Mid-term echocardiographic progression of patients with moderate-aortic regurgitation: Implications for aortic valve surgery

Background and aim of the study: Replacement of the aortic valve for moderate aortic regurgitation (AR) as an adjunct to another cardiac surgery, primarily for coronary artery bypass grafting (CABG) or mitral valve replacement or repair, remains the subject of much debate. The study aim was to monitor the progression rate of moderate AR by means of echocardiography, and to reveal the need for future surgical intervention. Methods: A total of 262 consecutive patients (162 males, 100 females; mean age 65 ± 15 years; range: 21-93 years) with moderate AR and no more than mild aortic stenosis, were followed for a mean of 42 ± 31 months. AR resulted from disease of the aortic leaflets in 145 patients (55%) and was secondary to dilatation of the aortic root in 70 patients (27%). The cause of AR could not be determined in 47 patients (18%). Results: Progression to severe AR occurred in 18 patients (6.9%), an average progression rate of 1.9% per year. Patients in whom the main pathology was aortic dilatation had a significantly higher rate of progression to severe AR (9/70; 3.7%/year) compared to those with leaflet pathology (7/145; 1.4%/year, p <0.03). Only three patients were referred for aortic valve replacement during follow up (yearly rate 0.3%); all of these patients had aortic dilatation as the cause of AR. In total, 26 patients (9.9%) died during the follow up, representing an annual all-cause mortality rate of 2.8%. Conclusion: In the face of a slow progression and a low event rate, there is no support for 'prophylactic' valve replacement in patients with moderate AR who have been referred for CABG or mitral valve surgery.