TIME-RELATED CHANGES IN LEFT-VENTRICULAR FUNCTION AFTER DOUBLE VALVE-REPLACEMENT FOR COMBINED AORTIC AND MITRAL REGURGITATION IN A YOUNG RHEUMATIC POPULATION - PREDICTORS OF POSTOPERATIVE LEFT-VENTRICULAR PERFORMANCE AND ROLE OF CHORDAL PRESERVATION

Background The long-term effects of double valve replacement on left v entricular function in patients with combined severe rheumatic aortic and mitral regurgitation have not been reported previously. Furthermor e, the importance of chordal preservation in this group of patients is unknown. Methods and Results Serial clinical and echocardiographic ev aluations were performed prospectively in 44 patients who underwent do uble valve-replacement for combined aortic and mitral regurgitation. C hordae to the posterior mitral leaflet were preserved in 27 patients. Mean follow-up was 40+/-19 months. Left ventricular end-diastolic diam eter decreased significantly 3 months after surgery (from 66+/-10 to 5 2+/-11 mm; P<.001) without a substantial change in end-systolic diamet er, resulting in a significant decline in ejection fraction (from 60+/ -9% to 48+/-15%; P<.001). At 1 year, a significant reduction in end-sy stolic dimension was observed without a concomitant decline in end-dia stolic diameter, thus normalizing the ejection fraction (55+/-12%; P=. 17 versus baseline). No further changes were seen at latest follow-up. Multivariate regression analysis identified baseline end-systolic dia meter and ejection fraction as independent predictors of postoperative systolic performance. Chordal preservation did not emerge as a univar iate or multivariate predictor. Conclusions After an initial postopera tive decline in ejection fraction, normalization in left ventricular s ystolic function may be expected 1 year after double valve replacement for combined rheumatic mitral and aortic regurgitation. End-systolic diameter and ejection fraction are the only independent predictors of postoperative left ventricular performance.