• DOI:10.1093/ejcts/ezs083
• Corpus ID: 23544409

Impact of residual regurgitation after aortic valve replacement.

@article{Sponga2012ImpactOR,
  title={Impact of residual regurgitation after aortic valve replacement.},
  author={Sandro Sponga and J. M. Perron and François Dagenais and Siamak Mohammadi and Richard G. Baillot and Daniel Doyle and Chiara Nalli and Pierre Voisine},
  journal={European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery},
  year={2012},
  volume={42 3},
  pages={
          486-92
        }
}

• S. Sponga, J. Perron, +5 authors P. Voisine
• Published 1 September 2012
• Medicine
• European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

OBJECTIVES
Mild-to-moderate aortic regurgitation (AR) is not infrequently encountered after standard aortic valve replacement, and reportedly more often following transcatheter aortic valve implantation. Patients are usually managed by observational follow-up, but the clinical significance and natural history of residual AR are unknown. The goal of this study was to determine its impact on the outcome of these patients.

METHODS
Between 1992 and 2011, 3201 consecutive patients underwent isolated standard aortic valve replacement in our institution. Of these, 135 patients (4.2%) were found to have paravalvular leak >1/4. Clinical, intraoperative as well as early and late postoperative outcome variables were studied. Factors associated with residual AR and their impact on survival were assessed by multivariate analysis.

RESULTS
Mean follow-up was 4.5 ± 3.4 years. The use of a bioprosthesis, longer cardiopulmonary bypass duration and preoperative atrial fibrillation were associated with a higher risk of presenting residual AR. Survival was negatively affected by commonly identified comorbidities (diabetes, stroke, pulmonary disease, renal failure, peripheral vascular disease) but also by the presence of >1/4 residual AR. Survival in the latter group was lower than for patients with ≤1/4 AR at all time points: 91.4 vs 96.7%, 77.5 vs 82.4% and 44.1 vs 54.5% at 1, 5 and 10 years, respectively (P < 0.01).

CONCLUSIONS
Postoperative residual AR >1/4 is an independent predictor of postoperative mortality and should be considered in the selection of surgical approach and management strategy for patients in need of standard and transcatheter aortic valve replacement.