Indices Predicting Long-term Survival after Valve Replacement in Patients with Aortic Regurgitation and Patients with Aortic Stenosis

The long-term results of aortic valve replacement were reviewed in all 88 patients with isolated aortic regurgitation and all 103 patients with isolated aortic stenosis who were operated upon at the National Heart and Lung Institute from 1963 to 1971. Survival curves were compared to determine whether any of 30 preoperative clinical and hemodynamic findings correlated with long-term survival. The indices that were of predictive value in patients with aortic regurgitation were found to be different from those in aortic stenosis. Symptoms, cardiac index, and cardiothoracic ratio did not influence survival in patients with aortic regurgitation. In these patients, survival was inversely correlated with the level of left ventricular end-diastolic pressure (LVEDP): six-year survival was 74% in patients with LVEDP ≤ 10 mm Hg, 41% with LVEDP 11-20 ( P 20 ( P 6 survived ( P .45 ( P < .01). This difference did not correlate with postoperative hemodynamic measurements, including magnitude of the transprosthetic gradient. We conclude that certain preoperative indices are of value in predicting long-term prognosis after valve replacement for aortic regurgitation and for aortic stenosis, but that the specific predictive indices for the two groups differ.