: Mahmood
authors.forename: Stephen
authors.initials: S
authors.lastname: Dobbin
authors.forename: Andrea
authors.initials: A
authors.lastname: Pozzi
authors.forename: Jenna F
authors.initials: JF
authors.lastname: McMinn
authors.forename: Andrew J E
authors.initials: AJ
authors.lastname: Sinclair
authors.forename: Roy S
authors.initials: RS
authors.lastname: Gardner
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.forename: Phil A
authors.initials: PA
authors.lastname: Curry
authors.forename: Nawwar H K
authors.initials: NH
authors.lastname: Al-Attar
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Pettit
mesh_terms: D001022:Aortic Valve Insufficiency / Q000150:complications / Q000628:therapy*; D006801:Humans; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy*
keywords: aortic regurgitation; aortic valve replacement; cardiac transplantation; left ventricular dysfunction; transcatheter aortic valve replacement; valvular heart disease