Functional rehabilitation after cardiac valve surgery

Functional rehabilitation after cardiac valve surgery was evaluated in a series of 267 patients operated upon during the years 1963 through 1970. All but a few were in N.Y.H.A. Functional Class III or IV prior to operation. Hospital mortality was 14%, and the late mortality was 26%. During the last four years (1967–1970), when only current-model Starr-Edwards valves were used, hospital mortality was reduced to 8% (5.4% for single- or double-valve replacement), but late mortality (15% within two years) was unchanged. The reduction in hospital mortality was due to improvements in surgical technique and postoperative care rather than to improved valve design.Although more than 70% of the survivors were in Functional Class I or II postoperatively, fewer than 20% returned to work and only 24% were asymptomatic. These findings did not improve during 1967–1970. Multivariable computer analysis failed to reveal specific preoperative factors that correlated with late mortality or functional results. Isolated mitral stenosis was associated with the lowest late mortality, and isolated mitral regurgitation had the highest late mortality. Long-standing congestive heart failure also carried a poor prognosis. Complications related to the prosthetic valve were reduced with current-model prostheses, but valve-related causes accounted for less than 12% of deaths, and late mortality due to progressive cardiac disease was unchanged. It is suggested that correction of cardiac valve lesions is performed too late in the course of the disease to significantly influence rehabilitation of most patients.