AORTIC REGURGITATION COMPLICATED BY EXTREME LEFT-VENTRICULAR DILATION- LONG-TERM OUTCOME LIFTER SURGICAL-CORRECTION

Objectives. This study sought to determine the outcome of aortic valve replacement for aortic regurgitation complicated by extreme left vent ricular dilation. Background. Aortic valve replacement has been recomm ended in aortic regurgitation with extreme left ventricular dilation ( diastolic dimension greater than or equal to 80 mm), but extreme left ventricular dilation raises concern about irreversible left ventricula r dysfunction, Methods. Thirty-one patients with a preoperative echoca rdiographic diastolic dimension greater than or equal to 80 mm (group 1) undergoing operation for severe isolated aortic regurgitation betwe en 1980 and 1989 were compared with 188 patients with a diastolic dime nsion <80 mm operated on during the same period (group 2). Results. Pr eoperatively, extreme left ventricular dilation was seen only in male patients and was associated with a reduced ejection fraction (43 +/- 1 2% vs. 53 +/- 11% [mean +/- SD], p < 0.0001). The postoperative outcom e of group 1 was compared with that of male patients in group 2 (group 2M, n = 144). The operative mortality rates for groups 1 and 2M mere 0% and 5.6%, respectively (p = 0.35). Late survival in operative survi vors was similar in groups 1 and 2M, but compared with expected surviv al, an excess mortality was observed for group 1 (p = 0.024). Preopera tive ejection fraction, but not diastolic dimension, independently pre dicted late survival and postoperative ejection fraction. Postoperativ ely, groups 1 and 2M showed a similar improvement in ejection fraction , but persistent left ventricular enlargement was more frequent in gro up 1. Conclusions. Extreme left ventricular dilation due to aortic reg urgitation is observed in male patients and is frequently associated p reoperatively with a reduced ejection fraction but is not a marker of irreversible left ventricular dysfunction. Operative risk and late pos toperative survival are acceptable in these patients, although a late excess mortality, predicted best by preoperative ejection fraction, is observed. Therefore, extreme left ventricular dilation is not a contr aindication to operation, which should be performed before left ventri cular dysfunction occurs.