The following is the summary of “Fate of moderate aortic regurgitation after cardiac surgery” published in the December 2022 issue of Thoracic and cardiovascular surgery by Ward, et al.

The goals of this study are to ascertain the frequency with which simultaneous aortic regurgitation (AR) is encountered during cardiac surgery and to evaluate the efficacy of available treatments for this condition. There were 3,289 individuals who had coronary artery bypass, mitral valve, or aortic aneurysm surgery between April 2004 and June 2018, but they did not have aortic stenosis. The severity of AR was rated as either non/trivial (score=0), mild (scoring =1+), or moderate (score =2+). The outcomes of patients with untreated (2+ AR) were compared to those with 0 or 1+ AR and those with (2+ AR) who underwent aortic valve surgery. 

Propensity score matching examined 30-day and long-term survival, echocardiogram, and clinical outcomes. When compared to the 2765 untreated patients with 0 AR and the 386 patients with (1+ AR), 138 patients (4.2% of the total) were found to have (2+ AR), and 45 (33% of the total) were treated with aortic valve repair (n=9) or replacement (n=36). Anatomic leaflet abnormalities were associated with a higher likelihood of valve surgery, including bicuspid aortic valve (9% vs. 0%; P<.01), rheumatic valve disease (16% vs. 3%; P<.01), and calcification (47% vs. 27%; P=.021). Unadjusted analysis found a significant correlation between AR grade before surgery and 10-year survival. 

In patients with moderate AR, 2.6% progressed to more-than-moderate AR by year 10, and 3.1% were treated late. The last echocardiogram results showed that 58% of the untreated 2+ AR group had improved AR, 41% were still 2+, and only 1% had progressed to severe AR. Untreated AR has no effect on long-term survival after cardiac surgery and rarely requires late intervention, but aortic valve surgery can be added with minimal risk to a select group of patients who also have concomitant moderate AR.

Source: sciencedirect.com/science/article/abs/pii/S0022522321000118