Fiedler AG, et al. - This work was designed to assess if a survival benefit exists with aortic valve replacement (AVR) compared with medical management in patients with severe aortic regurgitation (AR) and left ventricular ejection fraction (LVEF) <50%. Findings revealed that AVR was associated with higher survival among these patients even after adjustment for clinical characteristics and patient age. The results provided some evidence that in this high-risk patient group, surgery could be associated with prolonged survival, although treatment selection bias could not be completely eliminated by this analysis.