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European Heart Journal 2001 22(10):866-873; doi:10.1053/euhj.2000.2314
Copyright © 2001 by the European Society of Cardiology.
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Predictors of long-term survival after valve replacement for chronic aortic regurgitation. Is M-mode echocardiography sufficient?

R Cortia, C Binggelia, M Turinab, R Jennia, T.F Lüschera and J Turinaa,f1

a Division of Cardiology, University Hospital, Zurich, Switzerland
b Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland

revised June 10, 2000; accepted June 21, 2000

Abstract

Aims The clinical importance of pre-operative and follow-up echocardiographic studies in patients operated on for chronic severe aortic valve regurgitation is still a matter of debate. The prognostic significance of M-mode echocardiography has never been directly compared with clinical and angiographic data.

Methods and Results Univariate and multivariate analyses of cumulative survival were performed for clinical, echocardiographic and angiographic data of 125 patients operated on between 1975 and 1983, and followed for 13·3±6·4 years. Ten and 20 year survival rates were 77% and 48%, respectively. Age, NYHA class, angiographic volumes, ejection fraction, as well as M-mode echocardiographic end-systolic dimension and shortening fraction were the main pre-operative prognostic parameters for long-term survival. In a multivariate analysis the angiographic end-systolic volume index, age and preoperative NYHA class were independent pre-operative prognostic variables of long-term survival. A postoperative reduction in end-diastolic dimension of >20% predicted a significantly better late survival (74% vs 44% after 20 years,P <0·001).

Conclusions Age, pre-operative NYHA class and left ventricular systolic function are the main determinants of long-term survival after valve replacement for chronic aortic regurgitation. Despite a slightly lower predictive value of echocardiography when compared to angiography, it appeared sufficient for everyday clinical decision making for valve replacement. Echocardiography within 6 months postoperatively is able to detect recovery of left ventricular function, and enables additional risk-stratification, regardless of pre-operative findings.

Key Words: Aortic regurgitaton, echocardiography, prognosis, valves, valve replacement, angiography.

f1 Correspondence: Juraj Turina, MD, Cardiology, University Hospital, CH-8091 Zurich, Switzerland.

