HOW TO MANAGE PATIENTS WITH SEVERE LEFT-VENTRICULAR DYSFUNCTION AND VALVULAR REGURGITATION

Background and aims of the study: The purpose of this study is to anal yze treatment options for valvular regurgitation with severe left vent ricular dysfunction. Material and methods: Results of valvular surgery in 98 patients with mitral or aortic regurgitation and severe systoli c left ventricular dysfunction (LVD) were analyzed. Selection criteria were the absence of significant coronary heart disease and a resting ejection fraction (EF) <40% for aortic and <50% for mitral regurgitati on. Results: In patients with aortic regurgitation (n = 46) operative mortality was higher but not significantly so than in a control group of 238 cases (6.5% vs. 3.4%). The actuarial survival rates at five and 10 years were 84% and 55% vs. 84% and 67%, respectively. Independent preoperative predictors of severe postoperative LVD were rheumatic eti ology and increased left ventricular end-systolic diameter. In patient s with mitral regurgitation (n = 52), operative mortality was not sign ificantly different from that of a control group of 273 cases (3.8% vs . 2.6%), whether the surgical procedure was valve replacement or valve repair. Perioperative morbidity was frequent (30% of cases), mainly l ow cardiac output, after valve replacement. The actuarial survival rat es at eight years were respectively for the groups with and without LV D: 81% and 89% after valve repair, 60% and 75% after valve replacement . Independent predictors of severe postoperative LVD were increased le ft ventricular end-systolic volume and the type of surgery, Better res ults were observed after valve repair. Conclusions:It is concluded tha t a low EF is not a predictive factor of operative mortality but it in fluences late survival as do the degree of left ventricular dilatation , etiology in aortic and type of surgery in mitral regurgitation. Alte rnatives to valvular surgery have been envisaged but information on va sodilators in these patients is scant and results of heart transplanta tion are known only from a few small series.