[Long-term surgical prognosis of aortic valve diseases with pulmonary hypertension. Apropos of 34 cases].
Thirty-four patients underwent isolated aortic valve replacement with mean pulmonary artery pressures greater than 40 mmHg between 1972 and 1988. The aortic valve disease was stenotic in 10 cases, regurgitant in 14 cases and mixed in 10 cases. Thirty patients (88%) had invalidating cardiac failure (NYHA Classes III and IV). The mean preoperative ejection fraction was 44 +/- 15%. The hospital mortality was 17.6%. Ten patients died secondarily, five with terminal cardiac failure. The 5 year actuarial survival was 70 +/- 16%; the 10 year survival was 60 +/- 18% with an average follow-up of 115 +/- 61 months. None of the patients was lost to follow-up. Fifteen of the 18 survivors (83%) are asymptomatic or pauci-symptomatic after a follow-up of 126 +/- 62 months. Doppler echocardiography (n = 12) showed normal prosthetic valve function in 11 cases and aortic regurgitation in 1 case. Eight patients had tricuspid regurgitation with pulmonary artery systolic pressures less than 30 mmHg in 6 cases and between 30 and 40 mmHg in 2 cases. Severe pulmonary hypertension is therefore a poor early postoperative prognostic factor in aortic valve replacement surgery due to the associated left ventricular dysfunction. However, the long-term results are satisfactory: clinical improvement is usually related to a reduction of pulmonary hypertension.
Jegaden
O
O
Hôpital cardiologique, Lyon.
Rossi
R
R
Delahaye
F
F
Montagna
P
P
Delaye
J
J
Delahaye
J P
JP
Mikaeloff
P
P
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016277:Ventricular Function, Left
Pronostic opératoire à long terme des valvulopathies aortiques avec hypertension artérielle pulmonaire. A propos de 34 cas.