The Annals of Thoracic Surgery, Vol 58, 509-515, Copyright © 1994 by The Society of Thoracic Surgeons
Surgical timing in aortic regurgitation: left ventricular function analysis by contractility score
P Di Biasi, A Paje, M Salati, G Bozzi, M Viecca, A Cialfi, M Di Biasi, S Guzzetti and C Santoli
Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale Luigi Sacco, 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.
