Cardiac Valve Replacement

Cardiac valve replacement was performed in 200 consecutive patients with advanced disability. Mean cardiac index for the group was 2.2 liters/min/sq m, which included 40 patients with an index of 1.6 or below. Correction of two or more valves was required by 25% of the patients. Operative mortality was 27%, and cardiac failure was the most frequent cause of death. Increased operative risk was correlated with multiple valve procedures and with reduced cardiac index. Forty-four late deaths have occurred with actuarial prediction of a 42.6% five-year survival. The analysis suggests that delay in valve replacement is associated with excessive operative mortality and decreased long-term survival.