Mechanical Valve Replacement Versus Bioprosthetic Valve Replacement in the Tricuspid Valve Position

Background

The purpose of this study was to evaluate the clinical outcomes and risk of tricuspid valve replacements and to compare bioprosthetic versus mechanical valves.

Methods

Between 1991 and 2009, 104 consecutive patients (71 women; mean age, 57 ± 10.8 years) with tricuspid valvular disease underwent mechanical TVR (mechanical group; n = 59) or bioprosthetic TVR (bioprosthesis group; n = 45). Follow‐up was complete in 97.1% (n = 101) with a median duration of 49.9 months (range 0–230 months).

Results

Hospital mortality after mechanical TVR and bioprosthetic TVR was not different on adjusted analysis by propensity score. Ten‐year actuarial survival after mechanical and bioprosthetic TVR was 83.9 ± 7.6% and 61.4 ± 9.1%, respectively (p = 0.004). However, there was also no significant difference in terms of adjusted analysis by propensity score (p = 0.084). No statistically significant difference was detected between mechanical and bioprosthetic valves in regard to event‐free survival.

Conclusions

Mechanical TVR is not inferior to bioprosthetic TVR in terms of occurrence of valve‐related events, especially anticoagulation‐related complications. doi: 10.1111/jocs.12093 (J Card Surg 2013;28:212–217)     

Semilunar Valve Replacement with a Cylindrical Valve

A bstract A cylindrical valve was designed to prevent regurgitation of the semilunar valve. The valve is made of a sheet of polytetrafluoroethylene (PTFE) or porcine pericardium, and has three cusps and three commissures. The diameter of the valve is equal to the height of the cusps. We have used these valves in pulmonary stenosis after Jatene's operation and total correction of tetralogy of Fallot, and for truncal valve regurgitation. Regurgitation was trivial on color Doppler echocardiography in all cases. Advantages in comparison with the implantation of commercially available artificial valves include the ability to insert a larger size and no compression of the valve ring when closing the sternum. Outflow tract obstruction does not occur even when the valve is implanted in a small infant. In the present report, we describe this simple technique.     

应用自体心包瓣置换术治疗主动脉瓣病变

目的　报告无支架自体心包瓣置换主动脉瓣手术的临床应用效果。　方法　11例单纯主动脉瓣病变患者行自体心包瓣置换主动脉瓣手术,术后定期随访。　结果　11例均存活,顺利出院,随访时间5～30个月,平均随访时间24.2±5.6个月。1例因中等量反流而行二次手术,其余10例心包瓣膜功能良好。　结论　该手术是一种治疗单纯主动脉瓣病变较为理想的方法,术后患者无需长期抗凝,手术近期效果满意,远期效果有待进一步随访。     

Aortic Valve Replacement and Mitral Valve Repair with Allograft

A bstract Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of the aortic valve using allograft are presented. The case history and operative procedure of a reconstructive operation that did not require anticoagulant therapy after surgery are described for three adult patients. Mitral valve defects were repaired using the anterior leaflet of the mitral valve of the allograft. The aortic valve or entire root was replaced with the aortic allograft. The aortic/mitral allograft should be considered as an alternative to replacement of the aortic and mitral valves with prostheses in selected patients.     

人工心脏瓣膜置换术后感染性心内膜炎的外科治疗

目的探讨人工心脏瓣膜心内膜炎（PVE）再次外科手术指征、手术时机和手术治疗要点。方法2000年2月至2005年7月，手术治疗PVE患者18例，回顾性分析其临床表现、治疗经过和预后情况。结果术后早期死亡3例（16．7％），死于中毒性休克1例，多器官功能衰竭2例。2003年以后手术的11例患者无手术死亡。术后发生呼吸功能不全6例，肾功能不全2例，经相应的处理治愈。随访15例，随访时间1个月至5年，PVE再次复发1例，经内科治疗无效，死于全身衰竭；其余14例患者均治愈，恢复正常工作；心功能Ⅱ级12例，Ⅲ级2例。结论PVE的外科治疗风险大，死亡率高，而正确掌握手术指征、把握手术时机、彻底清除感染组织和围术期正确应用抗生素是保障PVE再手术治疗成功的关键。     

Transaortic Mitral Valve Repair in Double Valve Infective Endocarditis

Abstract We present a case of a transaortic mitral valve repair in double valve infective endocarditis. Through a conventional oblique aortotomy, the aneurysmal part of the anterior leaflet of the mitral valve was excised, an artificial neo chorda was implanted, and the aortic valve was replaced. (J Card Surg 2010;25:651‐653)     

二尖瓣置换术后三尖瓣关闭不全的外科治疗

目的总结二尖瓣置换术后三尖瓣关闭不全患者的外科治疗经验。方法14例心脏瓣膜疾病患者行二尖瓣置换术后发生中度或重度三尖瓣关闭不全,其中相对性关闭不全12例,器质性关闭不全2例。行三尖瓣成形术4例,均使用人工瓣环成形;行三尖瓣置换术10例,其中置换生物瓣6例,双叶机械瓣4例。在心脏不停跳下手术4例,常规心脏停搏手术10例。结果全组无手术死亡,术后发生低心排血量综合征3例,用升压药维持循环,患者均顺利出院。术后复查超声心动图,右心房、室均明显缩小,右心室前后径(22.5±5.6mm)较术前(31.9±5.9mm)明显减小(P<0.001)。随访14例,随访时间1.8±1.3年,心功能级2例、级9例,级2例,1例于术后4年因心力衰竭死亡。结论二尖瓣置换术后远期三尖瓣关闭不全的患者经外科矫治后疗效满意,合理掌握手术指征、手术时机和良好的围术期治疗是手术成功的关键。     

Bioprosthetic Valve Replacement of Aortic Valve Endocarditis: Detroit Experience

Bioprosthetic valve replacement for aortic valve endocarditis was reviewed in 98 patients, 39 nonaddicts and 59 addicts, from the Henry Ford Hospital in Detroit. Multivariate analysis was carried out, and the bioprosthetic valve is a reasonable valve replacement device for both native and prosthetic valve endocarditis.