Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Valves”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 397 records · Page 22Linked to original sources
PubMed1988

Heart valve replacement with St. Jude Medical valve prosthesis. Long-term experience in 743 patients in Switzerland.

Between November 1978 and June 1986, 828 St. Jude Medical valves were implanted in 743 patients whose mean age was 57 years (range, 1-83 years) and who had been admitted to the University Hospitals in Basel, Berne, and Lausanne, Switzerland. Aortic valve replacement was performed in 456 patients, mitral valve replacement in 200, tricuspid valve replacement in six, double valve replacement in 77, and triple valve replacement in four. In 187 patients, additional surgical interventions were performed. Operative mortality was 1.6%, and the 4-week postoperative mortality was 4.0%. During a mean follow-up period of 2.6 years, the annual mortality rate was 3.1%, and the annual cardiac mortality rate was 2.1%. The thromboembolic rate per 100 patient-years was 1.3 after aortic valve replacement, 3.0 after mitral valve replacement, and 1.0 after multiple valve replacement. The incidence of major bleeding was 1.3 per 100 patient-years. Valve dysfunction attributable to thrombotic obstruction occurred in three patients, and that attributable to leaflet dislocation in one (annual dysfunction rate, 0.2%). Twelve patients developed infectious endocarditis, six of whom died. However, in four patients, reoperation and, in two patients, antibiotic treatment alone were successful in treating the infection. A paravalvular leak necessitating reoperation developed in 10 patients. In three patients, the leak was caused by infectious endocarditis. Reoperation had no operative mortality. In three patients (0.4%), a mild hemolytic anemia was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[A case of secondary valve replacement caused by pulmonary bioprosthetic valve endocarditis].

A 42-year-old male with pulmonary bioprosthetic valve endocarditis accompanied by residual minor leakage through a previously closed patch for ventricular septal defect (VSD), underwent reoperation with a Carpentier-Edwards bioprosthetic valve. The patient had a history of pulmonary valve replacement and VSD in 1973. A massive vegetation on the pulmonary valve was demonstrated by echocardiography. Five repeated blood cultures yielded Eikenella corrodens. After medical treatment, reoperation was performed. The patient was free of complications after the procedure. Although bioprosthetic valves have potential problems of dysfunction and calcification in long-term use, these problems develop at a significantly slower rate in right-sided positions compared with left-sided positions and bioprosthetic valve thrombosis in the pulmonary position has apparently not been reported. Mechanical prostheses for pulmonary valve replacement have a poor prognosis, with a high incidence of valve thrombosis despite adequate anticoagulant therapy. For the replacement of prosthetic valves in right-sided positions (tricuspid and pulmonary), bioprosthetic valves are now our first choice.

Adult↗
PubMed1994

Doppler echocardiography evaluation of the CarboMedics valve in patients with small aortic anulus and valve prosthesis-body surface area mismatch.

A Doppler echocardiographic study was performed to evaluate the hemodynamic performances of small diameter CarboMedics aortic valves (CarboMedics, Inc., Austin, Tex.) in patients with a mismatch between the prosthetic valve and body surface area. Fourteen patients receiving either a 19 mm (n = 7) or a 21 mm valve (n = 7) prosthesis were studied. Only patients with a body surface area greater than 1.65 m2 were included in the study. Pulsed and continuous wave Doppler echocardiography was performed at rest and 2 minutes after treadmill exercise with the Bruce protocol. Peak and mean gradients across the valve prosthesis were estimated; effective orifice area, performance index, and discharge coefficient of the valve prosthesis were calculated. All patients achieved a significant increase in heart rate, systolic blood pressure, and cardiac output with exercise. Mean gradients +/- standard deviation of the mean at rest and 2 minutes after exercise were 20.1 +/- 7.1 mm Hg and 21.8 +/- 9 mm Hg for the 19 mm prosthesis and 12.3 +/- 3.4 mm Hg and 15.9 +/- 3.9 mm Hg for the 21 mm prosthesis. The 19 mm valve prosthesis significantly increased the effective orifice area with exercise (1.02 +/- 0.2 versus 1.20 +/- 0.3; p < 0.05), whereas it was almost unmodified for the 21 mm valve (1.38 +/- 0.2 versus 1.39 +/- 0.3; p = not significant). Therefore, despite a similar increase in cardiac output with exercise, only the 21 mm valve prosthesis showed a significant increase in peak (25.4 +/- 5.2 versus 34.9 +/- 8.1 mm Hg) and mean gradient (p < 0.01). We conclude that small diameter CarboMedics valves have satisfactory hemodynamic performances even after strenuous exercise in patients with large body surface areas. The hemodynamic performances of the 19 mm valve prosthesis seem to be optimized with exercise.

