Comparative mortality in medically treated aortic regurgitation.

OBJECTIVE To present and discuss in this article a table of comparative mortality of medically treated patients with aortic regurgitation, derived from data presented in the source article. BACKGROUND Although there is abundant information on the follow-up (FU) of patients after surgical replacement of a leaking aortic valve, FU studies of patients with aortic regurgitation prior to valve replacement give discordant and confusing results for a number of reasons. The aim of the source study was to confine the results to patients who had been and continued to be on medical treatment only. METHODS In this article, the triple decrement approach to life table analysis has been emphasized (death, withdrawal due to surgery, and withdrawal due to end of FU). Data in the source article were used to calculate exposures and to prepare a life table incorporating exposures, observed and expected deaths, to derive observed, expected, and excess death rates and mortality ratios. RESULTS There was no significant excess mortality above that in the age/sex-matched US population in the NYHA class I group. In NYHA class II group, the excess death rate (EDR) averaged 28 per 1000 per year over 0-10 years. In NYHA class III and IV groups, the EDR was very high, averaging 205 per 1000 per year over 0-5 years, with a mortality ratio (MR) of 1100%. CONCLUSION Based on data presented in the source article, there was no excess mortality in medically treated aortic regurgitation patients with no functional impairment (NYHA class I), compared to the control population. However, the long-term outlook for the AR patients with good NYHA functional classification includes a high incidence of heart failure and valve surgery. Excess mortality was significant in NYHA class II patients, and was very high in patients with NYHA class III and IV impairments. In the source study, exposure to risk of medically managed aortic regurgitation was greatly curtailed by the performance of aortic valve surgery soon after initial diagnosis, most within the first year of FU.