[Chronic aortic insufficiency with major left ventricle failure.ion. Results of aortic valve replacement and study of prognosis].

Twenty four patients with chronic aortic incompetence and major left ventricular dysfunction underwent aortic valve replacement. Left ventricular failure was responsible for severe symptoms: NYHA Classes III and IV. It was defined by the following haemodynamic criteria: LV ejection fraction (EF) 40 p. 100 (mean 37 +/- 13 p. 100), LV end diastolic volume 250 ml/m2 (mean 254 +/- 82 ml/m2), LV end diastolic pressure 20 mmHg (mean 26 +/- 10 mmHg), AV difference 6 vol p. 100 (mean 7,07 +/- 1,77). The mean cardiac index was 2,03 +/- 0,59 l/m2. Of the 24 patients, 9 died (Group A). There were 3 perioperative deaths and 6 deaths 5 to 60 months after surgery. One patient died suddenly after improving 3 years after surgery; 3 patients died with moderate persistent cardiac failure and 2 patients died without regression of cardiac failure after surgery. Of the 15 survivors, (mean follow-up 16 months), Group B, 6 were operated within the last three months and rapidly improved. Nine patients were followed up for 8 to 55 months after surgery and had significant symptomatic improvement (NYHA: Class II). No preoperative clinical, electrocardiographic or echocardiographic prognostic criteria were found to distinguish between these two groups of patients. There were no significant differences in cardiac surface area (1,89 +/- 34 compared to 1,95 +/- 23), LVEDP (26 +/- 11 compared to 26 +/- 10 mmHg), LVEDV (257 +/- 21 compared to 252 +/- 60 ml/m2), EF (31 +/- 11 compared to 40 +/- 13) or cardiac index (2,0 +/- 0,58 compared to 2,0 +/- 0,61 l/m2).(ABSTRACT TRUNCATED AT 250 WORDS)