Emergency aortic valve replacement.

The aortic valve was replaced as an emergency in twenty-seven patients between July 1970 and December 1974. Twenty-two patients had critical aortic stenosis and five had acute aortic insufficiency. The indications for emergency surgery were cardiac arrest in five patients, low cardiac output in four patients, and medically intractable pulmonary edema in eighteen patients. Cardiac catheterization was not undertaken in ten persons because of their critical condition. The clinical diagnosis in these patients was supported by noninvasive maneuvers. No surgical deaths occurred. Twenty-five patients are well, active and NYHA Class I at five to thirty-three months after surgery. There has been one late death and one patient has some residual exertional dyspnea. One patient required reoperation to relieve a clotted prosthetic valve. These results suggest that the patient with aortic valve disease may be offered a reasonable chance for survival, even when desperately ill.