Circulation, Vol 60, 48-58, Copyright © 1979 by American Heart Association
F Schwarz, W Flameng, F Langebartels, M Sesto, P Walter and M Schlepper
Postoperative survival and left ventricular function were studied in 128
patients who underwent isolated aortic valve replacement by the
Bjork-Shiley valve between 1973 and 1977. The average follow-up was 2.1
years. Patients with associated coronary artery disease or mitral valve
disease were excluded. Preoperative ejection fraction ranged from 15- 84%.
Forty-two patients were restudied by cardiac catheterization 9.1 +/- 1.1
months (mean +/- SEM) after valve replacement. The hospital mortality was
11%. Preoperative type of valve lesion, functional class, cardiothoracic
ratio, and ejection fraction (EF) had no significant effect on
postoperative survival up to 4 years. After operation, left ventricular
mass (LVMI) and peak systolic wall stress (PSWS) fell significantly, while
EF and mean normalized systolic ejection rate (MNSER) increased in aortic
stenosis and in aortic insufficiency. Neither in aortic stenosis nor in
aortic insufficiency was there a significant relation between preoperative
ejection fraction and postoperative LVMI, EF, MNSER and PSWS. We attributed
this to a marked improvement of left ventricular function in patients with
preoperative impaired ventricular function. Six patients with paravalvular
leak to restudy has a significantly lower EF and MNSER, and a higher PSWS
than patients without leak. Patients without leak had normal EF, MNSER and
PSWS when compared with 10 normal persons, but LVMI remained moderately
elevated. Postoperative transprosthetic gradient was 11.9 mm Hg (range 0-64
mm Hg). We conclude that impaired cardiac function is completely restored
after aortic valve replacement by Bjork-Shiley valve, if valve function is
good. Patients with impaired cardiac function preoperatively did not have a
poorer prognosis after operation than patients with normal function.
ARTICLES
Impaired left ventricular function in chronic aortic valve disease: survival and function after replacement by Bjork-Shiley prosthesis
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