References

  1. Borer JS, Hochreiter C, Herrold EM. Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance [see comments]. Circulation. 1998;97:525–534[Abstract/Free Full Text]
  2. Spagnuolo M, Kloth H, Taranta A, Doyle E, Pasternack B. Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients. Circulation. 1971;44:368–380[Abstract/Free Full Text]
  3. Rapaport E. Natural history of aortic and mitral valve disease. Am J Cardiol. 1975;35:221–227[CrossRef][Web of Science][Medline]
  4. Turina J, Hess O, Sepulcri F, Krayenbuehl HP. Spontaneous course of aortic valve disease. Eur Heart J. 1987;8:471–483[Abstract/Free Full Text]
  5. Braunwald E. Valvular heart diseases. Heart Disease. Philadelphia: W.B. Saunders Co; 1997. p. 1007–76
  6. Hegglin R, Scheu H, Rothlin M. Aortic insufficiency. Circulation. 1968;38:77–92
  7. Nishimura RA, McGoon MD, Schaff HV, Giuliani ER. Chronic aortic regurgitation: indications for operation— 1988. Mayo Clin Proc. 1988;63:270–280[Web of Science][Medline]
  8. Bonow RO, Epstein SE. Is preoperative left ventricular function predictive of survival and functional results after aortic valve replacement for chronic aortic regurgitation? J Am Coll Cardiol. 1987;10:713–716[Web of Science][Medline]
  9. Turina J, Turina M, Rothlin M, Krayenbuehl HP. Improved late survival in patients with chronic aortic regurgitation by earlier operation. Circulation. 1984;70:I147–152
  10. Bonow RO, Picone AL, McIntosh CL. Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: impact of preoperative left ventricular function. Circulation. 1985;72:1244–1256[Abstract/Free Full Text]
  11. Greves J, Rahimtoola SH, McAnulty JH. Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitation. Am Heart J. 1981;101:300–308[CrossRef][Web of Science][Medline]
  12. Borow KM, Green LH, Mann T. End-systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation. Am J Med. 1980;68:655–663[CrossRef][Web of Science][Medline]
  13. Henry WL, Bonow RO, Borer JS. Observations on the optimum time for operative intervention for aortic regurgitation. I. Evaluation of the results of aortic valve replacement in symptomatic patients. Circulation. 1980;61:471–483[Abstract/Free Full Text]
  14. Stone PH, Clark RD, Goldschlager N, Selzer A, Cohn K. Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement. J Am Coll Cardiol. 1984;3:1118–1126[Abstract]
  15. Gaasch WH, Carroll JD, Levine HJ, Criscitiello MG. Chronic aortic regurgitation: prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratio. J Am Coll Cardiol. 1983;1:775–782[Abstract]
  16. Daniel WG, Hood WP Jr., Siart A. Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening. Circulation. 1985;71:669–680[Abstract/Free Full Text]
  17. Taniguchi K, Nakano S, Hirose H. Preoperative left ventricular function: minimal requirement for successful late results of valve replacement for aortic regurgitation. J Am Coll Cardiol. 1987;10:510–518[Abstract]
  18. Turina J, Milincic J, Seifert B, Turina M. Valve replacement in chronic aortic regurgitation. True predictors of survival after extended follow-up. Circulation. 1998;98:II100–6
  19. Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976;37:7–11[CrossRef][Web of Science][Medline]
  20. Edmunds LH Jr., Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liason Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg. 1996;62:932–935[Abstract/Free Full Text]
  21. Thompson R, Ahmed M, Seabra-Gomes R. Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic regurgitation. J Thorac Cardiovasc Surg. 1979;77:411–421[Abstract]
  22. Bonow RO, Carabello B, de Leon AC Jr.. Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation. 1998;98:1949–1984[Free Full Text]
  23. Klodas E, Enriquez-Sarano M, Tajik AJ, Mullany CJ, Bailey KR, Seward JB. Aortic regurgitation complicated by extreme left ventricular dilation: long-term outcome after surgical correction [see comments]. J Am Coll Cardiol. 1996;27:670–677[Abstract]
  24. Lindblom D, Lindblom U, Qvist J, Lundstrom H. Long-term relative survival rates after heart valve replacement. J Am Coll Cardiol. 1990;15:566–573[Abstract]
  25. Nitter-Hauge S, Abdelnoor M, Svennevig JL. Fifteen-year experience with the medtronic-hall valve prosthesis. A follow-up study of 1104 consecutive patients. Circulation. 1996;94:II105–8
  26. Abdulla AM, Frank MJ, Canedo MI, Stefadouros MA. Limitations of echocardiography in the assessment of left ventricular size and function in aortic regurgitation. Circulation. 1980;61:148–155[Free Full Text]
  27. Bonow RO, Dodd JT, Maron BJ. Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation. Circulation. 1988;78:1108–1120[Abstract/Free Full Text]
  28. Carroll JD, Gaasch WH, Naimi S, Levine HJ. Regression of myocardial hypertrophy: electrocardiographic-echocardiographic correlations after aortic valve replacement in patients with chronic aortic regurgitation. Circulation. 1982;65:980–987[Abstract/Free Full Text]
  29. Christakis GT, Weisel RD, David TE, Salerno TA, Ivanov J. Predictors of operative survival after valve replacement. Circulation. 1988;78:I25–34
  30. Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med. 1996;335:407–416[Free Full Text]
  31. Bonow RO, Nikas D, Elefteriades JA. Valve replacement for regurgitant lesions of the aortic or mitral valve in advanced left ventricular dysfunction. Cardiol Clin. 1995;13:73–83[Medline]
  32. Fioretti P, Roelandt J, Sclavo M. Postoperative regression of left ventricular dimensions in aortic insufficiency: a long-term echocardiographic study. J Am Coll Cardiol. 1985;5:856–861[Abstract]
  33. Boucher CA, Bingham JB, Osbakken MD. Early changes in left ventricular size and function after correction of left ventricular volume overload. Am J Cardiol. 1981;47:991–1004[CrossRef][Web of Science][Medline]
  34. Starling MR, Kirsh MM, Montgomery DG, Gross MD. Mechanisms for left ventricular systolic dysfunction in aortic regurgitation: importance for predicting the functional response to aortic valve replacement. J Am Coll Cardiol. 1991;17:887–897[Abstract]
  35. Schon HR, Dorn R, Barthel P, Schomig A. Effects of 12 months quinapril therapy in asymptomatic patients with chronic aortic regurgitation. J Heart Valve Dis. 1994;3:500–509[Medline]

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