RELATION OF IMPAIRED LEFT-VENTRICULAR FUNCTION IN MITRAL REGURGITATION TO LEFT-VENTRICULAR CONTRACTILE STATE AFTER MITRAL-VALVE REPLACEMENT

To reevaluate the postoperative contractile state and survival, 34 patients (19 men and 15 women; average age 45 years, range 23 to 65) undergoing conventional mitral valve replacement between 1980 and 1990 were studied. There were 5 cardiac deaths (2 early and 3 late). Four of 5 deaths occurred in patients who had a preoperative left ventricular end-systolic volume index >100 ml/m(2). Sixteen patients with an end-systolic volume index <100 ml/m(2) (group I), and 5 with an index >100 ml/m(2) (group II) underwent repeat catheterization 8 months (range 4 to 17) after surgery. The ratio of end-systolic wall stress to end-systolic volume index increased significantly after surgery in group I, whereas it remained reduced in group II. The postoperative end-systolic wall stress/ volume index ratio correlated significantly with the preoperative end-systolic volume index (p <0.001). In the relation between end-systolic wall stress and ejection fraction, all patients in group II had values that were less than the 95% confidence limits for the normal relation. In conclusion, patients with a preoperative end-systolic volume index >100 ml/m(2) appeared to be at high risk of incurring irreversible depressed myocardial contractility, with a high postoperative mortality.