Impact of recent 2021 ESC guideline changes on postoperative survival of patients with severe aortic regurgitation: insights from the AVIATOR registry

Abstract Background Until 2021, the strongest guidelines on surgical correction of severe aortic regurgitation (AR) focused left ventricular systolic function (LVEF) and presence symptoms. However, those situations lead to an outcome penalty, even after correction. Left ventricle end-systolic diameter (LVESD) gained in strength 2021 European guidelines. Moreover, more inclusive cut-off values are now recommended (class IIb) patients at low risk, reflecting will recommend surgery before developing heart failure its consequences post-operative outcome. Purpose We sought evaluate impact triggers their recent changes postoperative survival with AR from a large multicentric international registry. Method results Postoperative overall 1899 operated for chronic (mean age 49±15 years, 85% male) multicenter registry valve surgery, AVIATOR, was evaluated over median 37 months. Twelve (0.6%) died postoperatively, 68 within 10 years. By multivariable Cox analysis, symptoms (HR 2.60; 95% CI [1.20–5.66]; p=0; 016), either LVESD >50 mm or >25 mm/m2 1.64; [1.05–2.55]; p=0.029) predicted independently above 2.25 per SD, [1.67–3.03], p<0.001), female gender bicuspid phenotype. Therefore, when meeting old new class I had worse adjusted (respectively 86±2% 87±2%) than without (97±2%, p<0.01). However asymptomatic while ESC IIb (ie >20 LVEF between 50–55%, 10-year 97±3%). sub-group having dilated but preserved >50% excellent (10-year 95±3%). Conclusions In AR, any trigger have penalty. Asymptomatic earlier better survival. This supports early as encouraged by ESC/EACTS Funding Acknowledgement Type funding sources: Public grant(s) – National budget only. Main source(s): Fondation Nationale de la Recherche Scientifique Belgian Government