Cardiac Valve Replacement in Patients with Severely Reduced Cardiac Output

Abstract

The results are presented of cardiac valve replacement in 50 patients with a preoperative cardiac index of 1.6 L. per minute per square meter of body surface area or less. Mean cardiac index for the group was 1.42 L./min./ m. 2, and the mean age was 48.1 years. Operative correction of more than one valve was required in 46% of the patients. Twenty-three hospital deaths resulted in an operative mortality of 46%. Seven deaths were related to technical errors, and 11 of the remaining 16 patients who died had significant myocardial fibrosis, myocardial necrosis, or coronary artery disease at postmortem examination. Eleven of the 27 survivors have subsequently died; the mean postoperative survival has been 21 months. Sixteen patients, or 32% of the entire group, are still alive and in Functional Class I or II (New York Heart Association) for one to seven years following operation. The results of operation in this group of patients suggest that irreversible myocardial damage may accompany longstanding valvular disease and emphasize the hazard which accompanies delay in valve replacement.