Aged↗
PubMedDate not supplied

[Change in mitral valve area after percutaneous transvenous mitral commissurotomy: prediction of mitral valve restenosis].

Factors indicating changes in mitral valve area after single-balloon percutaneous transvenous mitral commissurotomy (PTMC) were evaluated in 53 patients receiving PTMC by follow up for 3-48 months (mean 18 +/- 12 months) using serial transthoracic echocardiography to measure mitral valve area by planimetry. The echocardiographic scores of the mitral commissures and mitral valve, and other clinical variables were assessed. Mitral valve area showed an immediate increase from 1.1 +/- 0.3 to 1.8 +/- 0.3 cm2 (p < 0.01). There was a small but significant decrease in mitral valve area at follow-up to 1.6 +/- 0.4 cm2 (p < 0.01). Restenosis (a decrease in mitral valve area of more than 25% from immediately after PTMC to follow-up) occurred in nine patients (17%). There was no significant correlation between clinical or echocardiographic features and an increase in mitral valve area immediately after PTMC. The total echocardiographic score of the mitral commissures correlated with the decrease in mitral valve area at follow-up (r = 0.42, p = 0.002). Multiple regression analysis showed the total echocardiographic score of the mitral commissures was the best indicator of a decrease in mitral valve area at follow-up (p = 0.0059). Six of nine patients with restenosis had a commissure score of more than 3, while only five of 44 patients without restenosis had a commissure score of more than 3 (p < 0.01). Mitral valve area increases significantly immediately after PTMC, and decreases significantly at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Assessment of prosthetic valve hemodynamics by Doppler: lessons from in vitro studies of the St. Jude valve.

Although Doppler assessment of native heart valve hemodynamics is quite accurate, assessment of prosthetic mechanical valve hemodynamics presents more potential problems. These problems arise from the unique geometry of prosthetic valves. Two important prosthetic valve phenomena can violate the basic assumptions underlying Doppler calculations: pressure recovery and localized gradients. When pressure recovery is present, Doppler systematically overestimates the actual net catheter gradient across the valve. In contrast, the presence of localized gradients may cause Doppler to measure differing gradients depending on which part of the valve is interrogated. These phenomena can also affect the calculation of prosthetic valve areas using the continuity equation. When assessing prosthetic valves with Doppler echocardiography, it must be remembered that Doppler measures velocity, not pressure gradients and that the echocardiographer must exercise great care when interpreting Doppler velocities as either pressure gradients or in calculating valve areas for prosthetic valves.

Acceleration↗
PubMed1994

Long-term results of mitral valve reconstruction for regurgitation of the myxomatous mitral valve.

The myxomatous, degenerated, prolapsed or "floppy" mitral valve is the most common cause of mitral regurgitation in North America. Mitral valve reconstruction for mitral regurgitation was carried out in 219 consecutive patients with a myxomatous mitral valve from 1984 to 1993. Of the 139 men and 80 women, 23 to 84 years of age (mean 63 years), 36% of patients were 70 years of age or older, 77% were in New York Heart Association functional class III or IV, and 29% had coronary artery disease necessitating coronary bypass. The most common operation was posterior leaflet resection (161 patients [73%]). The anterior leaflet was resected in 14 patients, and both the anterior and posterior leaflets were resected in 15 patients. A variety of other techniques were used, including commissuroplasty and use of annuloplasty rings. A flexible Duran ring was used in 111 patients (51%), a Carpentier-Edwards ring in 44 patients (20%), and no ring was used in 64 patients (29%). Five operative deaths occurred (2.3%); four of the five deaths occurred in patients 70 years of age or older (5.1%); and one in 141 patients (0.7%) was younger than 70 years of age. In the late postoperative period (mean follow-up 2 years), 90% of patients had no symptoms, two had endocarditis, and seven patients had thromboemboli (transient in four, permanent in three). Structural valve degeneration requiring reoperation occurred late in 12 patients; eight were in posterior leaflet resection and two in anterior or anterior and posterior; six of 12 had no annuloplasty ring. The incidence of structural valve degeneration was less than 5% from 1990 to 1993. No systolic anterior motion of the mitral valve was seen with postoperative echocardiography before discharge. Actuarial analysis at 5 years for overall survival was 86% +/- 5%, freedom from infectious valve degeneration 97% +/- 2%, and freedom from thromboembolism 94% +/- 3%. Freedom from structural valve degeneration overall was 83% +/- 4%, with a flexible ring it was 89% +/- 6%, with a rigid ring it was 88% +/- 6%, and with no ring it was 67% +/- 12% (p = 0.03). Mitral valve reconstruction for complicated myxomatous disease of the mitral valve, regardless of leaflet involvement, is feasible and offers excellent early and late results.

