[Minimal requirement for successful late results of valve replacement for aortic regurgitation and aortic stenosis]

This study was consisted of 69 patients undergoing aortic valve replacement for chronic aortic regurgitation (AR) and 29 patients, for aortic stenosis (AS) between 1978 and 1985. There was no operative death. There were 7 late cardiac deaths in AR patients, with preoperative left ventricular end-systolic volume index (LVESVI) greater than 200 ml/m2. None of the 55 patients with an LVESVI less than 200 m/m2 died of cardiac-causes. In AR patients with preoperative LVESVI greater than 200 ml/m2, despite the postoperative reduction of the wall stress, the ejection fraction failed to return to normal, indicating that irreversible myocardial dysfunction was responsible in these patients. There were two cardiac-related deaths in 29 AS patients, who had preoperative LVESVI greater than 100 ml/m2. In postoperative AS patients with LVESVI greater than 100 ml/m2, postoperative contractile function of the left ventricle was poor. In conclusion, minimal preoperative left ventricular function for satisfactory late results and reversal of functional results may be at a lower level was LVESVI 200 ml/m2 in AR patients and 100 ml/m2 in AS patients.