Optimal time for replacement surgery in chronic aortic valve disease

The purpose of this study was to clarify the characteristic features of aortic valvular heart disease (VHD) compared with mitral VHD and to discuss the optimal time for replacement surgery. Serial echocardiographic studies on a medically treated group with aortic regurgitation disclosed that those patients presenting with congestive heart failure or dying during follow-up period showed the systolic dimension of the left ventricle (LVDs) over 55 mm and percentage fractional shortening (%FS) to be less than 27%. Factors influencing the result of replacement surgery for aortic regurgitation was studied by comparing the group in which the postoperative course was uneventful with the group in which postoperative support with catecholamine of the intra-aortic balloon pumping (IABP) was necessary. Systolic dimension of the left ventricle, %FS and mVcf by echocardiography were significantly different in the two groups. It is concluded from these results that aortic valve replacement for the aortic regurgitation should be performed just before, or immediately after, LVDs exceeds 50 mm, %FS falls below 28% and mVcf falls below 0.9, even in asymptomatic patients.