Techniques of modified mitral valve replacement with preservation of the posterior leaflet and chordae tendineae

Modified mitral valve replacement (MVR) was performed mostly with mechanical valves in 117 patients consisting of 53 patients with mitral regurgitation (MR) and 64 patients with mitral stenosis (MS) or combined mitral valve disease (MSR). Concomitantly, aortic valve replacement (AVR) was carried out in 42 patients, tricuspid annuloplasty (TAP) in 26, tricuspid valve replacement (TVR) in 2 and other procedures in 4. There were 3 hospital deaths and 3 late deaths. In this series, 4 types of technique were utilized in order to preserve the posterior leaflet and chordae tendineae. The authors recommend the following techniques. In pure or predominant MS, after removal of the anterior leaflet and chordae, buttress sutures are placed from the valvular annulus to the posterior leaflet near its free margin. In pure or predominant MR, excising part of the posterior leaflet is added prior to the above-described technique. By using these two techniques, modified MVR can be performed for any type of valve lesion and with any kind of prosthetic valve.     

左心瓣膜置换术后孤立性三尖瓣关闭不全的外科治疗及危险因素

目的 明确左心瓣膜置换术后出现远期孤立性三尖瓣关闭不全（tricuspid regurgitation,TR）的外科治疗效果和危险因素.方法 分析2000年1月至2010年12月广东省人民医院因左心瓣膜术后发生远期孤立性重度TR而接受三尖瓣外科治疗的41例患者的资料.三尖瓣成形（tricuspid valve repair,TVP）7例,三尖瓣置换（tricuspid valve replacement,TVR）34例,比较两组的近、远期结果.并比较存活组与术后早期死亡组及术后远期死亡组的临床资料,分析手术早期及远期死亡的危险因素.结果 随访时间（6.3±3.4）年,随访率97％,死亡14例（34.1％）.TVP组术后死于右心功能衰竭1例（14.3％）,无远期死亡;因再发重度TR于术后3.5年行TVR1例.TVR组手术死亡8例,远期死亡5例,死亡率38.2％.因右心功能衰竭死亡9例,感染性心内膜炎、脑出血、猝死、结肠癌术后肝转移死亡各1例.TVP组死亡率有高于TVR组的趋势（P=0.43）.手术早期死亡组三尖瓣反流面积、肌酐值明显高于与存活组,差异有统计学意义（P＜0.05）;而术后远期死亡组右心室大小、肌酐值明显高于存活组,差异有统计学意义（P＜0.05）.结论 左心瓣膜置换术后远期孤立性TR的再次手术死亡率高,选择TVP将有助于降低死亡率.三尖瓣反流程度重、术前肌酐值升高是手术早期死亡的危险因素;右心室大小和术前肌酐值升高是术后远期死亡的危险因素.     

244例瓣膜替换及术后抗凝临床分析

目的总结心脏瓣膜疾病行瓣膜替换及术后抗凝治疗经验。方法2001年10月至2009年6月共收治各类瓣膜替换患者244例,男性97例,女性147例,年龄16-76（42．8±11．4）岁。心功能Ⅱ级66例、Ⅲ级127例、Ⅳ级51例。二尖瓣替换（MVR）127例,二尖瓣及主动脉瓣替换（DVR）76例,主动脉瓣替换（AVR）38例,乏尖瓣替换（TVR）1例,DVR＋TVR2例。同期行三尖瓣成形46例、房颤改良射频消融31例、冠状动脉旁路移植（CABG）3例。结果手术死亡7例,余均治愈出院。随访2个月至8年,失访14例,2例猝死,不明原因死亡3例。存活在访者2例出现脑出血,2例脑梗塞,1例双下肢动脉栓塞。心功能I级122例、Ⅱ级83例、Ⅲ级13例。结论瓣膜替换术治疗各种原因导致的严重瓣膜病变疗效好,术后低剂量抗凝,须定期复查,随时调整华法林剂量。     

De Vega tricuspid annuloplasty for systemic tricuspid regurgitation in children with univentricular physiology

