Improved late survival in patients with chronic aortic regurgitation by earlier operation

Between 1970 and 1979, 156 patients with severe chronic aortic regurgitation underwent aortic valve replacement. Early mortality was 2.5%; 5 and 10 year survival rates were 85.9% and 69.2%, respectively. Early mortality decreased from 3.5% (2/56) in the period from 1970 to 1974 to 2.0% (2/100) in the period from 1975 to 1979; first-year survival rate was similar in the two periods (94.2% and 94.7%); 5 year survival rate increased from 80.1% in the period from 1970 to 1974 to 90.6% in the period from 1975 to 1979. The frequency of late death from heart failure decreased from 5/13 in the period from 1970 to 1974 to 0/9 in the period from 1975 to 1979. Preoperative NYHA class decreased from 2.7 (10 patients in class IV, none in class I) during 1970 to 1974 to 2.1 (one patient in class IV, 15 in class I) during 1975 to 1979 (p less than .001). From 1970 to 1974 preoperative cardiothoracic ratio (0.60 vs 0.57; p less than .001) and left ventricular end-diastolic pressure (33 vs 19 mm Hg; p less than .001) were higher and left ventricular ejection fraction (50% vs 54%; p less than .05) was lower than values during 1975 to 1979. The patients who died of heart failure were in a higher NYHA class before surgery, cardiothoracic ratio and left ventricular end-diastolic pressure were higher, and left ventricular ejection fraction was lower than those in patients who died suddenly. In all patients of both groups left ventricular end-diastolic volume exceeded 200 ml/m2.(ABSTRACT TRUNCATED AT 250 WORDS)