Survival and functional results after valve replacement for XXXX from 1976 to 1983: impact of preoperative left ventricular function.

@entity1 @entity453 @entity337 @entity1002
Recent studies suggest that preoperative left ventricular function may no longer be an important determinant of survival or functional results after operation for @entity337 because of improved operative techniques. To assess the effect of left ventricular function on prognosis in the current surgical era, we performed echocardiographic and radionuclide angiographic studies in 80 consecutive @entity1 undergoing valve replacement from 1976 to 1983. No @entity1 had associated @entity453 . For all @entity1 , 5 year survival was 83 +/- 5%, significantly better than the 62 +/- 9% 5 year survival in our @entity1 operated on from 1972 to 1976. Preoperative resting left ventricular ejection fraction (p less than .001), fractional shortening (p less than .001), and end-systolic dimension (p less than .01) were the most significant predictors of survival (univariate life-table analysis). Five year survival was 63 +/- 12% in @entity1 with subnormal ejection fraction (n = 50) compared with 96 +/- 3% in those with normal ejection fraction (n = 30). @entity1 with subnormal left ventricular ejection fraction and poor exercise tolerance or prolonged duration of @entity1002 (greater than 18 months) comprised the high-risk subgroup (5 year survival 52 +/- 11%). @entity1 in this subgroup also had persistent @entity1002 after operation, with greater left ventricular end-diastolic dimensions and reduced ejection fraction (both p less than .001) compared with @entity1 with normal preoperative left ventricular ejection fraction or a brief duration of @entity1002 (less than 14 months). Cold hyperkalemic cardioplegia was used for myocardial preservation in 46 @entity1 .(ABSTRACT TRUNCATED AT 250 WORDS)
