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Emergency aortic valve replacement.

J H Sanders, L H Cohn, J E Dalen

    American Journal of Surgery
    |April 11, 1976
    PubMed
    Summary
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    Emergency aortic valve replacement offers reasonable survival for critically ill patients with aortic valve disease. Despite severe conditions, no immediate surgical deaths occurred, with most patients achieving good functional status post-operation.

    Area of Science:

    • Cardiovascular Surgery
    • Cardiac Valve Disease
    • Emergency Medicine

    Background:

    • Aortic valve disease, including critical aortic stenosis and acute aortic insufficiency, presents significant mortality risks.
    • Emergency surgical intervention is often necessary for patients with severe symptoms like cardiac arrest, low cardiac output, or intractable pulmonary edema.
    • Pre-operative assessment challenges exist in critically ill patients, sometimes precluding invasive diagnostic procedures like cardiac catheterization.

    Purpose of the Study:

    • To evaluate the outcomes of emergency aortic valve replacement in critically ill patients.
    • To assess the survival rates and functional status following emergency aortic valve surgery.

    Main Methods:

    • Retrospective analysis of 27 patients undergoing emergency aortic valve replacement between July 1970 and December 1974.

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  • Indications included critical aortic stenosis (22 patients) and acute aortic insufficiency (5 patients).
  • Diagnosis was clinical, supported by noninvasive maneuvers, with cardiac catheterization omitted in 10 critically ill patients.

    • Main Results:

    • No surgical deaths occurred in the study cohort.
    • At 5–33 months post-surgery, 25 patients were alive, active, and in New York Heart Association (NYHA) Class I.
    • One late death and one case of residual exertional dyspnea were reported; one patient required reoperation for prosthetic valve thrombosis.

    Conclusions:

    • Emergency aortic valve replacement can be a life-saving procedure for desperately ill patients with aortic valve disease.
    • The study demonstrates a reasonable chance of survival and good functional recovery even in high-risk surgical candidates.
    • These findings support the consideration of urgent surgical intervention for severe aortic valve pathology irrespective of critical pre-operative status.