Actuarial Analysis↗
PubMedDate not supplied

Transluminal aortic valve placement. A feasibility study with a newly designed collapsible aortic valve.

Percutaneous stents are used in vascular applications in conjunction with angioplasty and in combination with graft material for repair of abdominal aneurysms. The authors have designed a collapsible bioprosthetic aortic valve for placement by a transluminal catheter technique. This trileaflet stent valve is composed of stainless steel and bovine pericardium. Stent valves, 23 and 29 mm, were tested in a pulse duplicator system with rigid rings from 21 to 31 mm in 2 mm increments. At a mean flow of 3.1 L/min (+/-0.7), normal systemic aortic pressure was generated with a transvalvular gradient of 14.9 +/- 7 mmHg (mean +/- SD). Regurgitation fraction ranged from 10 to 18% (mean 13.8 +/- 3%) in the best ring size. Valves with the best hemodynamic profile were used for implantation in three 70 kg pigs in an open chest model. The valve was collapsed in a 24 Fr catheter designed to allow slow, controlled release. After resection of the native leaflets, the new valve was placed in the subcoronary position. No additional sutures were used for securing the valve. Two animals were successfully weaned from cardiopulmonary bypass and maintained systemic pressures of 100/45 (+/-10) and 116/70 (+/-15) mmHg, respectively. Intraoperative color echocardiography revealed minimal regurgitation, central flow, full apposition of all leaflets, and no interference with coronary blood flow. Both animals were sacrificed after being off bypass for 2 hr. Postmortem examination revealed the valves to be securely anchored. The third animal was weaned from cardiopulmonary bypass but developed refractory ventricular fibrillation because of valve dislodgment due to structural failure. Although long term survival data are needed, development of a hemodynamically acceptable prosthetic aortic valve for transluminal placement is feasible.

Animals↗
PubMed1996

The use of pulmonary allografts for aortic valve replacement. Short term results and comparative morphometric analysis of the aortic and pulmonary valves.

