Table 2

Timing of valve replacement in chronic aortic regurgitation

Study n Symptoms at entry Mean (range) age (years) Conclusions
Henry 198049Yes46 (19–68)Pre-op ESD > 55 mm and FS < 25% were associated with poor outcome post AVR
Henry 198037No35 (17–64)ESD and FS predicted which patients became symptomatic and required AVR
Bonow 198377No37 (16–67)AVR is not needed until symptoms or LV dysfunction occurs
Bonow 198437Yes41 (20–46)Duration of pre-op LV dysfunction is an important predictor of reversibility of LV function
Taniguchi 198762Yes43 (18–64)Pre-op LV-ES volume index was most important predictor of subsequent cardiac death
Bonow 198861Yes43 (19–72)Long term improvement in LV function is related to early reduction in EDD post-op
Siemienczuk 198950No48 (16)2-150 Patients can be risk stratified for “early progression to AVR” based on measurement of LV size and function
Taniguchi 199035Yes43 (15–60)The post-op increase in EF correlated with the decrease in ESS. Contractile dysfunction persisted
Bonow 1991104No 36 (17–67)Multivariate predictors of outcome (death, ventricular dysfunction or symptoms) were age, initial ESD, and rate of change in ESD and rest EF
Pirwitz 199427Yes(18–72)The peak systolic pressure to ESV ratio was the strongest predictor of postoperative (post-op) functional class
Klodas 199631Yes50 (15)2-150 Pre-op EF (not EDD) predicted late survival and post-op EF. Severe LV dilation is not a contraindication to surgery
Borer 1997104No46 (15)2-150 Change in EF from rest to exercise (normalise to the change in wall stress) was the strongest predictor of outcome
Dujardin 1999264No56 (19)2-150 Predictors of outcome were age, functional class, comorbidity, AF, and ESD
  • AF, atrial fibrillation; AVR, aortic valve replacement; EF, ejection fraction; EDD, end diastolic dimension; ESD, end systolic dimension; ESS, end systolic stress; ESV, end systolic volume; FS, functional shortening; LV, left ventricular;

  • 2-150 SD.

  • Sources: Henry WL, et al. Circulation1980;61:71–483; Henry WL,et al. Circulation1980;61:484–92; Bonow RO.Circulation1983;68:509–17; Taniguchi K,et al. J Am Coll Cardiol 1987;10:510–18; Bonow RO.Circulation1988;78(II):108–20; Siemienczuk D,et al. Ann Intern Med 1989;110:587–92; Taniguchi K,et al. Circulation1990;82:798–807; Bonow RO.Circulation1991;84:1625–35; Pirwitz MJ,et al. J Am Coll Cardiol 1994;24:1672–7; Klodas E,et al. J Am Coll Cardiol 1996;27:670–7; Borer JS,et al. Circulation1997; 97: 525–34; Dujardin KS,et al. Circulation1999; 99:1851–7.