British Heart3Journal, I974, 36, IOI-I03. Preoperative mortality in aortic stenosis

Of I35 patients investigated for severe aortic stenosis, I6 died while awaiting surgery. The catheterization data on these patients were compared with those on.55 patients who underwent surgery and were long-term survivors and 42 who died at operation or during the early postoperative period. Of the I6 patients who died before operation, 15 had evidence of left ventricular failure. In addition, the pulmonary artery wedge and the left ventricular end-diastolic pressures were significantly higher than in patients reaching surgery. The patients who were not long-term surgical survivors waited an average period of 5-8 months between cardiac catheterization and operation, during which period left ventricular function may have deteriorated. There was no significant difference in transvalvar pressure gradients. These findings suggest that in severe aortic stenosis, catheterization evidence of left ventricular failure is an indication for urgent surgery. Though the risk of sudden death and the grave significance of left ventricular failure in aortic stenosis are well known, the death of several patients while awaiting operation prompted a re-view of all the adult patients with this condition wh