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Aortic Valve Replacement is Associated with Better Survival in High-risk Patients

Anaesthesiology

The Aortic Valve Replacement (AVR) is associated with survival improvements in patients with severe aortic regurgitation and severely reduced left-ventricular ejection fraction (LVEF). Although AVR is a surgical option, these patients often have a high surgical risk.

Dr. Jason H. Wasfy from Massachusetts General Hospital told Reuters Health through email that this replacement is performed in a very-high-risk operative group. However, when the patients receive this surgery, they tend to do relatively well. He added, “With very-high-risk patients, we are often reluctant to offer surgery because surgery may hurt them more than help them.”

The researcher's team compared survival between 40 patients (mean age at echocardiography, 66) who had severe aortic regurgitation and LVEF <35%. Among 40 patients, 18 received isolated AVR and 22 managed without surgery.

According to the November 1 online report in Heart, during the average follow-up period of 6.6 years, mean survival of patients undergoing AVR was 6.3 years and 0.5 years in patients without surgery.

The survival rate in the AVR group at the end of the last observed event was 72.2% compared with 28.7% in the no-surgery group; after adjusting for end-stage renal disease, atrial fibrillation, age >65 years, and peripheral vascular disease.

The AVR was associated with 85.7% lower relative mortality, compared to no surgery.

Dr. Wasfy cautioned, "This is an analysis of observational data. As such, we are able to generate insight about how to manage patients in ways that we would never be able to understand from a randomized control trial. But the trade-off is that this analysis is subject to treatment-selection bias. Although we controlled for certain comorbidities, there was no randomization, so it may have been that the surgeons were not offering surgery to the patients likely to do poorly with surgery.”

Dr. Wasfy concluded that the findings inspire us to offer surgery more often. Despite the higher-risk of surgery, patients appear to fare badly without surgery and reasonably well with surgery.