Early surgical intervention versus watchful waiting and outcomes for asymptomatic severe aortic regurgitation Christophe de Meester, MS, Bernhard L.

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Presentation transcript:

Early surgical intervention versus watchful waiting and outcomes for asymptomatic severe aortic regurgitation Christophe de Meester, MS, Bernhard L. Gerber, MD, PhD, David Vancraeynest, MD, PhD, Anne-Catherine Pouleur, MD, PhD, Philippe Noirhomme, MD, Agnès Pasquet, MD, PhD, Gébrine El Khoury, MD, Jean-Louis Vanoverschelde, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 5, Pages 1100-1108 (November 2015) DOI: 10.1016/j.jtcvs.2015.07.053 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow chart of the study population. AR, Aortic regurgitation; MR, mitral regurgitation; AS, aortic stenosis; LV, left ventricular; LVEDD, left ventricular end-diastolic dimension; GFR, glomerular filtration rate. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1100-1108DOI: (10.1016/j.jtcvs.2015.07.053) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan–Meier survival curves comparing 10-year overall postoperative survival in patients undergoing early surgery (blue line) or initial medical management (red line). Survival in the overall population (A), propensity score–matched cohorts (B), and IPW-adjusted cohorts (C). Numbers at bottom indicate patients at risk. IPW, Inverse probability-weighted. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1100-1108DOI: (10.1016/j.jtcvs.2015.07.053) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Kaplan–Meier survival curves comparing major cardiovascular events in initially asymptomatic patients with severe AR between those undergoing early surgery (blue line) and those managed conservatively (red line). The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1100-1108DOI: (10.1016/j.jtcvs.2015.07.053) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Kaplan–Meier survival curves comparing overall mortality in initially asymptomatic patients with severe AR managed conservatively, according to the regularity and quality of follow-up (yearly regular follow-up [red line], looser follow-up [brown line]). The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1100-1108DOI: (10.1016/j.jtcvs.2015.07.053) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

In asymptomatic severe AR, early surgery and a watchful waiting result in similar outcomes. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 1100-1108DOI: (10.1016/j.jtcvs.2015.07.053) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions