Recent results and problems in the surgical treatment of acquired valvular heart disease

From June, 1977 to August, 1981, 388 patients underwent open heart surgery for acquired valvular heart diseases. The over-all surgical mortality rate during this period was only 4%, but a high incidence of postoperative complications (26% for major complications) was still observed. It is an urgent concern for all cardiac-surgeons to reduce postoperative complications in order to obtain better surgical results. Even with improved techniques in modern cardiac surgery, 28 patients with a giant left atrium were still in the high risk group, with an over-all mortality rate of 29% and with a high incidence (68%) of postoperative complications. This seemed to be attributable mainly to deteriorated conditions such as cardiac cachexia, but not necessarily to impaired pulmonary function. Therefore, more careful considerations should be paid not only for their circulatory and pulmonary conditions, but also for the improvement of their general condition, including nutrition and metabolism. On the other hand, 27 patients with infective endocarditis showed a remarkable improvement after prosthetic valve replacement in spite of their seriously deteriorated preoperative condition. There were 4 hospital deaths (15% mortality). All transferred to our institution in a far advanced stage of the disease. Early surgical intervention for intractable cardiac failure should be strongly recommended for these patients.