[The evaluation of operability for patients with severe valvular disease]

The present study was designed to evaluate and determine the factors which affected the prognosis of the surgical patients with severe valvular diseases. Four hundred and forty six cases which underwent valvular surgery from 1977 to 1987 were used for this study. There were 16 early death cases (3.6%) and 16 late death cases (3.6%), respectively. The early death rate after surgery was significantly high in the cases which had 1) poor LV function (LVEF less than 35%), 2) liver dysfunction (T-Bil greater than 1.3mg/dl, ICG-Rmax less than 1.0 mg/kg/min, Ch-E less than 0.6PH, K-ICG 0.10/min), and/or 3) PVE after valve replacements. These factors were recognized in 9 (56.3%) of the early death cases and 10 (62.5%) of the late death cases. Thus, we consider that these factors affect the surgical prognosis and that the border line values for the factors are: 1) LVEF less than 0.3%, LVDI greater than 40 ml/m2 in MS group and 50 mg/m2 in other valvular groups. 2) T-Bil greater than 2.7 mg/dl, ICG-Rmax less than 0.5mg/kg/min in cardiac cachectic cases, and 3) active PVE cases which showed drug-resistance. Furthermore, these values should be corrected by IVH and immunosupportives during the pre- and post-operative periods.