Reduction in left ventricular volume following aortic valve replacement does not predict improved ventricular function

Background  Aortic valve replacement in rheumatic disease is one of the procedures that clearly prolonged the life expectancy of adult patients. Our study objectives are to assess the mortality and morbidity associated with aortic valve replacement, and study the effects of successful, valve replacement on ventricular volume and performance in aortic stenosis and in aortic incompetence. Methods  Between January 1997 and December 2001, 148 patients underwent aortic valve replacement at our institution. The records of these patients were evaluated retrospectively. A total of 136 survivors were followed up both actively and passively. Results  There were 9 deaths (6.07%) with an early mortality at 30 days of 4.05% and valve related mortality of 4.05%. Bleeding events and operated valve endocarditis occurred infrequently (0.03% and 0.04% / patient year). 2 patients had nonstructural valve dysfunction (paravalvular leak) (0.02% / patient year). Following successful valve replacement, ventricular volume decreased substantially, while there was no significant increase in ventricular performance in aortic stenosis, and aortic incompetence. Conclusion  Aortic valve replacement can be performed today with a low mortality and morbidity. Although the ventricular volume and cardiac size reduced substantially following valve replacement, the ventricular performance remained unchanged in aortic stenosis, and aortic incompetence because of the impaired ventricular function pre-operatively and because the ejection fraction tends to over estimate contractile function in aortic regurgitation. Low preoperative ejection fraction is therefore an important risk factor for postoperative left ventricular dysfunction.