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(Circulation. 1996;94:2355-2357.)
© 1996 American Heart Association, Inc.

Articles

Aortic Regurgitation in Women

Does the Measuring Stick Need a Change?

Blase A. Carabello, MD

the Department of Medicine and the Gazes Cardiac Research Institute, Medical University of South Carolina, and the Ralph H. Johnson Department of Veterans Affairs, Charleston, SC.

Correspondence to Blase A. Carabello, MD, Charles Ezra Daniel Professor of Cardiology, Cardiology Division, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425-221.

Key Words: Editorials • regurgitation • aorta • surgery

	Introduction

 
The outlook for patients with aortic regurgitation has improved dramatically over the past two decades. Operative mortality has decreased from as high as 20% in the early 1970s to 2% to 4% today.^{1 2 3} Survivorship after aortic valve replacement for aortic regurgitation has also improved so that there now is approximately an 85% 5-year and 70% 10-year survivorship.^{3 4 5}

Improvement in survival derives from several underlying factors, including (1) newer prosthetic valves, which have improved hemodynamic profiles and a reduced risk of thromboembolism; (2) the almost universal use of intraoperative cardioplegia, which protects the enlarged left ventricle of aortic regurgitation from ischemic damage; and (3) progressively earlier surgery performed on candidates with better preoperative left ventricular function resulting, in turn, in better postoperative left ventricular function. While once surgery was delayed until the patient suffered from far-advanced symptoms refractory to medical therapy,⁶ now patients with mild symptoms and even asymptomatic patients are referred for surgery if preoperative echocardiographic evaluation demonstrates evidence of early left ventricular dysfunction.⁷ Although valvular heart disease imparts abnormal loading conditions on the left ventricle, making load-sensitive ejection phase indexes such as ejection fraction sometimes difficult to interpret, the "55" rule has been extremely effective in helping physicians time aortic valve replacement for patients with aortic regurgitation. By operating on patients before ejection fraction falls below 55%⁸ or before the left ventricle can no longer contract to an end-systolic dimension of 55 mm or less,⁹ low operative mortality and normal postoperative ejection fraction is expected unless an unusual event . . . [Full Text of this Article]