UNLABELLED: The satisfactory results of aortic valve replacement with pulmonary autograft and the limited availability of aortic allografts prompted us to use the pulmonary valve as an aortic valve substitute and to perform a morphometric analysis of the two valves in cadavers. CLINICAL STUDY: From March 1994 to March 1995 20 patients underwent an aortic valve replacement (AVR) with a pulmonary allograft (PA). Twelve patients were men, 8 women; age ranged from 15 to 58 years. In 4 cases the indication to AVR was an infective endocarditis which was acute in two patients. Functional class was NYHA II in 18 cases and NYHA III in 2 patients with active endocarditis. Left ventricular ejection fraction (LVEF%) was preserved in the majority of patients (mean LVEF=53% range 36% to 65%). End diastolic aortic valve diameters were measured by bidimensional echocardiography in parasternal long axis view and ranged from 18 mm to 29 mm. The diameters of the allografts implanted ranged from 19 mm to 27 mm. Donors age ranged from 19 years to 55 years. We tried to use the allograft from the youngest donor available. The surgical technique was the classic "Ross" coronary freehand implantation in 11 cases, a "Miniroot" implant in 8 instances and a "Miniroot" implant combined with a "Nicks" annular enlargment in 1 case. Aortic cross clamping ranged from 66 mm to 118 m (92m+/-10m). One patient died (5%) of infarction. In this patient the allograft was replaced with a mechanical valve because the echocardiography showed a rapidly increasing aortic regurgitation. At hospital discharge a slight aortic regurgitation was detected in 2 cases. In these two patients, whose annulus diameters were 26 mm and 28 mm respectively, we adopted a classic freehand technique of implantation. Mean postoperative transvalvular gradient was 4 mmHg+/-3 mmHg. The follow-up ranges from 45 days to 14 months (mean 8 months). The aortic regurgitation in the two cases remains stable and no new aortic regurgitations have been detected to date. No embolic or infective episodes occurred during the follow-up. ANATOMIC STUDY: Analysis was performed on 6 couples of valves obtained from cadevers without evidence of previous valvular disease. The normalized Free Edge (FE) dimensions and Leaflet Surfaces (LS) of the pulmonary valve (PV) proved to be larger than the corresponding aortic (AV) measurements (Free edge/Diameter: PV 1.25+/-0.2 vs AV 1.16+/-0.2 p<0.05; Annular Attachment/Diameter PV 1.9+/-0.1 vs AV 1.74+/-0.2 p=NS; Valve Surface/Leaflet Surface PV 0.97+/-0.2 vs AV 0.80+/-0.2 p=0.004) indicating that the PV has a larger coapting surface.

Adolescent↗
PubMed1986

Comparative study of primary tissue valve failure between Ionescu-Shiley pericardial and Hancock porcine valves in the aortic position.

From August 1977 to June 1981, 221 patients received a Hancock porcine valve and 133 an Ionescu-Shiley bovine (I-S) pericardial valve as aortic valve substitutes. No special selection or randomization was used and no patient with either of these types of valves was excluded. Preoperative data show no differences between the groups influencing the appearance of primary tissue failure. Hospital survivors were followed until June 1984 and those with an uneventful history at least 36 months. Patients who died late postoperatively or who underwent reoperation for causes other than primary dysfunction were considered at risk until death or reoperation. Primary tissue failure occurred in 8 patients in the I-S group from 36 to 70 months postoperatively and in 6 patients of the Hancock group from 24 to 83 months. Linearized rates of primary failure were 0.61 valves per 100 patient-years for the Hancock and 1.70 valves per 100 patient-years for the I-S group. Mean age of patients with failing valves was 38 years (range 25 to 55) for Hancock valves and 39 years (range 15 to 62) for I-S valves. Actuarial analysis shows a lower rate of primary dysfunction in the Hancock group since the fourth year, which is statistically significant in the sixth and seventh years (96.5 +/- 1.5% vs 79.6 +/- 7.6% in the sixth year and 93.1 +/- 3.6 vs 79.6 +/- 7.6% in the seventh year). Microscopically, calcium and collagen degeneration were consistently associated and present on failing bioprostheses.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1992

Surgical pathology of the mitral valve: gross and histological study of 1288 surgically excised valves.

A consecutive series of 1288 mitral valves surgically excised from 1981 through 1989 were studied macroscopically and histologically. The explanted valves were affected by: chronic rheumatic disease (1179, 91.5%), floppy mitral valve (84, 6.5%), bacterial endocarditis (19, 1.5%), and post-ischemic mitral incompetence (6, 0.5%). Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent malfunction (747, 58%). Isolated mitral incompetence was diagnosed in 72 (6.11%) cases only, and isolated stenosis in 360 cases. In 52 valves, excised because of chronic rheumatic disease, the histology showed unexpected signs of acute rheumatism of the leaflets and the papillary muscles. In these patients clinical symptoms and blood tests were negative for rheumatic disease. Mitral incompetence, possibly due to papillary muscle dysfunction, was the prevalent lesion (61.5%). A total of 181 patients (14.05%) with pure mitral incompetence underwent surgery. In 84 patients (46.4%), the floppy mitral valve was the most frequent cause of valve dysfunction, 72 (39.8%) had rheumatic disease, 19 (10.5%) infective endocarditis, and 6 (3.4%) ischemic heart disease. In the group with floppy mitral valve, males were more prevalent than females (51:33). The mean age of the 4 patients with Marfan's syndrome and non-Marfan patients was noticeably different (17 vs 49 yr). Moreover leaflet deformation, tendinous cord elongation and annulus dilatation were the most common causes of valve incompetence. Floppy mitral valve and infective endocarditis were the cause of cordal rupture in 43.5% of the cases. This was a severe complication which always required emergency surgery.

