Postoperative Outcomes of Patients with Severe Aortic Regurgitation and Decreased Left Ventricular Ejection Fraction

Background and Objectives: The postoperative outcomes of patients with severe aortic regurgitation (AR) and a low ejection fraction (EF) were elucidated. Subjects and Methods: The study group consisted of 201 consecutive patients that underwent corrective surgery for isolated AR. The clinical data of patients with a preoperative EF<50% (n=59, group I) and of patients with an EF≥50% (n=142, group II) were compared. The clinical follow-up duration was 3.2±2.4 years. Results: There was no operative mortality for patients in both groups. Group I patients showed significant improvement of the EF after surgery, from 41±6% to 53±12% (p<0.001) and the EF (53±12 vs 56±1%, p=0.09) at follow-up was not significantly different between patients in the two groups. The 5-year survival rate was 70.5±8.9% for group I patients and 88.0±3.5% for group II patients (p= 0.06). The cumulative incidence of congestive heart failure at 5 years was significantly higher in group I patients (32.1±9.7% vs 8.5±3.1%, p=0.003). Independent determinants of development of congestive heart failure in group I patients were age [hazards ratio (HR)=1.1, 95% confidence interval (CI)=1.02-1.16, p=0.01] and EF (HR=0.82, 95% CI=0.69-0.97, p=0.02). The best cut-off value of the preoperative EF in predicting the development of congestive heart failure was 41.5%, with a sensitivity and specificity of 90.9% and 68.9%, respectively. Conclusion: A relatively high 5-year survival rate without operative mortality is anticipated in patients with reduced a preoperative left ventricular ejection fraction (LVEF) and the incidence of congestive heart failure was higher when compared to patients with a normal preoperative LVEF, which could be predicted by the level of the preoperative LVEF. (Korean Circulation J 2007;37:503-509)