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/m2. Sixteen patients with an end-systolic volume index < 100 ml/m2 (group I), and 5 with an index > 100 ml/m2 (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/m2 appeared to be at high risk of incurring irreversible depressed myocardial contractility, with a high postoperative mortality.