BACKGROUND AND AIM OF THE STUDY: Significant tricuspid valve regurgitation (TR) is problematic in children with univentricular physiology and a systemic tricuspid valve occasionally requiring tricuspid (systemic atrioventricular) valve replacement. Since 1998, the De Vega tricuspid annuloplasty technique has been applied for TR in these children. METHODS: Twelve children (median age 2.2 years; range: 6 months to 17 years) with moderate or severe systemic TR underwent a De Vega tricuspid annuloplasty during a bidirectional Glenn anastomosis (n = 3), Fontan procedure (n = 8) or aortic valve replacement late after a Fontan procedure (n = 1). Nine patients (75%) had prior Norwood palliation for hypoplastic left heart syndrome. Four patients had simultaneous repair of an abnormal tricuspid valve in addition to the De Vega procedure. RESULTS: There were no deaths during a mean follow up of 2.0 +/- 1.4 years (range: 6 months to 5.1 years). One child required pacemaker implantation early after operation, and one child with a Glenn anastomosis underwent cardiac transplantation 21 months postoperatively. In the remaining 11 patients, the most recent echocardiogram showed mild or no TR in eight children, mild-to-moderate TR in one child, and moderate TR in two children. No child had symptomatic TR (including the two with moderate TR), significant tricuspid stenosis, or late pacemaker implantation. CONCLUSION: The De Vega tricuspid annuloplasty safely provides excellent relief of systemic TR in children with univentricular physiology, with a majority of patients (73%) having mild or less residual TR at follow up examination. This simple technique is preferred to tricuspid (systemic) valve replacement in these children.     

1566例联合瓣膜置换手术早期疗效分析

目的:分析1566例联合瓣膜病变外科治疗的早期疗效。方法:回顾性分析我院联合瓣膜置换术的早期临床资料,本组1566例,占同期瓣膜手术患者34.6%(1566/4526),瓣膜疾病的病因以风湿性心脏病为最常见,占96.3%。男/女比例为654/912,年龄(45.51±15.48)岁,病程(12.42±7.75)年,术前心功能等级(NYHA,级)为3.11±1.72。本组全部患者行联合瓣膜置换术,其中心脏停跳下手术1259例,心脏不停跳下手术307例,行二尖瓣置换+主动脉瓣置换手术1510例,二尖瓣置换+三尖瓣置换手术8例,二尖瓣置换+主动脉瓣置换手术+三尖瓣置换手术例48例;另外,本组同期行三尖瓣环缩成形术342例,左心房血栓清除173例,左心房折叠术87例,冠状动脉搭桥手术27例,主动脉根部加宽21例。结果:手术早期病死率(住院病死率)为1.40%(22/1566),其余均痊愈出院。其中低心输出量综合征(低心排)死亡8例,严重心律紊乱(主要指心室颤动、心脏骤停)4例,呼吸衰竭3例,多脏器功能衰竭4例,肾衰竭1例,脑部并发症1例,主动脉根部破裂1例。结论:联合瓣膜置换术的主要并发症为低心排、顽固性心律紊乱、呼吸衰竭、多脏器功能衰竭及肾衰竭等;手术早期疗效好,中、远期疗效有待进一步随访研究。     

Predictors of persistent pulmonary hypertension after mitral valve replacement

Persistent pulmonary hypertension (P-PH) after mitral valve replacement (MVR) leads to an increased risk of morbidity and mortality. We sought to determine which factors were involved in its occurrence. Patients undergoing MVR for a 3-year period were collected in a retrospective way. We excluded those with an available follow-up shorter than 3 months. Sample size was 111 patients. PH was diagnosed if systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography was >40 mmHg. Clinical, echocardiographic, and surgical factors were analyzed. P-PH was present in 42.3 % of patients after 12.6 months of mean follow-up. P-PH was more frequently observed in elderly and female patients, in those with severe degrees of PH before surgery, and significant tricuspid regurgitation (TR). On multivariable analysis, significant TR (OR 1.739; p = 0.01) and more severe degrees of PH before surgery (OR 1.761; p = 0.03) were significantly associated with the presence of P-PH after MVR. Surgical factors related to P-PH were prosthesis size and tricuspid annuloplasty: no need for the performing of tricuspid annuloplasty (OR 0.345; p = 0.025) and the implantation of a smaller prosthesis (OR 0.656; p = 0.004) were related to higher rates of P-PH after MVR. MVR was associated with high prevalence of P-PH after mid-term follow-up. Both PH and significant TR before surgery were associated with P-PH. Our data point out that MVR should be planned before the development of PH and greater TR. Smaller prosthetic size is also a risk factor for P-PH and bigger prostheses are desirable when possible.     

