[Results of singular valve replacement with a mechanical prosthesis or bioprosthesis in valve diseases with advanced myocardial failure].

Surgery may prolong survival in some patients in advanced cardiac failure due to valvular heart disease refractory to digitalo-diuretic and vasodilator therapy. The operative risk is high and myocardial dysfunction after surgery is also a problem. However, in some cases, surprising improvement is observed. An analysis of the principal publications in the literature on the natural history of valvular heart disease and the results of surgery in the last ten years show that: In chronic aortic valve disease complicated by congestive heart failure, the natural prognosis does not exceed 2 to 3 years in either aortic stenosis or regurgitation. On the other hand, prosthetic valve replacement is associated with a 57% 4 years survival in aortic regurgitation, and a 70% 5 years survival in aortic stenosis, but with an operative mortality of 20 to 27%. Surgery is even more valuable in acute aortic regurgitation due to endocarditis, leading to a 60% 2 years survival compared to only 6% with medical therapy alone. In chronic mitral valve disease with advanced cardiac failure, the natural prognosis does not exceed 4.5 years in mitral regurgitation, 8 years in mitral stenosis and an intermediate period in mixed mitral valve disease. On the other hand, prosthetic valve replacement with an operative risk of 21 to 26% is associated with a life expectancy of 56 to 60% at 5 years, and 46% at 10 years, operative mortality included. The surgical results depend on good myocardial protection and intensive pre-, per- and post-operative care using positive inotropic agents, vasodilators and, when necessary, intra aortic balloon pumping.(ABSTRACT TRUNCATED AT 250 WORDS)