Aortic Regurgitation With Markedly Reduced Left Ventricular Function Is Not a Contraindication for Aortic Valve Replacement

Background. The current study assesses outcomes and risk factors for aortic valve replacement (AVR) for aortic regurgitation (AR) in the setting of markedly reduced left ventricular (LV) function compared with moderately reduced LV function and preserved LV function. Methods. Between January 2002 and June 2013, 485 consecutive patients underwent AVR for severe AR. Overall, 37 of 485 patients (8%) had an LV ejection fraction (EF) less than or equal to 35% (low EF) with median of 30%; 141 of 485 patients (27%) had an LVEF of 36% to 50% (moderate) with median of 45%, and 307 of 485 patients (65%) had an LVEF greater than 50% (preserved) with median of 60%. Results. Preoperative characteristics were similar across groups, except patients with low EF were older (67.4 +/- 12.1 years versus moderate [58.6 +/- 15.0 years], p = 0.003 versus preserved [56.9 +/- 14.3 years], p = 0.001), more often had reoperations (35.1% versus preserved 19.9%, p = 0.054), and had more concomitant coronary artery bypass grafts 37.6% versus preserved 14.3%, p = 0.001). Operative mortality for the entire cohort was 1.9% (9 or 485) and was similar across groups, 0% in the low EF group, 2.1% (3 of 141) in the moderate group, and 2.0% (6 of 307) in the preserved group (all p > 0.5). Cox proportional hazard modeling indicated that age (hazard ratio [HR] 1.061, p <= 0.001), preoperative creatinine (HR 1.478, p <= 0.014), history of atrial fibrillation (HR 1.920, p = 0.095), and New York Heart Association class III/ IV (HR 2.127, p = 0.004) predicted survival. At median follow-up of 26 months, in the low EF group, the mean LVEF at follow-up was 49.5% +/- 10.2% versus baseline 30% +/- 4.6% (p <= 0.001). Conclusions. In this series, patients with markedly reduced LV function (LVEF <= 35%) had similar postoperative outcomes and survival as patients with moderate LV dysfunction or preserved LV function. (C) 2016 by The Society of Thoracic Surgeons