Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitation

Forty-five patients underwent aortic valve replacement (AVR) for severe isolated aortic regurgitation from 1973 to 1979. There were two (4.4%) hospital deaths, both functional class IV. Six patients with mechanical prosthesis not receiving anticoagulants were excluded from further analysis. These data relate to 39 patients; the two operative deaths, 35 patients with mechanical prosthesis receiving anticoagulants, and two with bioprosthesis. There were three late cardiac deaths with 5-year survival 85%; average annual mortality rate of 3%. The 5-year survival with pre-AVR left ventricular (LV) ejection fraction ≥ 0.45 was 87% vs 54% < 0.45, (p < 0.04); cardiac index ≥ 2.5 L/min/m² 92% vs 66% < 2.5 (p < 0.04); mean VCF ≥ 0.75 vs < 0.75 circ/sec (p < 0.09); end-diastolic pressure ≤ 20 vs > 20 mm Hg (p < 0.08). Late survival was not significantly different between pre-AVR functional class I and II vs class III and IV; LV end-diastolic volume index ≥ 210 vs < 210 ml/m²; LV end-systolic volume index ≥ 110 vs < 110 ml/m²; and LV mass ≥ 240 vs < 240 gm/m². With ejection fraction ≥ 0.50 there was only one operative death (functional class IV) and no late cardiac deaths. Thus late survival following aortic valve replacement for severe isolated aortic regurgitation is better predicted preoperatively by the LV systolic pump function variables of ejection fraction and cardiac index than by LV diastolic parameters and clinical status.