Early and late prognosis after valve replacement in aortic regurgitation. Preoperative risk stratification and reasons for a more aggressive surgical approach.

From 1965 through 1986 136 patients underwent valve replacement for aortic regurgitation. Mean age was 50 years and male:female ratio 3.7:1. Hospital mortality (HM, less than or equal to 30 days) varied with NYHA classes and digitalis/diuretics treatment (D/D):I (n = 80) 0%, II without D/D (n = 17) 0%, II with D/D (n = 21) 5%, III (n = 55) 7%; and IV (n = 35) 29% (p less than 0.01). Long-term survival was examined for 121 patients who were alive 30 days postoperatively. Five- and 10-year cumulative survival +/- SE were 80 +/- 4% and 66 +/- 6%, respectively. No late deaths were noted for NYHA class I and NYHA class II without D/D; NYHA class II with D/D had survival characteristics comparable to NYHA class III with 10-year survivals of 60%. Patients with acute regurgitation (endocarditis, n = 35) had a 10-year survival +/- SE of 88 +/- 5% compared to 57 +/- 7% for chronic regurgitation (p = 0.05). A Cox regression analysis revealed that ventricular ectopic beats, chronic regurgitation, left ventricular failure, and right ventricular failure were independent risk factors. Presence and different combination of these risk factors identified 5 risk groups (A-E) with 10-year survivals of:A (n = 16) 100%; B (n = 50) 75%; C (n = 37) 63%; D (n = 15) 27%; and E (n = 3) 0% (p less than 0.0001). Minimally symptomatic patients without preoperative medical treatment for congestive heart failure had superior survival characteristics compared to those who received treatment.(ABSTRACT TRUNCATED AT 250 WORDS)