Surgical management of acquired tricuspid valve disease--the effects and comparison of tricuspid annuloplasty (De Vega) and tricuspid valve replacement

A total of 92 patients with tricuspid valvular disease (TR) had surgical repair of DeVega's annuloplasty in 80 patients (87%) and of valve replacement in 12 patients (13%) from January, 1978, to March, 1988. All of those patients were diagnosed by cardiac catheterization and angiogram, clinical findings and in recent cases, pulsed and color Doppler echocardiography were applied. Eighty-nine of 92 patients (97%) were in NYHA class III or IV before operation. There were 7 early death (8.5%) with DeVega procedure and one death (8.3%) in TVR and late deaths were noted in 3 patients (3.6%) (DeVega's procedure) and one (8.3%) in TVR. Two patients after DeVega procedure at 5 and 6 years were required re-operation of TVR because of recurrent mitral valvular disease. Seventy-seven of 80 survivors were in NYHA class I or II postoperatively. Twenty-seven randomized selected patients after DeVega's annuloplasty were investigated by pulsed and color Doppler echocardiography, 17 of them (63%) had no regurgitation and the remaining 10 patient had mild to moderate regurgitation. This study suggests that DeVega's annuloplasty has a simple and reliable procedure in patients with functional TR and results in excellent hemodynamic and functional effects postoperatively.     

A 12-year clinical experience of cardiac valve replacement with domestic tilting disc valve prostheses in 1013 cases]

1013 patients with cardiac valve replacement during a 12-year period from 1978 to 1990 were reported. 566 cases were implanted with Shanghai-made tilting disc valve prostheses and 447 with Lanzhou-made (C-L valves). Mitral valve replacement (MVR) in 753 patients, aortic valve replacement (AVR) in 102 and double valves replacement (DVR) in 158. The overall early mortality rate was 6.2% with 4.9%, 7.8% and 11.3% after MVR, AVR and DVR respectively. Follow-up study was made in 3097.43 patient-year (mean 3.26 years). The late death rate was 1.6% patient-years and with 1.4, 1.8 and 3.2 after MVR, AVR and DVR respectively. The incidence of late valve-related complication (% patient-years) were: thromboembolism 0.39, anticoagulant-related hemorrhages 0.77, prostheses failure 0.22, prosthetic valve endocarditis 0.38, periprosthetic leak 0.12, and reoperations 0.38. The domestic tilting disc valve prostheses are considered to be qualified valves with low mortality and satisfactory results.     

