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Concomitant aortic regurgitation is a predictor of outcome after surgical aortic valve replacement in patients with severe aortic stenosis

Prashant Mishra, Chandan Kumar Ray Mohapatra, Jayant V Khandekar, Chaitanya Raut, Harsh S Seth, Ganesh Kumar K Ammannaya, Jaskaran Singh, Vaibhav Shah.

Background: Concomitant aortic regurgitation (AR) might worsen the prognosis of severe aortic stenosis (AS). But the prognostic value of concomitant AR in patients operated for severe AS is not addressed.

Objective: The aim of this study was to assess the impact and association of presence and severity of concomitant AR in patients operated for severe AS on long-term left ventricular (LV) function, functional capacity, and mortality.

Materials and Methods: Study group consisted of 200 patients operated due to severe AS retrospectively. The patients were divided into AS group (100 patients with AS without AR or with mild AR) and AS+AR group (100 patients with AS and moderate, severe or very severe AR). Follow-up included a clinical examination and echocardiography 530 months after AVR.

Result: Patients in AS group had improved symptoms than AS+AR group. The patients with postoperative follow-up in AS group had lower LV volume indices than patients in AS+AR which was statistically significant(AS group; LVEDVi - 679.1, LVESVi - 227.2 compare to AS+AR group; LVEDVi - 8421.3, LVESVi - 3411, p-value< 0.05). Postoperative mean LVEF was 6111 and 5812 in AS and AS+AR group, respectively.

Conclusion: Our study indicates that the preoperative presence and severity of concomitant AR has an impact on the outcome after aortic valve replacement for the patients having severe aortic stenosis symptoms on the basis of symptoms, LV remodeling, systolic and diastolic function.

Key words: Aortic Stenosis (AS), Aortic Regurgitation (AR), Aortic Valve Replacement (AVR)

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