The Journal of thoracic and cardiovascular surgery · 2015
Early surgical intervention versus watchful waiting and outcomes for asymptomatic severe aortic regurgitation.
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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de Meester Christophe, Gerber Bernhard L, Vancraeynest David, Pouleur Anne-Catherine, Noirhomme Philippe, Pasquet Agnès, El Khoury Gébrine, Vanoverschelde Jean-Louis
Аннотация
OBJECTIVES: The management of asymptomatic patients with severe aortic regurgitation remains controversial. Accordingly, the aim of the present study was to assess the long-term outcomes and incidence of cardiac complications among asymptomatic patients with severe aortic regurgitation who underwent operation early, in the absence of any class I or class IIa guideline triggers, or were managed conservatively and eventually underwent operation whenever these triggers appeared.
METHODS: A total of 160 consecutive asymptomatic patients (50 ± 17 years) with severe aortic regurgitation were prospectively followed up for a median of 7.2 years. Overall and cardiovascular survivals and the need for repeat aortic regurgitation surgery were evaluated in an "early surgery" group (n = 91) and a "conservatively managed" group (n = 69).
RESULTS: Ten-year overall (91% ± 4% vs 89% ± 5%, P = .87) and cardiovascular (96% ± 2% vs 96% ± 3%, P = .79) survivals were similar among the early surgery and conservatively managed groups. Conservatively managed patients were further sub-stratified according to the regularity and quality of their follow-up. Patients who were regularly followed up by a certified cardiologist had a better 10-year overall survival than patients undergoing no or a looser follow-up (95% ± 5% vs 79% ± 10%, P = .045). Multivariate Cox proportional hazards analysis identified age (P = .003) and male gender (P = .024) as independent predictors of survival. Early surgical management was not a predictor of outcome (P = .45).
CONCLUSIONS: Our results show that the outcome of asymptomatic patients with severe aortic regurgitation is not different between an early surgical and a more conservative strategy, provided that the conservatively managed patients are regularly followed up and timely referred to surgery as soon as operative triggers develop. This suggests that surgery should not be recommended in patients with aortic regurgitation who do not meet current guidelines for intervention.
METHODS: A total of 160 consecutive asymptomatic patients (50 ± 17 years) with severe aortic regurgitation were prospectively followed up for a median of 7.2 years. Overall and cardiovascular survivals and the need for repeat aortic regurgitation surgery were evaluated in an "early surgery" group (n = 91) and a "conservatively managed" group (n = 69).
RESULTS: Ten-year overall (91% ± 4% vs 89% ± 5%, P = .87) and cardiovascular (96% ± 2% vs 96% ± 3%, P = .79) survivals were similar among the early surgery and conservatively managed groups. Conservatively managed patients were further sub-stratified according to the regularity and quality of their follow-up. Patients who were regularly followed up by a certified cardiologist had a better 10-year overall survival than patients undergoing no or a looser follow-up (95% ± 5% vs 79% ± 10%, P = .045). Multivariate Cox proportional hazards analysis identified age (P = .003) and male gender (P = .024) as independent predictors of survival. Early surgical management was not a predictor of outcome (P = .45).
CONCLUSIONS: Our results show that the outcome of asymptomatic patients with severe aortic regurgitation is not different between an early surgical and a more conservative strategy, provided that the conservatively managed patients are regularly followed up and timely referred to surgery as soon as operative triggers develop. This suggests that surgery should not be recommended in patients with aortic regurgitation who do not meet current guidelines for intervention.
Предметные рубрики MeSH
AdultAge FactorsAgedAortic Valve InsufficiencyAsymptomatic DiseasesChi-Square DistributionEarly Medical InterventionFemaleHumansKaplan-Meier EstimateMaleMiddle AgedMultivariate AnalysisPatient SelectionPropensity ScoreProportional Hazards ModelsRegistriesRetrospective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexSex FactorsTime FactorsTreatment OutcomeVascular Surgical ProceduresWatchful Waiting