The CarboMedics prosthetic heart valve: experience with 1,084 implants

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate our clinical experience with the CarboMedics heart valve prosthesis. METHODS: Between October 1991 and December 2000, 942 consecutive patients (514 males, 428 females; mean age 58+/-11 years; range: 6-78 years) underwent mechanical valve implantation with the CarboMedics prosthesis. Preoperatively, 47% of patients were in NYHA class III and 22% in class IV; in addition, 134 patients (14.2%) had undergone a previous cardiac operation. Aortic valve replacement (AVR) was performed in 469 patients (49.8%), mitral valve replacement (MVR) in 330 (35.0%), double valve replacement (DVR) in 142 (15.1%), and isolated tricuspid valve replacement (TVR) in one patient. Eighty-eight patients (9.3%) underwent associated myocardial revascularization. Mean cardiopulmonary bypass and aortic cross-clamp times for the entire group were 107+/-39 min and 74+/-24 min, respectively. RESULTS: Overall early mortality was 2.3% (6/469 AVR, 1.2%; 12/330 MVR, 3.6%; 4/142 DVR, 2.8%). Late mortality was 3.1% (n = 29; including 17 cardiac deaths (10 were valve-related). Mean follow up was 66+/-31 months (range: 1-109 months), and was 98% complete yielding a total follow up of 4959 years. Actuarial survival at five years for the entire group was 89.3+/-1.6% (AVR 91.1%, MVR 86.4%, DVR 90.5%). Thromboembolism occurred in 26 patients (2.8%, 0.52%/pt-year) and major hemorrhagic events in 20 (2.1%, 0.4%/pt-year). Nine patients (0.9%) required a reoperation, in three cases (0.3%) after Staphylococcus epidermidis-mediated endocarditis. No structural deterioration occurred. Among 891 survivors, 94% of the patients are currently in NYHA classes I or II (p <0.05). CONCLUSION: This study confirmed the safety and reliability of the CarboMedics mechanical valve prosthesis, even in old age groups. This bileaflet prosthesis showed no structural deterioration, and a low incidence of overall complications.     

Six-year experience with the St. Jude Medical prosthesis: early and late results of 540 valves in 462 patients

From July 1978 to June 1984, 540 St. Jude Medical valve prostheses were implanted in 462 adult patients. Overall operative mortality was 4.8% (22/462): 5.7% after aortic valve replacement (AVR) (8/140); 3.3% after mitral valve replacement (MVR) (8/244); and 7.7% after aortic and mitral valve replacement (DVR) (6/78). There were 16 late deaths among 440 operative survivors; six (38%) were valve related. The actuarial survival rate at six years was 94.5% in AVR and 93.5% in MVR. At five years it was 91.6% in DVR. The freedom from valve-related death at six years after AVR, MVR and at five years after DVR was 97.8%, 98.6% and 95.8%, respectively. The incidence of valve-related complications (expressed as %/patient-year (number of events] was as follows: thrombo-embolism (AVR 0.7 (2), MVR 2.0 (13), DVR 2.8 (5], valve thrombosis (AVR 0.3 (1), MVR 0.2 (1), DVR 0 (0], prosthetic valve endocarditis (AVR 0.3 (1), MVR or DVR 0 (0]. There were no cases of primary structural failure, serious anticoagulant-related hemorrhage or clinical event of hemolysis. The incidence of all valve-related complications in AVR, MVR and DVR was 1.3, 2.2 and 2.8%/pt-yr, respectively. The freedom from thrombo-embolism at six years after AVR and MVR and at five years after DVR were 91.4%, 92.4% and 88.7%, respectively. Re-operation was performed in only one patient with MVR because of valve thrombosis (0.2%/pt-yr after MVR, overall 0.1%/pt-yr). These results indicate that St. Jude Medical prosthesis has provided a satisfactory performance with acceptable risks of late complications in patients who were properly anticoagulated during six-year follow-up period.     

Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation

BACKGROUND AND AIM OF THE STUDY: Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients after mitral valve replacement (MVR), both in the immediate and late postoperative period. The aim of this study was to evaluate the prevalence and the clinical importance of TR late after MVR, as assessed both clinically and echocardiographically. METHODS: The study group comprised 65 patients (39 women, 26 men; mean age 61+/-12 years) with rheumatic heart disease who had undergone MVR without tricuspid valve surgery between one and 30 years (mean 11.3+/-8 years) before their last clinical examination. All patients underwent a complete color-Doppler echocardiographic examination. The predominant presurgical mitral lesion was stenosis in 44 patients and regurgitation in 21. The severity of the tricuspid valve disease was assessed echocardiographically using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins, and by clinical evaluation. RESULTS: Echocardiography revealed significant late TR in 44 patients (67%), which was moderate in 16 and severe in 28, and evident on physical examination in 24 cases (37%). Age (relative risk (RR) = 1.1; C.I. 1-1.1) and female sex (RR = 1.8; C.I. = 1.0-3.2) were identified as statistically significant predictors for late clinical TR development, but only age was found as a statistically significant predictor for echocardiographic TR development. An elevated RR for organic TR and predominant mitral regurgitation was found. In contrast, pre- and postoperative pulmonary artery pressure, predominant mitral lesion, prosthetic valve gradient and regurgitation were similar in patients with and without late TR. CONCLUSIONS: Significant TR diagnosed by echocardiography late after MVR is common, and clinically evident in more than one-third of patients. Therefore, a lower threshold for tricuspid valve repair should be considered when mitral valve surgery is carried out.     

