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Ann Thorac Surg 1990;50:779-785
© 1990 The Society of Thoracic Surgeons

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Articles

Timing of operation for aortic regulation: Relation to postoperative contractile state

First Department of Surgery, Osaka University Medical School, and Division of Cardiovascular Surgery, Sakurabashi-Watanabe Hospital, Osaka, Japan

Accepted for publication July 23, 1990.

^_* Address reprint requests to Dr Taniguchi, First Department of Surgery, Osaka University Medical School, 1-1-50, Fukushima, Fukushima-ku Osaka 553, Japan.

With angiography and pressure measurement, we determined left ventricular volume, wall stress, and systolic performance in 30 patients with aortic regurgitation before and after successful aortic valve replacement. End-systolic wall stress was greatly elevated preoperatively and decreased to normal postoperatively. Systolic pump performance assessed as ejection phase indexes was severely depressed preoperatively and improved to normal or near-normal postoperatively in most patients. The ratio of end-systolic wall stress to end-systolic volume index (ESS/ESVI), an index of myocardial contractility, was greatly decreased before operation. Postoperatively, the ratio increased in all patients, becoming normal in 12 of the 13 patients who had a preoperative ESS/ESVI of 2.9 or greater. However, 15 of 17 patients in whom the ESS/ESVI ratio was less than 2.9 still had subnormal ratios, which indicates the presence of irreversible contractile dysfunction. Stepwise multivariate analysis showed that preoperative ESS/ESVI was the only independent discriminator of postoperative normalization of the contractile function as assessed by ESS/ ESVI. After aortic valve replacement, myocardial contractile state does not return to normal in a considerable number of patients. It is important to offer aortic valve replacement for aortic regurgitation before the chance for a good functional result is lost. The ESS/ESVI ratio may be a useful index in determining the timing of operation in patients with aortic regurgitation.

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