Original articleAdult cardiacSurvival Benefit of Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Pulmonary Hypertension
Section snippets
Patient Population
This retrospective cohort study is from a large university medical center. This study was approved by our Institutional Review Board, which waived the need for patient consent because of the retrospective nature of the study. As described previously, our echocardiographic database between the years 1993 and 2007 was searched for patients with severe AR, defined by a jet height ratio of greater than 60% or prominent holodiastolic flow reversal in the distal aortic arch or abdominal aorta [3].
Baseline Patient Characteristics
The baseline features of the 83 patients with severe PHT are summarized in Table 1, along with the 423 patients without PHT. The two groups were comparable in terms of age, sex, LV wall thickness, and comorbidities such as hypertension, diabetes mellitus, and coronary artery disease. However, patients with PHT had greater LV end-diastolic dimensions (5.9 ± 1.2 cm versus 5.6 ± 1.0 cm, p = 0.03) and end-systolic dimensions (4.2 ± 1.3 cm versus 3.9 ± 1.2 cm, p = 0.02), lower LV ejection fraction
Comment
This observational study confirms that AVR can be performed with an acceptable operative mortality rate (3%) and that it may confer a survival benefit to severe AR patients with associated severe PHT. Our series is larger than all other reported series and has, additionally, comprehensive echocardiographic and pharmacologic data that have potential prognostic implications.
References (10)
- et al.
Comparison and reproducibility of visual echocardiographic and quantitative radionuclide left ventricular ejection fractions
Am J Cardiol
(1996) - et al.
Superiority of visual versus computerized echocardiographic estimation of radionuclide left ventricular ejection fraction
Am Heart J
(1989) - et al.
Severe pulmonary hypertension in advanced aortic valve disease
Br Heart J
(1978) - et al.
Pulmonary hypertension in aortic regurgitation: early surgical outcome
Q J Med
(1991) - et al.
Effect of beta blocker therapy on survival in patients with severe aortic regurgitation: results from a cohort of 756 patients
J Am Coll Cardiol
(2009)