BalMedic成形软环治疗功能性三尖瓣反流的疗效观察

目的 研究BalMedic成形软环治疗三尖瓣功能性反流的临床效果.方法 同顾性分析18例行左心瓣膜手术同时应用BalMedic成形环行三尖瓣成形术治疗三尖瓣功能性反流患者的临床资料,着重分析手术方法和手术结果,通过胸心脏B超榆查来评估手术前后三尖瓣反流情况.结果 共植入27#成形环13枚(72%,13/18),29#成...     

Ten-years' clinical experience with the Sorin Pericarbon valve

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate 10 years' results obtained with the Pericarbon pericardial bioprosthesis. METHODS: Between September 1988 and December 1997, 277 patients (mean age 75.8 +/- 8.5 years) received a total of 287 Pericarbon pericardial valves. Of these patients, 224 (80.8%) underwent single aortic valve replacement (AVR) and 39 single mitral valve replacement (MVR); one patient had a tricuspid valve replacement (TVR), three patients had a pulmonary valve replacement (PVR) and 10 had both aortic and mitral valve replacement (DVR). Associated cardiac procedures were performed in 86 patients (31.0%), mainly coronary artery bypass graft (n = 71). Mean patient follow up was 4.9 +/- 2.6 years; total cumulative follow up was 1,221.4 patient-years. RESULTS: The overall hospital mortality rate was 10.1%. There were 50 late deaths (20.1%), four (1.6%) being valve-related. The patient survival rate at 10.8 years was 60.0 +/- 4.5% for AVR and 46.5 +/- 11.9% for MVR. Freedom from valve-related death at 10.8 years was 97.6 +/- 1.1% for AVR and 100% for MVR. Freedom from structural valve deterioration was 96.1 +/- 2.7% for AVR and 100% for MVR. Freedom from embolic events was 96.0 +/- 1.5% for AVR and 100% for MVR. In total, 16 patients needed reoperation, three for stenosis due to dystrophic calcification, six for endocarditis and seven for paravalvular leak. Freedom from reoperation was 89.9 +/- 4.2% for AVR and 80.6 +/- 7.3% for MVR. CONCLUSION: These results show that, over a period of up to 10 years, the Pericarbon pericardial bioprosthesis constitutes an excellent and safe replacement valve.     

Long-term results of triple-valve procedure

Triple-valve procedures are associated with high early and late mortality. We reviewed our experience in 25 patients who underwent combined mitral and aortic valve replacement with tricuspid valve repair or replacement between 1979 and 2004. The mean follow-up was 7.8 years (range, 10 days to 24.5 years). The mean age at operation was 52 years (range, 31 to 72 years). Four patients underwent triple-valve replacement and 21 had double-valve replacement and tricuspid annuloplasty. Perioperative mortality was 20% and late mortality was 24%. Cumulative survival, calculated taking perioperative mortality into account, was 71% +/- 10% at 10 years and 36% +/- 15% at 15 years after surgery. Only 1 of 20 perioperative survivors required re-operation for prosthetic valve dysfunction. Double-valve replacement with tricuspid annuloplasty offers satisfactory long-term survival with freedom from thromboembolism and re-operation.     

