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Are patients with isolated chronic aortic regurgitation operated in time?: Analysis of survival data over a decade
Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences.
2005 (English)In: Clinical Cardiology, ISSN 0160-9289, Vol. 28, no 7, 329-332 p.Article in journal (Refereed) Published
Abstract [en]

Background: Patients suffering from chronic isolated aortic regurgitation have a less favorable outcome than patients with aortic stenosis. According to international recommendations, these patients should undergo surgery as soon as left ventricular function begins to deteriorate, that is, surgery is not to be postponed until clinical symptoms become relevant.

Hypothesis: The study was undertaken to evaluate how satisfactory our timing of surgery was, as reflected by survival data.

Methods: Survival was studied retrospectively in a consecutive series of patients undergoing surgery for chronic isolated aortic regurgitation during a 10-year period in our institution. Results were compared with data from the literature. By excluding patients with aortic aneurysms and acute endocarditis, we formed a homogeneous patient group of 88 subjects.

Results: Thirty-day mortality was 1% and late mortality after a mean follow-up period of 6 years was 11%. Compared with survival data from an earlier study in which the patient population was similar and resided in the same geographic area, the results in our patient group seem to be better. It is noteworthy that despite a strong effort to recommend surgery at an earlier stage of the disease than previously, 35% of the patients had moderate or severe left ventricular dysfunction pre-operatively because of late referrals.

Conclusion: This stresses the importance of early detection and careful preoperative follow-up with noninvasive methods in patients with aortic regurgitation.

Place, publisher, year, edition, pages
2005. Vol. 28, no 7, 329-332 p.
Keyword [en]
aortic regurgitation, left ventricular function, surgery
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13337DOI: 10.1002/clc.4960280705OAI: oai:DiVA.org:liu-13337DiVA: diva2:18515
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2009-06-05
In thesis
1. Surgical treatment in chronic aortic regurgitation: Timing, results, prognosis and left ventricular function
Open this publication in new window or tab >>Surgical treatment in chronic aortic regurgitation: Timing, results, prognosis and left ventricular function
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic aortic regurgitation (AR) of varying degree affects 13% of men and 8.5% of women. In persons with severe AR, the expected length of life and its quality are influenced. Some individuals remain asymptomatic for a long period, due to effective compensatory mechanisms, but dysfunction of the left ventricle (LV) usually begins before symptoms appear and can be irreversible by then. This thesis addresses questions of LV function and optimal time for operation of patients suffering from chronic AR. Moreover, detailed echocardiographic studies of the anatomy of the normal aortic valve have been performed to obtain a better understanding of the in vivo anatomic relations within the aortic root.

Patients with chronic AR, without concomitant cardiac disease, were studied both retrospectively (n=88) and prospectively (n=29) and the aortic valves of persons (n=32) free from cardiac disease were investigated.

For the retrospectively studied patients, survival was 82% at 10 years which is an improvement compared with previously published results. The majority of the patients, however, had LV dysfunction preoperatively. By studying patients prospectively by echocardiography, radionuclide ventriculography (MUGA) and cardiopulmonary exercise testing (CPET) our aim was to evaluate the predictive value of measurements of LV function at rest and during exercise for postoperative outcome. LV diameters were markedly elevated prior to and diminished significantly after surgery. Patients with an abnormal exercise ejection fraction (EF) response by MUGA preoperatively, presented the same reaction postoperatively. This could not be predicted by LV function determination at rest, or by NYHA functional class. In spite of median NYHA class II, these patients had a low work capacity on CPET, which was neither improved 6 months postoperatively nor correlated to echocardiographic LV dimensions. Thus, both MUGA and CPET may be useful complements for timing of surgery in patients with chronic AR.

Assuming that patients would benefit from preservation of their native valves the normal aortic valve was studied to gain detailed information about the echocardiographic anatomy and relations within the normal aortic root. This extended examination of the aortic root may facilitate a better planning of aortic valve‐preserving interventions in the future.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 50 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1069
Keyword
Aortic regurgitation, left ventricular function, exercise, physical capacity, echocardiography
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-12284 (URN)978-91-7393-857-0 (ISBN)
Public defence
2008-09-12, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-06-18 Created: 2008-06-18 Last updated: 2012-05-09

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Tamás, ÉvaNylander, Eva

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