Adult↗
PubMed2005

The St. Jude Medical cardiac valve prosthesis: a 25-year experience with single valve replacement.

BACKGROUND: From October 1977 to October 2002, 4,480 patients (age range, 17 to 94 years; average, 64 +/- 13 years) underwent single valve replacement with the St. Jude Medical heart valve. Of 2,982 aortic (AVR) and 1,498 mitral valve replacements (MVR), concomitant coronary artery bypass grafting was performed on 42% and 33%, respectively. METHODS: Cardiac Surgical Associates has maintained an independent database of patients having valve replacement with the St. Jude Medical prosthesis since the world's first implant. Patients were contacted by questionnaire or phone from November 2002 through June 2003. Hospital course and valve-related events were verified by patient chart review or physician contact. RESULTS: Follow-up was 95% complete. Operative mortality was 4% with AVR and 9% with MVR. Total follow-up was 32,190 patient-years (range, 1 month to 24.8 years; average, 7 +/- 5 years). During the study period, patient freedom from late mortality was 61% (AVR, 61%; MVR, 63%), and from valve-related mortality 92% (AVR, 93%; MVR, 91%). Freedom from thromboembolic events was 85% (86% AVR, 81% MVR), from bleeding events, 81% (81% AVR, 81% MVR), from reoperation, 98% (99% AVR, 97% MVR), from endocarditis, 98% (99% AVR, 98% MVR), and from valve thrombosis, 99% (99% AVR, 98% MVR). There was one MVR structural failure (0.06%). CONCLUSIONS: The St. Jude Medical valve has proven to be an effective and durable valve prosthesis with a low event rate during the long term.

Adolescent↗
PubMed1993

Semilunar valve replacement with a cylindrical valve.

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.

Animals↗
PubMed1981

Homograft aortic valve replacement: seven years' experience with antibiotic-treated valves.

One hundred and sixty-five patients had their aortic valve replaced with antibiotic-sterilised homograft. In all cases, a two-layered freehand technique of valve implantation was used. Tailoring (narrowing) of the annulus was required in 29 cases, and an aortic root gusset was used to enlarge the non-coronary sinus in 68 cases. There was an early mortality of 1.8% and late mortality of 2.4%. The actuarial survival rate was 95% at a maximum follow-up of seven years. The incidence of valvar regurgitation (early diastolic murmur) was 11.5% up to six months after operation and an additional 7.2% subsequent to this. Overall, it was trivial in 10.3%, mild in 7.8%, and moderate in 0.6%. Most valve regurgitation was non-progressive and actuarial analysis showed 74% regurgitation-free valves at the end of seven years. The age of the donor and the valve storage time showed some relationship to valve deterioration. Special attention has been paid to the control of hypertension to prevent accelerated graft degeneration. The results suggest that this has been successful. Anticoagulant therapy was not used and thromboembolism has not been seen in patients undergoing isolated aortic valve replacement. There was one case of miliary tuberculosis after homograft valve replacement but no pyogenic or fungal endocarditis occurred. No haemolysis, calcification, or valvar stenosis were observed. This series, followed for a maximum of seven years, shows excellent sustained valve performance and a very low incidence of important postoperative regurgitation, with 91.8% of the survivors symptom-free.

Adolescent↗
PubMed1999

Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients.

