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Maurizio Salati
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Ann Thorac Surg 1994;58:509-515
© 1994 The Society of Thoracic Surgeons

Articles

Surgical timing in aortic regurgitation: Left ventricular function analysis by contractility score

Pietro Di Biasi, MD*, Antonella Pajé, MD, Maurizio Salati, MD, Giorgio Bozzi, MD, Maurizio Viecca, MD, Alessandro Cialfi, MD, Maurizio Di Biasi, MD, Stefano Guzzetti, MD, Carmine Santoli, MD

Divisione di Chirurgia Toracica e Cardiovascolare and Divisione di Cardiologia, Clinica Medica II, Ospedale Luigi Sacco, Milano, Italy

Accepted for publication December 23, 1993.

* Address reprint requests to Dr Di Biasi, Divisione di Cardiochirurgia Ospedale Luigi Sacco, via G. B. Grassi n° 74, 20174, Milano, Italy.

In 32 patients with aortic regurgitation, angiographic evaluation of global left ventricular performance before and after aortic valve replacement was carried out by means of a computer-analyzed contractility scoring system. A strong correlation was detected between the preoperative 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 greater exhibited a persistently elevated score after operation that indicated the presence of irreversible contractile dysfunction. Patients in groups A and B (preoperative score, 0 to 40) experienced a good surgical outcome, and at 5-year follow-up were in New York Heart Association functional class I. Patients in group C (preoperative score, > 40) altogether had a very poor surgical outcome, although they did experience a short to midterm period of symptomatic relief. It is important to offer aortic valve replacement to patients with aortic regurgitation before their chances for a good functional result are lost. The computer-analyzed contractility score may be a useful index for determining the optimal timing of operation in these patients, particularly those who show features consistent with impaired left ventricular function but are asymptomatic and who should undergo aortic valve replacement before symptoms of definitive left ventricular failure develop.






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Copyright © 1994 by The Society of Thoracic Surgeons.