Optimizing timing of surgical correction in patients with severe aortic regurgitation: role of symptoms

J Am Coll Cardiol. 1997 Sep;30(3):746-52. doi: 10.1016/s0735-1097(97)00205-2.


Objectives: We sought to determine the independent effect of preoperative symptoms on survival after surgical correction of aortic regurgitation (AR).

Background: Aortic valve replacement for severe AR is recommended after New York Heart Association functional class III or IV symptoms develop. However, whether severe preoperative symptoms have a negative influence on postoperative survival remains controversial.

Methods: Preoperative characteristics and postoperative survival in 161 patients with functional class I or II symptoms (group 1) were compared with those in 128 patients with class III or IV symptoms (group 2) undergoing surgical repair of severe isolated AR between 1980 and 1989.

Results: Compared with group 1, group 2 patients were older (p < 0.0001), were more often female (p = 0.001) and more often had a history of hypertension (p = 0.001), diabetes mellitus (p = 0.029) or myocardial infarction (p = 0.005) and were more likely to require coronary artery bypass graft surgery (p < 0.0001). The operative mortality rate was higher in group 2 (7.8%) than in group 1 (1.2%, p = 0.005), and the 10-year postoperative survival rate was worse (45% +/- 5% [group 2] vs. 78% +/- 4% [group 1], p < 0.0001). Compared with age- and gender-matched control subjects, long-term postoperative survival was similar to that expected in group 1 (p = 0.14) but significantly worse in group 2 (p < 0.0001). On multivariate analysis, functional class III or IV symptoms were significant independent predictors of operative mortality (adjusted odds ratio 5.5, p = 0.036) and worse long-term postoperative survival (adjusted hazard ratio 1.81, p = 0.0091).

Conclusions: In the setting of severe AR, preoperative functional class III or IV symptoms are independent risk factors for excess immediate and long-term postoperative mortality. The presence of class II symptoms should be a strong incentive to consider immediate surgical correction of severe AR.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aortic Valve Insufficiency / classification
  • Aortic Valve Insufficiency / mortality
  • Aortic Valve Insufficiency / surgery*
  • Female
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index
  • Survival Analysis
  • Time Factors
  • Treatment Outcome