BACKGROUND AND AIMS OF THE STUDY: Patients with symptoms of right heart failure due to severe tricuspid regurgitation following a prior operation on left heart valves present a difficult problem. The outcome of tricuspid surgery in this setting is not well defined. We describe a single-center experience of isolated tricuspid valve surgery after prior left heart valve surgery, and analyze potential risk factors for a poor outcome. METHODS: Thirty-four patients who underwent isolated tricuspid valve operation for severe tricuspid regurgitation following prior valvular surgery for left-sided valve disease between 1980 and 1997 were identified. Charts were reviewed for clinical, echocardiographic, catheterization and surgical data. Follow up of survivors was conducted by telephone to ascertain functional status. RESULTS: Three patients died in hospital (early mortality rate, 8.8%). At a follow up of 71 +/- 39 months, 13 patients were alive and 21 reached an end-point (three cardiac reoperations, 18 deaths). Event-free actuarial survival at five years was 41.6 +/- 9.2%. Patients who were alive at follow up had a mean NYHA functional class of 2.1 +/- 0.6 compared with 3.4 +/- 0.5 preoperatively; 85% of survivors were symptomatically improved. Predictors of poor outcome were: increased age at the time of tricuspid surgery (p = 0.0007) and higher number of prior cardiac operations (one versus two or three, p-value 0.01, relative risk 3.4). Pulmonary artery systolic pressure, left ventricular ejection fraction, right ventricular function and size, annulus diameter, tricuspid valve pathology, and valve replacement versus repair were not predictive of outcome. CONCLUSIONS: Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior surgery for left-sided heart valve disease can be performed with acceptable early mortality. There remains a high late mortality that is predicted only by age and the number of previous cardiac operations. However, in this selected group of severely symptomatic patients, significant improvement in symptoms are achieved in the survivors.

Adolescent↗
PubMed1975

Aortic valve allografts for mitral valve replacement.

Between May, 1967, and April, 1971, 122 patients underwent mitral valve replacement with fresh aortic valve allografts mounted on rigid support rings. The operative mortality rate was 6.6 percent. Current evaluation was obtained on all patients; the average postoperative follow-up interval for surviving patients is 4.8 years (range, 3.3 to 7.1). Survival rates 1, 2, and 5 years after mitral valve replacement are 89, 86, and 71 percent, respectively. The average functional class of 90 current survivors is 1.6, as compared to 2.9 preoperatively. Thirty-six thromboembolic episodes have occurred in 28 patients, generating a thromboembolism rate of 7 percent per patient year of analysis. Allograft valve dysfunction has occurred in 64 patients, requiring reoperation in 16 and causing death in two. The linearized valve dysfunction rate is 13 percent per patient year. Pathological examination of recovered allograft valves revealed predominantly leaflet fibrosis and calcification, acellular collagenous valve matrix, and infiltration with chronic inflammatory cells. The results of this long-term analysis indicate that mitral valve replacement with fresh aortic allografts provides significant functional improvement and an acceptably low rate of thromboembolism. However, the time-related rate of allograft valve dysfunction is unacceptably high and does not justify further clinical use of this type of bioprosthesis.

Adolescent↗
PubMed2001

Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency.

BACKGROUND: Mitral valve repair is considered the gold standard in surgery of degenerative mitral valve insufficiency (MVI), but the long-term results (>20 years) are unknown. METHODS AND RESULTS: We reviewed the first 162 consecutive patients who underwent mitral valve repair between 1970 and 1984 for MVI due to nonrheumatic disease. The cause of MVI was degenerative in 146 patients (90%) and bacterial endocarditis in 16 patients (10%). MVI was isolated or, in 18 cases, associated with tricuspid insufficiency. The mean age of the 162 patients (104 men and 58 women) was 56+/-10 years (age range 22 to 77 years). New York Heart Association functional class was I, II, III, and IV in 2%, 39%, 52%, and 7% of patients, respectively. The mean cardiothoracic ratio was 0.58+/-0.07 (0.4 to 0.8), and 72 (45%) patients had atrial fibrillation. Valve analysis showed that the main mechanism of MVI was type II Carpentier's functional classification in 152 patients. The leaflet prolapse involved the posterior leaflet in 93 patients, the anterior leaflet in 28 patients, and both leaflets in 31 patients. Surgical technique included a Carpentier's ring annuloplasty in all cases, a valve resection in 126 patients, and shortening or transposition of chordae in 49 patients. During the first postoperative month, there were 3 deaths (1.9%) and 3 reoperations (2 valve replacements and 1 repeat repair [1.9%]). Six patients were lost to follow-up. The remaining 151 patients with mitral valve repair were followed during a median of 17 years (range 1 to 29 years; 2273 patient-years). The 20-year Kaplan-Meier survival rate was 48% (95% CI 40% to 57%), which is similar to the survival rate for a normal population with the same age structure. The 20-year rates were 19.3% (95% CI 11% to 27%) for cardiac death and 26% (95% CI 17% to 35%) for cardiac morbidity/mortality (including death from a cardiac cause, stroke, and reoperation). During the 20 years of follow-up, 7 patients were underwent surgery at 3, 7, 7, 8, 8, 10, or 12 years after the initial operation. Valve replacement was carried out in 5 patients, and repeat repair was carried out in 2 patients. At the end of the study, 65 patients remained alive (median follow-up 19 years). Their median age was 76 years (age range 41 to 95 years). All except 1 were in New York Heart Association functional class I/II. CONCLUSIONS: Mitral valve repair using Carpentier's technique in patients with nonrheumatic MVI provides excellent long-term results with a mortality rate similar to that of the general population and a very low incidence of reoperation.

