Skip to main content
SpringerLink
Log in

Valve surgery for regurgitant lesions of the aortic or mitral valves in advanced left ventricular dysfunction

  • Chapter
Surgical Options for the Treatment of Heart Failure

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 225))

  • 79 Accesses

Abstract

Cardiologists and cardiac surgeons frequently must decide when it is appropriate to offer early surgical intervention to prevent compromise of left ventricular function from regurgitant lesions of the aortic or mitral valve. Both aortic and mitral regurgitation place a volume load on the left ventricle leading to dilatation and eventually impairment of left ventricular systolic function. This chapter however deals with the opposite issue: that of late surgical intervention after deterioration of left ventricular systolic function has occurred and reached advanced levels. Important questions to consider include (1) whether surgical intervention is contraindicated once advanced left ventricular dysfunction has become established (2) whether the risks of surgery are too high in this setting and (3) whether, even after successful surgery, improvements in left ventricular function, symptoms, or survival can realistically be anticipated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bonow RO. Management of chronic aortic regurgitatton. N Engl J Med 1994;331:736–7.

    Article  PubMed  CAS  Google Scholar 

  2. Scognamiglio R, Rahimtoola S, Fasoli G et al. Nifedipine in asymptomatic patients with severe aortic regurgitation and normal left ventricular function. N Engl J Med 1994;331:689–94.

    Article  PubMed  CAS  Google Scholar 

  3. Forman R, Firth BF, Barnard MS. Prognostic significance of pre-operative left ventriculaar ejection fraction and valve lesion in patients with aortic valve replacement. Am J Cardiol 1980;45:1120–5.

    Article  PubMed  CAS  Google Scholar 

  4. Bonow RO, Picone AL, McIntosh CL et al. Survival and functional results after valve replacement for aortic regurgitation from 1976–1983: Impact of preoperative left ventricular function. Circulation 1985;72:1244–56.

    PubMed  CAS  Google Scholar 

  5. Cohn PF, Gorlin R, Cohn LH et al. Left ventricular ejection fraction as a prognostic guide in surgical treatment of coronary and valvular heart disease. Am J Cardiol 1974; 34:136–41.

    Article  PubMed  CAS  Google Scholar 

  6. Copeland JG, Griepp RB, Stinson EB et al. Long-term follow-up after isolated aortic valve replacement. J Thorac Cardiovasc Surg 1977; 74:875–89.

    PubMed  CAS  Google Scholar 

  7. Greves J, Rahimtoola SH, McAnulty JH et al. Preoperative criteria predictive of late survival following valve replacement for severe aortic regurgitation. Am Heart J 1981; 101:300–8.

    Article  PubMed  CAS  Google Scholar 

  8. Bonow RO: Radionuclide angiography in the management of aortic regurgitation. Circulation 1991;84(Suppl 1): I-296–302.

    CAS  Google Scholar 

  9. Ross J Jr. Afterload mismatch in aortic and mitral valve disease: Implications for surgical therapy. J Am Coll Cardiol 1985; 5:811–26.

    Article  PubMed  Google Scholar 

  10. Ross J Jr. Afterload mismatch and preload reserve. A conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis 1976; 18:255–64.

    Article  PubMed  Google Scholar 

  11. Bonow RO, Lakatos E, Maron BJ et al. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation 1991; 84:1625–35.

    PubMed  CAS  Google Scholar 

  12. Bonow RO, Rosing DR, Kent KM et al. Timing of operation for chronic aortic regurgitation Am J Cardiol 1982; 50:325–36.

    Article  PubMed  CAS  Google Scholar 

  13. Daniel WG, Hood WP Jr, Siart A et al. Chronic aortic regurgitation: Reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening. Circulation 1985; 71:669–80.

    PubMed  CAS  Google Scholar 

  14. Fioretti P, Roelandt J, Bos RJ et al. Echocardiography in chronic aortic insufficiency: Is valve replacement too late when left ventricular end-systolic dimension reaches 55 mm? Circulation 1983; 67:216–21.

