Improved surgical outcome for chronic severe aortic regurgitation with severely depressed left ventricular systolic function.

摘要

Chronic severe aortic regurgitation (AR) imposes a combined pressure and volume overload on the left ventricle (LV). Fortunately, preload reserve and compensatory hypertrophy allow most patients with chronic severe AR to maintain normal LV systolic function for many years. Most such patients are asymptomatic and have an excellent prognosis . Over the course of time, adverse loading conditions may cause LV systolic dysfunction, which often precedes the onset of symptoms. The standard of care is to monitor patients with chronic severe AR carefully and operate at the first sign of symptoms or LV dysfunction . However, some patients do not come to medical attention until they already have severely depressed LV systolic function. The question then arises as to whether such patients will benefit from surgery because of relief of afterload mismatch or whether it is too late to operate because irreversible LV dysfunction has already occurred.