J.Jpn. Surg. Soc.. 88(8): 991-999, 1987

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Original article

RISK FACTORS INFLUENCING THE PROGNOSIS OF SEVERE AFORTIC VALVE DISEASE FOLLOWING AORTIC VALVE REPLACEMENT

As a result of improvement in intraoperative and postoperative management, severe aortic valve disease can be cured by operation, however, late cardiogenic sudden death after aortic valve replacement (AVR) has been existed as one of the important unsolved problem. This report is aimed to predict the risk factors influencing the postoperative prognosis of severe aortic valve disease.
Twenty-three cases with aortic regurgitation (AR) and 20 cases with aortic stenosis (AS) were selected by postoperative period over l2 months. In 18 AR cases with normal coronary artery substantiated by selective coronary angiography, cross sectional area index of left ventricular wall (CSAI) and ST depression in left chest leads of electrocardiogram correlated well as the CSAI increased, so decreased the ST segment. This shows the increment of CSAI leads left ventricular endocardial ischemia. By means of introduction of this indicator, 23 AR and 20 AS patients were divided into two groups as group C-I having CSAI over 20cm²/m² and group C-II under 20cm²/m². Left ventricular ejection fraction (EF) was selected as an predictive indicator of left ventricular function. As same as CSAI, AVR cases were divided into two groups as group E-I having EF under 50％ and E-II over 50％. Each group was compared concerning with the complication rate of postoperative low cardiac output syndrome (LOS) and late cardiogenic sudden death.
In C-I group of AR, 55％ cases accompanied with LOS, 18％ died due to LOS and 18％ died suddenly from late cardiogenic cause, however, none of cases in C-II group had these complications. In C-I group of AS, 67％ cases developed into LOS and late sudden death occurred in 33％, however, there was not late cardiogenic death in C-II group. In the group of E-I in AR, LOS occurred in 44％, 22％ died from LOS and late cardiogenic sudden death occurred in 22％, however, there was no complication in E-II group. A case of AS in E-II, C-I group died due to late cardiogenic sudden death.
Thus, CSAI over 20cm²/m² appears to be a suggestive risk factor for aortic valve disease in the prediction of postoperative LOS and late cardiogenic sudden death.

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