Bioprosthetic Versus Mechanical Valve Replacement in Patients with Infective Endocarditis

During the 5-year period, 1979-1984, at the Texas Heart Institute, 4,598 patients underwent cardiac valve replacement procedures of which 185 were for acute infective endocarditis. Staphylococcus and streptococcus accounted for 80% of the cases and congestive heart failure was a leading indication in 63%. The purpose of this article is to evaluate the recurrence of endocarditis dependent upon whether the patient had an Ionescu-Shiley bioprosthetic pericardial valve or a mechanical valve (St. Jude Medical). Actuarial freedom from both early and late reoperation was higher for prosthetic valves than bioprosthetic valve patients. We conclude that mechanical valves are the valves of choice in acute infective endocarditis which apparently is the results of less biologic tissue available for exposure to infection by the offending organisms.     

Early and Late Phase Events Following Bioprosthetic Tricuspid Valve Replacement

From 1961 through 1987, 9,247 patients underwent an intracardiac repair for valvular heart disease. Five hundred thirty patients had a procedure that included a tricuspid valve operation (6%), with tricuspid valve replacement performed in 175 patients (2%), of whom 154 had a bioprosthetic valve implanted (1.7%). These 154 patients with a bioprosthetic valve in the tricuspid position are the subject of this review. There were 27 males and 127 females. Ages ranged from 10 to 75 years. There was tricuspid valve insufficiency in 139 patients (90%), and stenosis plus insufficiency in 15 (10%). Carpentier-Edwards prostheses were implanted in 83 (54%), Ionescu-Shiley in 55 (35%), Hancock in 12 (8%), and Mitroflow in 4 (3%). Concomitant procedures were performed in 146 patients (95%). At least one previous operation had been performed in 86 patients (56%). Preoperatively, 139 patients were in functional Class III or IV (90%). Hospital death occurred in 20 patients (13%). Logistic regression analysis revealed that incremental risk factors for hospital death included increasing peripheral edema preoperatively (p = 0.04), and use of a Hancock prosthesis in the tricuspid position (p = 0.03). All 134 hospital survivors were followed at a mean of 66.01 months, range 1 to 162 months. There were 70 late deaths (52%). Log-rank test indicated that incremental risk factors for late death were: longer cross-clamp time at repair (p = 0.0007); higher pulmonary artery systolic pressure preoperatively (p = 0.01); earlier date of surgery (p = 0.03); and larger tricuspid prosthesis size (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)     

三尖瓣替换术

总结１９７９年７月至１９９３年１０月期间，３１例原发三尖瓣病变病人施行三尖瓣替换术的经验。病人中男１８例，女１３例。年龄１０～４２岁，平均２３岁。三尖瓣病变包括下移畸形２３例、严重发育不良６例、Ｕｈｌ＇ｓ病１例、感染性心内膜炎１例。术前心功能ＩＩ级者６例、ＩＩＩ级１９例和ＩＶ级６例。三尖瓣替换术后５例死亡，手术死亡率１６．１％；２６例顺利康复出院。４例分别于出院后４８天、４年半、６年和１１年晚期死亡，晚期死亡的主要原因为心力衰竭。术后５年生存率为６６．６％，１０年生存率６３．６％。     

A Continuous Suture Technique for Mechanical or Bioprosthetic Aortic Valve Replacement

A bstract A continuous suture technique for aortic valve replacement was developed early in our experience. This technique has proved to be simple, quick, effective, and to have several advantages over alternative techniques.     

Tricuspid Atresia: Corrective Operation without a Bioprosthetic Valve

A case of successful correction of type IB tricuspid atresia is described in which the patient's own normal pulmonary valve was used in its natural location. Morphological features of tricuspid atresia suggest that use of the in situ pulmonary valve is possible in most patients with normally related great arteries. Elimination of the requirement for valved conduits and bioprosthetic valves may eventually permit corrective operation in the very young child.     

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.     

Experimental Endocarditis in Calf after Tricuspid Valve Replacement

A calf model for reproducible, prosthetic tricuspid valve endocarditis was developed using Staphylococcus aureus. The course of late prosthetic valve endocarditis was characterized as a fulminant disease when untreated with antibiotics. The earliest sign of a colonized valve prosthesis was an elevation of body temperature, which correlated with occurrence of positive blood cultures. The dose required to colonize an endothelialized tricuspid prosthetic valve in the calf model was 10⁷ to 10⁸S. aureus organisms. In the model for late prosthetic valve endocarditis, silver-allantoin-heparin (SAH) treatment of the prosthetic valve gave no protection from inoculums of 10⁸S. aureus injected 60 days after operation. SAH treatment may be beneficial in early stages of prosthetic valve endocarditis, but this requires further study. Simultaneous cultures from the right atrium, the right ventricle, and the aorta of 2 animals showed that there was a 1,000- to 10,000-fold decrease in the bacterial titers across the combined pulmonary and systemic capillary beds. Bacterial titers drawn from the jugular vein had a 46% false negative result, and positive cultures from the external jugular vein showed only 1.3 S. aureus organisms per milliliter of blood. These bacteriological findings point out the risks of depending on sampling from the peripheral venous system when culturing for right heart endocarditis.     

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。