Evaluation of the Carpentier-Edwards porcine bioprosthesis in the tricuspid position

In spite of the efficacy of tricuspid annuloplasty, there remain occasional cases in which tricuspid valve replacement (TVR) is indicated. There is to date no late follow-up data on the Carpentier-Edwards porcine bioprosthesis (CEPB) in the tricuspid position. We present a series of twelve consecutive cases of TVR with the CEPB. Ten patients had multiple valve replacements. The duration of follow-up was 5 to 50 months (mean 27.7 months) on all patients. The operative mortality was 18% (2/12), with 82% (10/12) actuarial 5-year survival. The mean valve follow-up was 2.3 years per prosthesis. Ten patients were in the New York Heart Association (NYHA) Class IV preoperatively. Postoperatively, eight patients moved to Class II, one to Class III and one remained unchanged. There was no valve replacement necessary. Subclinical pulmonary emboli were detected by lung scan in one patient for 4.3% events per year. Echocardiography revealed no evidence of orifice thrombus or leaflet calcification. In our opinion, the Carpentier-Edwards bioprosthesis can be used safely in the tricuspid position with satisfactory functional results.     

Tricuspid valve replacement: factors influencing early and late mortality

Seventy four patients underwent tricuspid valve replacement (TVR), between 1968 and 1983. 93% were female, mean age was 44 +/- 4 years. Tricuspid valve was replaced with a mechanical prosthesis in 52 and a bioprosthesis in 22 patients. Fifty seven patients underwent primary TVR and 17 underwent a secondary TVR following a mean interval of 41 +/- 2 months (SEM) following a previous mitral or tricuspid valve operation. Preoperatively 86% patients were in NYHA class III-IV and congestive cardiac failure (CHF). Early mortality for primary TVR was 36.8% and 35.2% for secondary TVR. Early mortality has been significantly reduced since the introduction of cardioplegic protection for the associated valve lesions. Early mortality was significantly influenced by the reduced preoperative values of FVC and FEV1 in patients with long standing mitral valve disease and by raised preoperative levels of plasma bilirubin and alkaline phosphate in patients with CHF. Risk of thrombotic occlusion and late deaths remained high during the first year after TVR with a mechanical prosthesis.     

Long-term management of patients with cardiac valve prostheses

Marked improvements have been achieved in the results of valve replacement due to recent developments in cardiac valve prostheses, surgical procedures, myocardial protection methods, and supportive techniques. Since 1974, the aortic valve has been replaced with mechanical valves and the mitral valve with biological valves at our institution. During a cumulative follow-up of 1024 patient-years after 306 valve replacements (126 AVR, 148 MVR and 32 AVR + MVR), the 10-year survival rates were 88% for AVR, 72.6% for MVR and 77.5% for AVR + MVR. The cardiac function of 90% of the survivors was evaluated as Class I or II according to NYHA Functional Classification. As for valve-related postoperative complications, thromboembolism was observed in 2.3%/pt-yr, hemorrhage in 0.5%/pt-yr, prosthetic valve endocarditis in 1.3%/pt-yr, perivalvular regurgitation in 1.3%/pt-yr and valve malfunction in 1.1%/pt-yr. Of the causes of late deaths, 62.5% were related to valve complications. Re-replacement of the prosthesis was necessary in 17 patients due to valve-related complications, and early death occurred in 1 (5.9%) of these 17. While cardiac valve replacement contributes to improvements in the quality of the patients' long-term postoperative life, currently employed artificial valves are still not ideal with regard to their materials and design, and re-replacement may become necessary in the late postoperative period. Therefore, in addition to selection of the appropriate valve prosthesis for different disorders and optimal prevention of valve-related complications, early diagnosis by non-invasive techniques and early treatment of these complications if they have occurred are of particular importance for the long-term management of patients following cardiac valve replacement.     

Prosthetic mitral valve thrombosis,malfunction, and paroxysmal mitral regurgitation

Intermittent dysfunction of mechanical mitral valve prosthesis is an uncommon condition. It carries serious clinical implications if unrecognized. Here, we present a case of a 28‐year‐old female with a history of rheumatic multivalvular disease, for which she had undergone double valve replacement and tricuspid annuloplasty. Six months later, she presented with heart failure. Clinical examination revealed intermittent loss of closing clicks followed by a pansystolic murmur at the apex, suggestive of mitral prosthetic valve dysfunction. We highlight the echocardiographic findings of paroxysmal mitral valvular regurgitation secondary to prosthetic valve malfunction secondary to prosthetic valve thrombosis.     

