| Survival in patients with severe aortic regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement: results from a cohort of 166 patients with an ejection fraction < or =35%. | |
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MedLine Citation:
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PMID: 19752358 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular (LV) dysfunction entails a higher surgical risk. Though it may improve symptoms and LV size, it is not known whether it translates into a survival benefit. METHODS AND RESULTS: This retrospective cohort study included patients screened from our echocardiographic database between 1993 and 2007 for patients with severe AR and LV ejection fraction (EF) < or =35%. Charts reviews were conducted for clinical, pharmacological, and surgical information. Mortality data were obtained from the social security death index and analyzed as a function of AVR adjusted for the propensity score. Of the 785 patients with severe AR, 166 patients had severe LV dysfunction defined as an EF < or =35%: 69% of these were men, age 65+/-16 years, and LV EF was 23+/-8%. Kaplan-Meier analysis revealed that performance of AVR (n=53) was associated with a better survival (P=0.001). Adjusted for the propensity score, AVR was associated with a significantly lower mortality hazard (HR 0.59, CI 0.42 to 0.98, P=0.04). CONCLUSIONS: There is a clear reluctance to offer AVR in a large number of patients with severe AR associated with LV dysfunction. However, the performance of AVR in these patients is associated with a mortality benefit supporting the current ACC/AHA guidelines. |
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Authors:
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Ashvin R Kamath; Padmini Varadarajan; Rami Turk; Unnati Sampat; Reena Patel; Sumit Khandhar; Ramdas G Pai |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 120 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-09-15 Completed Date: 2009-10-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: S134-8 Citation Subset: AIM; IM |
Affiliation:
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Loma Linda University Medical Center, CA 92354, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aortic Valve / surgery* Aortic Valve Insufficiency / mortality*, physiopathology, surgery Bioprosthesis Cohort Studies Female Heart Valve Prosthesis Implantation* / mortality Humans Male Middle Aged Retrospective Studies Stroke Volume* Ventricular Dysfunction, Left / mortality*, physiopathology, surgery |
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