While class I indications for surgery, mainly symptoms, are the most common triggers for aortic valve surgery (AVR), class II indications may be associated with better postoperative outcome, based on new data published March 4 in Journal of the American College of Cardiology, which will be presented during ACC.19 in New Orleans, LA.

Li-Tan Yang, et al., examined 748 patients with significant aortic regurgitation (AR) without prior heart surgery, myocardial infarction or overt coronary artery disease between 2006 and 2017. The median age of study participants was 58, 82 percent were men and 387 were medically treated compared with 361 who had AVR. Of those patients undergoing AVR, 93 percent met guideline criteria (79 percent with class I indications, 14 percent with class II indications and 7 percent opting for surgery without class I or II indications).

At a median follow-up of 4.9 years, 175 patients (17 percent) had died. Researchers noted that patients having increased LV end-systolic dimension (LVESDi) of greater than 20mm/m2 had increased risk of death. Additionally, AVR was associated with better survival – a finding that suggests AVR should be considered at an earlier stage of chamber enlargement.

"Class II indications were associated with better postoperative outcome and thus merit more attention," researchers said. "LVESDi was the only LV parameter independently associated with all-cause mortality and the ideal cut-off seems to be lower than previously recommended."

In a related editorial comment, Patrick T. O'Gara, MD, MACC, and Yee-Ping Sun, MD, FACC, caution that the study is limited by being a single center, retrospective analysis that can't account for several variables impacting both total and cardiovascular mortality, including the intensity of medical supervision and echocardiographic surveillance before and after referral; the rigor of long-term post-operative care; and the emergence of other comorbidities following surgery. They write that nevertheless, one important takeaway from this and other studies "is that isolated [AVR] for AR in the modern era can be performed with very low peri-operative risk in appropriately selected patients at high volume centers of excellence." They highlight that "it will be important to establish whether such results can be generalized."

Clinical Topics: Cardiovascular Care Team, Noninvasive Imaging, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Echocardiography/Ultrasound

Keywords: ACC19, ACC Annual Scientific Session, Aortic Valve Insufficiency, Aortic Valve, Coronary Artery Disease, Echocardiography, Research, Myocardial Infarction, Comorbidity, Referral and Consultation

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