RT Journal Article SR Electronic T1 Aortic valve replacement associated with survival in severe regurgitation and low ejection fraction JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP heartjnl-2017-312024 DO 10.1136/heartjnl-2017-312024 A1 Amy G Fiedler A1 Vijeta Bhambhani A1 Elizabeth Laikhter A1 Michael H Picard A1 Meagan M Wasfy A1 George Tolis A1 Serguei Melnitchouk A1 Thoralf M Sundt A1 Jason H Wasfy YR 2017 UL http://heart.bmj.com/content/early/2017/11/09/heartjnl-2017-312024.abstract AB Objectives Although guidelines support aortic valve replacement (AVR) in patients with severe aortic regurgitation (AR) and left ventricular ejection fraction (LVEF) <50%, severe left ventricular dysfunction (LVEF <35%) is thought to confer high surgical risk. We sought to determine if a survival benefit exists with AVR compared with medical management in this high-risk, relatively rare population.Methods A large institutional echocardiography database was queried to identify patients with severe AR and LVEF <35%. Manual chart review was performed. Due to small sample size and population heterogeneity, corrected group prognosis method was applied, which calculates the adjusted survival curve for each individual using fitted Cox proportional hazard model. Average survival adjusted for comorbidities and age was then calculated using the weighted average of the individual survival curves.Results Initially, 2 54 614 echocardiograms were considered, representing 1 45 785 unique patients, of which 40 patients met inclusion criteria. Of those, 18 (45.0%) underwent AVR and 22 (55.0%) were managed medically. Absolute mortality was 27.8% in the AVR group and 91.2% in the medical management group. After multivariate adjustment, end-stage renal disease (HR=17.633, p=0.0335) and peripheral arterial disease (HR=6.050, p=0.0180) were associated with higher mortality. AVR was associated with lower mortality (HR=0.143, p=0.0490). Mean follow-up time of the study cohort was 6.58 years, and mean survival for patients undergoing AVR was 6.31 years.Conclusions Even after adjustment for clinical characteristics and patient age, AVR is associated with higher survival for patients with low LVEF and severe AR. Although treatment selection bias cannot be completely eliminated by this analysis, these results provide some evidence that surgery may be associated with prolonged survival in this high-risk patient group.