    PubMed  CAS  Google Scholar 

  15. Gaasch WH, Andrias CW, Levine HJ. Chronic aortic regurgitation: The effect of aortic valve replacement on left ventricular volume, mass, and function. Circulation 1978; 58:825–36.

    PubMed  CAS  Google Scholar 

  16. Gaasch WH, Carroll JD, Herbert HJ et al. Chronic aortic regurgitation: Prognostic value of left ventricular end-systolic dimension and end-diastolic radius/thickness ratio. J Am Coll Cardiol 1983; 1:775–82.

    PubMed  CAS  Google Scholar 

  17. Bonow RO, Dodd JT, Maron BJ et al. Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitation. Circulation 1988; 78:1108–20.

    PubMed  CAS  Google Scholar 

  18. Michel PL, Iung B, Jaoude SA et al. The effect of left ventricular systolic function on long term survival in mitral and aortic regurgitation. J Heart Valve Dis 1996; 4(Supp II):S160–169.

    Google Scholar 

  19. Klodas E, Enriquez-Sarano M, Tajik AJ et al. Aortic regurgitation complicated by extreme left ventricular dilation long-term outcome after surgical correction. J Am Coll Cardiol 1996; 27:670–7

    Article  PubMed  CAS  Google Scholar 

  20. Bonow RO, Nikas D, Elefteriades JA. Valve replacement for regurgitant lesions of theaortic or mitral valve in advanced left ventricular dyefunction. In: Cardiology Clinics 1995; Volume 13: WB Saunders, Toronto.

    Google Scholar 

  21. Wisenbaugh T, Spann JF, Carabello BA. Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitation. J Am Coll Cardiol 1984; 3:916–23.

    PubMed  CAS  Google Scholar 

  22. Bonow RO. The value of radioisotope blood pool imaging for evaluation of valvular heart disease. In Comparative Cardiac Imaging 1990; Aspen Publishers.

    Google Scholar 

  23. Gaasch WH, Zile MR. Lett ventricular function after surgical correction of chronic mitral regurgitation. Eur Heart J 1991; 12(Suppl B):48–51.

    PubMed  Google Scholar 

  24. Hansen DE, Cahill PD, DeCampli WM et al. Valvular-ventricular interaction: Importance of the mitral apparatus in canine left ventricular systolic performance. Circulation 1986; 73:1310–20.

    PubMed  CAS  Google Scholar 

  25. Hilder FJ, Javier RP, Cohen LS. Myocardial dysfunction associated with valvar heart disease. Am J Cardiol 1972; 30:319–26.

    Article  Google Scholar 

  26. Rozich JD, Carabello BA, Usher BW et al. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation: Mechanisms for differences in postoperative ejection performance. Circulation 1992; 86:1718–26.

    PubMed  CAS  Google Scholar 

  27. Schuler G, Peterson KL, Johnson A. Temporal response of left ventricular performance to mitral valve surgery. Circulation 1979; 59:1218–31.

    PubMed  CAS  Google Scholar 

  28. Tyers G. Mitral valve replacement: What should be the standard technique? Ann Thorac Surg 1990; 49:861–2.

    Article  PubMed  CAS  Google Scholar 

  29. Phillips UR, Levine FH, Carter JE et al. Mitral valve replacement for isolated mitral regurgitation: Analysis of clinical course and late postoperative left ventricular ejection fraction. Am J Cardiol 1981; 48:647–54.

    Article  PubMed  CAS  Google Scholar 

  30. Enriquez-Sarano M, Tajik AJ, Schaff HV et al. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation 1994; 90:830–7.

    PubMed  CAS  Google Scholar 

  31. Yun KL, Rayhill SC, Niczyporuk MA et al. Mitral valve replacement in dilated canine hearts with chronic mitral regurgitation: Importance of the mitral subvalvular apparatus Circulation 1991; 84(Suppl 3):112–24.

