Circulation, Vol 72, 1244-1256, Copyright © 1985 by American Heart Association
RO Bonow, AL Picone, CL McIntosh, M Jones, DR Rosing, BJ Maron, E Lakatos, RE Clark and SE Epstein
Recent studies suggest that preoperative left ventricular function may no
longer be an important determinant of survival or functional results after
operation for aortic regurgitation because of improved operative
techniques. To assess the effect of left ventricular function on prognosis
in the current surgical era, we performed echocardiographic and
radionuclide angiographic studies in 80 consecutive patients undergoing
valve replacement from 1976 to 1983. No patient had associated coronary
artery disease. For all patients, 5 year survival was 83 +/- 5%,
significantly better than the 62 +/- 9% 5 year survival in our patients
operated on from 1972 to 1976. Preoperative resting left ventricular
ejection fraction (p less than .001), fractional shortening (p less than
.001), and end-systolic dimension (p less than .01) were the most
significant predictors of survival (univariate life- table analysis). Five
year survival was 63 +/- 12% in patients with subnormal ejection fraction
(n = 50) compared with 96 +/- 3% in those with normal ejection fraction (n
= 30). Patients with subnormal left ventricular ejection fraction and poor
exercise tolerance or prolonged duration of left ventricular dysfunction
(greater than 18 months) comprised the high-risk subgroup (5 year survival
52 +/- 11%). Patients in this subgroup also had persistent left ventricular
dysfunction after operation, with greater left ventricular end-diastolic
dimensions and reduced ejection fraction (both p less than .001) compared
with patients with normal preoperative left ventricular ejection fraction
or a brief duration of left ventricular dysfunction (less than 14 months).
Cold hyperkalemic cardioplegia was used for myocardial preservation in 46
patients.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: impact of preoperative left ventricular function
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