SURGICAL TIMING IN AORTIC REGURGITATION - LEFT-VENTRICULAR FUNCTION-ANALYSIS BY CONTRACTILITY SCORE

In 32 patients with aortic regurgitation, angiographic evaluation of g lobal left ventricular performance before and after aortic valve repla cement was carried out by means of a computer-analyzed contractility s coring system. A strong correlation was detected between the preoperat ive and postoperative contractility score. Postoperatively, the score decreased in all but 3 patients, becoming normal or near normal in 21 of 27 patients whose preoperative value had been less than 40. However , all 5 patients with a preoperative contractility score of 40 or grea ter exhibited a persistently elevated score after operation that indic ated the presence of irreversible contractile dysfunction. Patients in groups A and B (preoperative score, 0 to 40) experienced a good surgi cal outcome, and at 5-year follow-up were in New York Heart Associatio n functional class I. Patients in group C (preoperative score, >40) al together had a very poor surgical outcome, although they did experienc e a short to midterm period of symptomatic relief. It is important to offer aortic valve replacement to patients with aortic regurgitation b efore their chances for a good functional result are lost. The compute r-analyzed contractility score may be a useful index for determining t he optimal timing of operation in these patients, particularly those w ho show features consistent with impaired left ventricular function bu t are asymptomatic and who should undergo aortic valve replacement bef ore symptoms of definitive left ventricular failure develop.