Determinants of prognosis of patients with aortic regurgitation who undergo aortic valve replacement
PH Stone,
RD Clark,
N Goldschlager,
A Selzer,
and
K Cohn
Insidious and potentially irreversible left ventricular dysfunction may develop in patients with aortic regurgitation. To determine whether preoperative variables can predict postoperative outcome, 113 consecutive patients with aortic regurgitation who underwent surgical correction between 1962 and 1977 were studied and survivors were followed up for 4.6 +/- 3.3 years. Clinical and hemodynamic examinations were made in all patients before the operation. Echocardiograms were performed in 44 patients preoperatively and in 36 patients postoperatively. Perioperative or postoperative death due to congestive heart failure occurred in only eight patients (19%). No statistically significant predictors of total mortality or death due to cardiac failure were found based on preoperative clinical, hemodynamic or echocardiographic findings. Survivors of the operation showed significant functional improvement: preoperatively, 77% of all patients were in functional class III or IV; postoperatively, 84% of patients were in class I or II (p less than 0.0001). A weak statistical correlation of functional improvement was found with a preoperative presence of increased cardiac diameter on the chest radiograph (p less than 0.05) and the severity of left ventricular hypertrophy (p less than 0.05). Improvement of left ventricular function was also consistently found in survivors and correlated best with the degree of preoperative preservation of left ventricular function. Patients with an echocardiographic preoperative fractional shortening of the minor diameter greater than 26%, end-systolic dimension less than 55 mm and end-diastolic dimension less than 80 mm were most likely to have normal function after the operation. It is concluded that operative mortality and survival after surgical correction of aortic regurgitation cannot be accurately predicted from preoperative findings.(ABSTRACT TRUNCATED AT 250 WORDS)
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