Cardiac valve surgery in patients with poor left ventricular function.

Of 316 patients who underwent operation for valvular heart disease at the Toronto Western Hospital, between January 1978 and December 1981, 41 (31 men, 10 women), ranging in age from 24 to 74 years, had severely impaired left ventricular function (ejection fraction less than 40% and left ventricular end-diastolic pressure more than 18 mm Hg). All 41 patients were in New York Heart Association (NYHA) class III or IV. Fourteen patients had disease of the aortic valve, 13 of the mitral valve and 14 of both aortic and mitral valves. Twenty-two patients also had serious coronary artery disease. The valve dysfunction was corrected in all patients by replacement or repair and all severe coronary artery stenoses were bypassed with saphenous vein grafts. There were three hospital deaths and five late deaths during a mean follow-up of 26 months (range from 6 to 48 months). All patients improved symptomatically by a least one functional NYHA class. The actuarial survival including operative deaths was 79%.