Korean Circ J.  2007 Oct;37(10):503-509. 10.4070/kcj.2007.37.10.503.

Postoperative Outcomes of Patients with Severe Aortic Regurgitation and Decreased Left Ventricular Ejection Fraction

• Lee CH
• Song JK
• Kim HY
• Ahn JM
• Park HG
• Lee JY
• Lee SH
• Jung YH
• Park DW
• Kim MJ
• Song JM
• Kang DH
• Song H
• Chung CH
• Lee JW
• Song MG

• KMID: 2227052
• DOI: http://doi.org/10.4070/kcj.2007.37.10.503

Abstract

BACKGROUND AND OBJECTIVES: The postoperative outcomes of patients with severe aortic regurgitation (AR) and a low ejection fraction (EF) were elucidated.
SUBJECTS AND METHODS
The study group consisted of 201 consecutive patients that underwent corrective surgery for isolated AR. The clinical data of patients with a preoperative EF<50% (n=59, group I) and of patients with an EF> or =50% (n=142, group II) were compared. The clinical follow-up duration was 3.2+/-2.4 years.
RESULTS
There was no operative mortality for patients in both groups. Group I patients showed significant improvement of the EF after surgery, from 41+/-6% to 53+/-12% (p<0.001) and the EF (53+/-12 vs 56+/-1%, p=0.09) at follow-up was not significantly different between patients in the two groups. The 5-year survival rate was 70.5+/-8.9% for group I patients and 88.0+/-3.5% for group II patients (p=0.06). The cumulative incidence of congestive heart failure at 5 years was significantly higher in group I patients (32.1+/-9.7% vs 8.5+/-3.1%, p=0.003). Independent determinants of development of congestive heart failure in group I patients were age [hazards ratio (HR)=1.1, 95% confidence interval (CI)=1.02-1.16, p=0.01] and EF (HR=0.82, 95% CI=0.69-0.97, p=0.02). The best cut-off value of the preoperative EF in predicting the development of congestive heart failure was 41.5%, with a sensitivity and specificity of 90.9% and 68.9%, respectively.
CONCLUSION
A relatively high 5-year survival rate without operative mortality is anticipated in patients with reduced a preoperative left ventricular ejection fraction (LVEF) and the incidence of congestive heart failure was higher when compared to patients with a normal preoperative LVEF, which could be predicted by the level of the preoperative LVEF.

Keyword

Aortic regurgitation; Ventricular ejection fraction; Left ventricular dysfunction; Echocardiography

MeSH Terms

Aortic Valve Insufficiency*
Echocardiography
Follow-Up Studies
Heart Failure
Humans
Incidence
Mortality
Sensitivity and Specificity
Stroke Volume*
Survival Rate
Ventricular Dysfunction, Left

Figure

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  Fig. 1 Changes of left ventricular ejection fraction after operation for significant aortic regurgitation according to the preoperative ejection fraction. Pre-op: preoperative, F/U: follow-up.

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  Fig. 2 Cumulative incidence of development of congestive heart failure (CHF) after surgery requiring hospital admission. LVEF: left ventricular ejection fraction.

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  Fig. 3 Comparison of actual survival (A) and event-free survival rates (B) after successful open heart surgery between groups. LVEF: left ventricular ejection fraction.

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  Fig. 4 Incidence of development of congestive heart failure (CHF) according to the pre- and postoperative [pre(post)-op]ejection fraction.

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  Fig. 5 scatter plot between pre- and postoperative left ventricular ejection fraction. Patients who developed congestive heart failure (CHF) were marked with a closed circle

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  Fig. 6 Relationship between preoperative New York Heart Association (NYHA) functional class and the incidence of congestive heart failure (CHF) (A) with its distribution (B). Pre (post)-op: pre (post) operative.

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  Fig. 7 A receiver operating characteristic curve of ejection fraction (EF) for predicting development of congestive heart failure (CHF) in patients with low preoperative ejection fraction. AUC: area under the curve.

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