Adult↗
PubMed2003

Fourteen years' experience with the CarboMedics valve in young adults with aortic valve disease.

BACKGROUND AND AIM OF THE STUDY: Homografts and the Ross procedure are recommended by many surgeons for aortic valve replacement (AVR) in young adults. The study aim was to monitor patient outcome over a 14-year period after implanting mechanical CarboMedics prosthetic heart valves in young adults with aortic valve disease. METHODS: Between November 1987 and December 2000, 55 patients (42 males, 13 females; median age 33 years; range 15-40 years) each received a CarboMedics valve in the aortic position. All patients were included on a consecutive and non-selected basis. Concomitant surgery was performed in five patients. Anticoagulation was commenced on postoperative day 1. After discharge, patients were followed up by their cardiologist or general practitioner using questionnaires and telephone calls. Actuarial estimates of survival and freedom from morbid events were calculated using the Kaplan-Meier method. RESULTS: No patient died during surgery. Complete follow up data were available for all patients; total follow up was 404 patient-years (pt-yr). The 30-day mortality rate was zero. Actuarial survival at 14 years was 90 +/- 4.9%, and actuarial freedom from all valve-related events 92 +/- 3.7%. No valve thrombosis or major bleeding events were identified. Linearized rates per 100 pt-yr were: embolism 0.25; paravalvular leakage 0.25; prosthetic endocarditis 0.25; and reoperation 0.50. There was no hemolysis, prosthetic valve dysfunction, or structural deterioration. CONCLUSION: Over a 14-year period, implantation of the CarboMedics prosthetic heart valve has proven to be an excellent solution for AVR in young adults with aortic valve disease.

Adolescent↗
PubMed2003

Aortic valve repair versus replacement in bicuspid aortic valve disease.

BACKGROUND AND AIM OF THE STUDY: The study aim was to compare the results of aortic valve repair and replacement with biological valves in adult patients with aortic insufficiency (AI) caused by congenital bicuspid aortic valve (BAV) METHODS: Forty-four patients who had aortic valve repair were matched for age and left ventricular function to 44 patients who had aortic valve replacement (AVR) with biological valves. Patients were followed annually using echocardiography. The mean follow up was 2.6 +/- 2.1 years for the repair group, and 3.5 +/- 2.1 years for the replacement group. Follow up was complete. RESULTS: There was no operative or late death in either group. Early postoperative echocardiography showed trace or no AI in 35 patients and mild AI in nine who had repair, and trace or no AI in 38 patients and mild AI in five who had AVR. The mean peak systolic gradient was 16.2 +/- 7.6 mmHg for repair and 13.2 +/- 7.2 mmHg for AVR. Four patients who had valve repair and two who had AVR, needed repeat aortic valve surgery because of progressive AI or endocarditis. Freedom from reoperation at five years was 91 +/- 5% for repair and 94 +/- 6% for replacement (p = 0.2), while freedom from moderate or severe AI at five years was 79 +/- 8% for repair and 94 +/- 6% for replacement (p = 0.024). The peak systolic gradient at follow up was 11.7 +/- 6.8 mmHg after repair and 13.3 +/- 9.6 mmHg after AVR (p = 0.4). There were no thromboembolic complications in either group. CONCLUSION: Repair of BAV is feasible in certain patients with AI, but the hemodynamics and clinical outcomes do not appear to be superior to AVR with biological valves during the first five years of follow up.

Adult↗