DETERMINANTS OF SURVIVAL AND RECOVERY OF LEFT-VENTRICULAR FUNCTION AFTER AORTIC-VALVE REPLACEMENT

To determine factors that influence survival and recovery of ventricul ar function in patients undergoing aortic valve replacement in the cur rent surgical era, baseline risk factors related to outcome were analy zed in 1,012 consecutive patients undergoing aortic valve replacement between 1983 and 1990. Forty-two percent of patients underwent concomi tant coronary bypass. Observed survival probabilities (expressed as 30 -day/5-year) were 0.97/0.81 overall, 0.99/0.89 for patients aged less than 70 years, and 0.95/0.74 for patients aged 70 years or greater. Ad vanced age (p < 0.0001), decreased ejection fraction (p < 0.0001), ext ent of coronary disease (p < 0.006), smaller prosthetic valve (p < 0.0 3), and advanced New York Heart Association class (p < 0.04) were incr emental risk factors for mortality. In patients with preoperative vent ricular dysfunction (ejection fraction less-than-or-equal-to 0.45), ej ection fraction measured 1.4 years after aortic valve replacement impr oved in 72% and the mean increment in ejection fraction was 0.175 (95% confidence interval 0.154 to 0.195). The increment in ejection fracti on was greater in female patients than in male patients (p < 0.02) and greater in patients without than with coronary disease (p < 0.02). Fe male sex (p < 0.02) and lesser extent of coronary disease (p < 0.05) w ere independent predictors of change in ejection fraction. In all pati ents, early improvement in ejection fraction conveyed an independent s ubsequent survival benefit (p < 0.0001). The results of aortic valve r eplacement in the current era are excellent, and the majority of patie nts with ventricular dysfunction demonstrate significant improvement. Early improvement in ejection fraction, influenced by coexistent coron ary artery disease and sex-associated factors, importantly affects sub sequent survival.