Survival and functional results after valve replacement for aortic regurgitation from 1976 to 1983: Impact of preoperative left ventricular function

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 < .001), fractional shortening (p < .001), and end-systolic dimension (p < .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 (> 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 < .001) compared with patients with normal preoperative left ventricular ejection fraction or a brief duration of left ventricular dysfunction (< 14 months). Cold hyperkalemic cardioplegia was used for myocardial preservation in 46 patients. Survival was not influenced by cardioplegia, nor did cardioplegia alter the influence of left ventricular function on postoperative prognosis. Hence, despite improved operative techniques and better long-term survival compared with earlier results, preoperative resting left ventricular dysfunction continues to identify patients with aortic regurgitation at risk of death or persistent left ventricular dysfunction after aortic valve replacement. Early operation in such patients may result in further improvement in survival and functional results.