Reoperations after tricuspid valve repair: re-repair versus replacement

Background

Data demonstrating results of reoperation after initial tricuspid valve repair are scarce. We evaluated outcomes of tricuspid reoperations after tricuspid valve repair and compared the results of tricuspid re-repair with those of tricuspid valve replacement (TVR).

Methods

From 1994 to 2012, 53 patients (56±15 years, male:female =14:39) underwent tricuspid reoperations due to recurrent tricuspid regurgitation (TR) after initial repair. Twenty-two patients underwent tricuspid re-repair (TAP group) and 31 patients underwent TVR (TVR group).

Results

Early mortality occurred in 6 patients (11%). Early mortality and incidence of postoperative complications were similar between the 2 groups. There were 14 cases of late mortality including 9 cardiac deaths. Five- and 10-year free from cardiac death rates were 82% and 67%, respectively, without any intergroup difference. Recurrent TR (> moderate) developed in 6 TAP group patients and structural valve deterioration occurred in 1 TVR group patient (P=0.002). Isolated tricuspid valve surgery (P=0.044) and presence of atrial fibrillation during the follow-up (P=0.051) were associated with recurrent TR after re-repair. However, the overall tricuspid valve-related event rates were similar between the 2 groups with 5- and 10-year rates of 61% and 41%, respectively.

Conclusions

Tricuspid valve reoperation after initial repair resulted in high rates of operative mortality and complications. Long-term event-free rate was similar regardless of the type of surgery. However, great care might be needed when performing re-repair in patients with atrial fibrillation and those who had isolated tricuspid valve disease due to high recurrence of TR after re-repair.     

Clinical evaluation of the carbomedics prosthesis: experience at providence health system in Portland

BACKGROUND AND AIMS OF THE STUDY: This study details the authors' experience with the CarboMedics bileaflet mechanical prosthesis, and assesses the valve's efficacy in terms of early mortality and long-term morbidity. METHODS: Between July 1994 and December 2000, a total of 696 CarboMedics valves was implanted in 616 patients. Aortic valve replacement (AVR) was performed in 350 (57%) patients, mitral valve replacement (MVR) in 161 (26%), double (aortic + mitral) valve replacement (DVR) in 79 (13%), and other procedures in 26 (4%). RESULTS: There were 32 operative deaths. Operative mortality was 4.3% for AVR, 6.8% for MVR, and 7.6% for DVR. Linearized rates for late death were 3.4%/patient-year (pt-yr), 5.5%/pt-yr and 7.7%/pt-yr for AVR, MVR and DVR, respectively. Survival at five years was 80.1% for AVR, 73.0% for MVR, and 64.6% for DVR (p = 0.004). Freedom from reoperation at five years was 97.6% for AVR, 98.1% for MVR, and 94.1% for DVR (p = 0.718); freedom from thromboembolism at five years was 96.3% for AVR, 98.6% for MVR, and 88.3% for DVR (p = 0.04). Linearized rates of late thromboembolism were 0.7%/pt-yr, 0.4%/pt-yr and 2.3%/pt-yr, respectively. Freedom from PVE at five years was 98.4% for AVR, 97.0% for MVR, and 89.7% for the DVR group (p = 0.172). Linearized rates of PVE were 0.5%/pt-yr, 0.9%/pt-yr and 1.8%/pt-yr, respectively. Freedom from anticoagulant-related bleeding at five years was 98.0% in the AVR group, 97.8% in the MVR group, and 88.3% in the DVR group (p <0.001); linearized rates of this event were 0.4%/pt-yr, 0.6%/pt-yr and 3.2%/pt-yr, respectively. One valve thrombosis was found after MVR, and another in the mitral position after DVR. CONCLUSION: Early and intermediate-term follow up of the CarboMedics prosthesis indicates that the clinical performance of this valve is satisfactory, and results are comparable with those obtained for other mechanical valves.