    Google Scholar 

  32. Lillehei CW, Levy MJ, Bonnabeau RC. Mitral valve replacement with preservation of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg 1964; 47:532–543.

    PubMed  CAS  Google Scholar 

  33. Sarris GE, Cahill PD, Hansen DE et al. Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae. J Thorac Cardiovasc Surg 1998; 95:969–79.

    Google Scholar 

  34. Moon MR, DeAnda A, Daughters GT, et al. Experimental evaluation of different chordal preservation methods during mitral valve replacement. Ann Thorac Surg 1994; 58:931–44.

    Article  PubMed  CAS  Google Scholar 

  35. Yun KL, Farm JI, Rayhill S et al. Importance of the mitral subvalvular apparatus for left ventricular segmental systolic mechanics. Circulation 1990; 82(5 Suppl):IV89–104.

    PubMed  CAS  Google Scholar 

  36. Yun KL, Niczyporuk MA, Sams GE et al. Importance of mitral subvalvular apparatus in terms of cardiac-energetics and systolic mechanics in the ejecting canine heart. J Clin Invest 1991; 87:247–51.

    Article  PubMed  CAS  Google Scholar 

  37. David TK, Uden DE, Strauss HD. The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 1983; 68(Suppl II):1176–82.

    Google Scholar 

  38. Goldman ME, Mora F, Guarino T et al. Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function: An intraoperative two-dimensional echocardiographic study. J Am Coll Cardiol 1987; 10:568–75.

    Article  PubMed  CAS  Google Scholar 

  39. Hennein HA, Swain JA, McIntosh CL et al. Comparative assessment of chordal preservation versus chordal resection during mitral valve replacement. J Thorac Cardiovasc Surg 1980; 99:828–37.

    Google Scholar 

  40. Horstkotte D, Schulte HD, Bircks W et al. The effect of chordal preservation on late outcome after mitral valve replacement: A randomized study. J Heart Valve Dis 1993:2:150–8.

    Google Scholar 

  41. Miki S, Kusuhara K, Ueda Y et al. Mitral valve replacement with preservation of chordae tendineae and papillary muscles. Ann Thorac Surg 1988; 45:28–34.

    Article  PubMed  CAS  Google Scholar 

  42. Carpentier A, Chauvaud S, Fabiani JN et al. Reconstructive surgery of mitral valve incompetence: Ten year appraisal. J Thorac Cardiovasc Surg 1980; 79:338–345.

    PubMed  CAS  Google Scholar 

  43. Cosgrove DM, Stewart WJ: Mitral valvuloplasty. Curr Probl Cardiol 1989; 7:355–415.

    Google Scholar 

  44. Kaul TK, Ramsdale DR, Meek D et al. Mitral valve replacement in patients with severe mitral regurgitation and impaired left ventricular function. Int J Cardiol 1992; 35:169–79.

    Article  PubMed  CAS  Google Scholar 

  45. Yacoub M, Halin M, Radley-Smith R et al. Surgical treatment of mitral regurgitation caused by floppy valves: Repair versus replacement. Circulation 1981; 64(Suppl II):II-210–6.

    CAS  Google Scholar 

Download references

Authors
  1. Robert O. Bonow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roy G. Masters
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

    Roy G. Masters MD FRCSC

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Kluwer Academic Publishers

About this chapter

Cite this chapter

Bonow, R.O., Masters, R.G. (1999). Valve surgery for regurgitant lesions of the aortic or mitral valves in advanced left ventricular dysfunction. In: Masters, R.G. (eds) Surgical Options for the Treatment of Heart Failure. Developments in Cardiovascular Medicine, vol 225. Springer, Dordrecht. https://doi.org/10.1007/978-0-585-29191-8_3

Download citation

  • DOI: https://doi.org/10.1007/978-0-585-29191-8_3

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-0-7923-6130-5

  • Online ISBN: 978-0-585-29191-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation