RESUMEN
OBJECTIVE: Hemodynamic performances of mechanical valve prostheses in patients with aortic valve stenosis and a small aortic annulus are crucial. We analyzed the in vitro hydrodynamics of 5 currently available bileaflet mechanical prostheses that fitted a 21-mm-diameter valve holder of a Sheffield pulse duplicator. METHODS: Three samples of 5 high-performance production-quality prostheses, including the sewing ring cuffs, were tested in the aortic chamber of a Sheffield pulse duplicator. Sizes of the prostheses fitting the 21-mm valve holder were as follows: 18-mm ATS, 19-mm SJM Regent, 19-mm Sorin Bicarbon Slimline, 19-mm On-X, and 21-mm Carbomedics Top Hat. The tests were carried out at a fixed pulse rate (70 beats/min) and at increasing cardiac outputs of 2, 4, 5, and 7 L/min. Each valve was tested 10 times for each different cardiac output. This resulted in a total of 40 tests for each valve and 120 tests for each valve model. The aortic pressure was set at 120/80 mm Hg (mean pressure, 100 mm Hg) throughout the experiment for all cardiac outputs. Forward flow pressure decrease, total regurgitant volume, closing and leakage volumes, effective orifice area, and stroke work loss were recorded while the valve operated under each cardiac output. RESULTS: The SJM Regent valve and the Sorin Bicarbon Slimline prosthesis showed the lowest mean and peak gradients at increasing cardiac outputs. The closure volume was higher for the SJM Regent and Sorin Bicarbon Slimline prostheses, unlike with the ATS prosthesis at 7 L/min of cardiac output. The ATS and SJM Regent prostheses showed the largest regurgitant volume, whereas the Sorin Bicarbon Slimline prosthesis showed the lowest regurgitant volume. The calculated effective orifice area and stroke work loss were significantly better with the SJM Regent and Sorin Bicarbon Slimline prostheses. CONCLUSION: Assuming that the 21-mm valve holder in which all the tested prostheses were accommodated is comparable with a defined aortic valve size, this hydrodynamic evaluation model allowed us to compare the efficiency of currently available valve prostheses, and among these, the SJM Regent and the Sorin Bicarbon Slimline exhibited the best performances.
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Válvula Aórtica , Prótesis Valvulares Cardíacas , Válvula Aórtica/anatomía & histología , Fenómenos Biomecánicos , Diseño de Prótesis , AguaRESUMEN
This case report presents the first totally endoscopic coronary artery bypass performed with a robotic system in Italy at the Department of Cardiovascular Surgery of Padua University in December 2001. A 66-year-old male, with an indication to a single bypass of the left anterior descending coronary artery using the left mammary artery, was considered eligible for a robot-assisted myocardial revascularization using the da Vinci robotic system. The left internal mammary artery takedown was performed through three 1 cm ports on the thoracic wall. The "end-to-side" anastomosis between the mammary artery and the target coronary artery was totally performed endoscopically on a beating heart by means of a stabilizing device introduced through an additional subxiphoid port. Angiographic follow-up at 1 year showed patency of the graft. Since September 2001, robot-enhanced left mammary artery harvesting has been performed in another 18 patients without complications.
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Puente de Arteria Coronaria/instrumentación , Anastomosis Interna Mamario-Coronaria , Infarto del Miocardio/cirugía , Robótica , Anciano , Humanos , Italia , MasculinoAsunto(s)
Válvula Aórtica/cirugía , Bioprótesis , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Factores de Edad , Anciano , Bioprótesis/efectos adversos , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/mortalidad , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Italia , Persona de Mediana Edad , Complicaciones Posoperatorias , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to analyze the 8-year experience, survival, prosthetic complications, and hemodynamics of patients who received the Biocor valve, a new-generation tissue valve, in the aortic position. METHODS: From May 1992 through May 2001, 257 consecutive patients (129 women and 128 men; mean age, 75 +/- 6 years; age range, 45-91 years) received 258 aortic Biocor porcine prostheses. One female patient who received 2 Biocor valves in the aortic position during 2 consecutive operations was entered twice in the statistical analysis. Twelve (4.6%) patients had previous aortic valve operations. Preoperatively, 82 (32%) patients were in New York Heart Association functional class III or IV. Associated surgical procedures included coronary artery bypass grafting in 56 (21.7%) patients, aortic annular enlargement or aortoplasty in 20 (8%) patients, and others in 8 (3%) patients. Echocardiography was performed in the majority of long-term survivors (91.6%). Follow-up included 1215 patient-years and was 100% complete, with a median time of 5 patient-years (range, 0.4-10.5 years). RESULTS: There were 16 (6.2%) early deaths. According to a univariate analysis, New York Heart Association functional class III or IV, concomitant procedures, ejection fractions of less than 40%, and urgent operations were identified as significant perioperative risk factors. At follow-up, 75 patients died; 8-year actuarial Kaplan-Meier survival was 48% +/- 5%. At 8 years, the actuarial freedom from valve-related death was 92% +/- 2.6%, the freedom from thromboembolism was 93% +/- 2%, the freedom from anticoagulant-related hemorrhage was 95% +/- 2%, the freedom from endocarditis was 99% +/- 0.6%, the freedom from paravalvular leak was 96% +/- 1.5%, the freedom from all valve-related complications was 78% +/- 4.5%, and the freedom from structural valve deterioration was 95% +/- 3.7%. At 8 years, the actuarial freedom from structural valve deterioration was 89% +/- 10% and 95.8% +/- 4% in patients younger and older than 65 years, respectively. At 10 years, in patients older than 65 years, the actual freedom from structural valve deterioration was 97.9% +/- 2.1%, and the freedom from reoperation was 97% +/- 1.3%. New York Heart Association status was I or II in 90% of patients at the end of follow-up. The mean echocardiographic follow-up time was 4.6 +/- 2 years. By using Doppler echocardiography, the peak and mean transprosthetic gradients were determined to be 30.8 +/- 9.3 mm Hg and 16.6 +/- 5.3 mm Hg, respectively. Mean mass/volume ratio and left ventricular end-diastolic volume were 1.37 +/- 0.17 g/mL and 63.4 +/- 22.6 mL/m(2), respectively. The majority of patients showed a persistent left ventricular hypertrophy. CONCLUSION: The Biocor is an effective bioprosthesis with a low incidence of valve-related complications comparable with that of other second-generation bioprostheses. This stented porcine prosthesis provides satisfactory results in terms of hemodynamics, valve durability, and freedom from reoperation.
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Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis , Prótesis Valvulares Cardíacas , Hemodinámica/fisiología , Anciano , Anciano de 80 o más Años , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estudios de Cohortes , Intervalos de Confianza , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Complicaciones Posoperatorias/mortalidad , Probabilidad , Diseño de Prótesis , Falla de Prótesis , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: We sought to assess the efficiency of 2 different sternal wiring techniques in preventing deep sternal wound infection or sternal instability. METHODS: Seven hundred patients were randomized to 2 different groups according to chest-closure techniques. Three hundred fifty patients who underwent a peristernal double crisscross wire closure were included in group X, whereas 350 patients who underwent a standard transsternal closure were included in group T. After sternal closure, the technique for wound suturing was the same for both groups, namely triple-layer sutures up to the intracutaneous skin. All data were prospectively collected and entered in our institute database. RESULTS: The 2 groups of patients were comparable for sex, age, preoperative risk factors, and operative procedures. The overall mortality rate was 4.3% in group X and 4.6% in group T. Postoperative morbidity and mortality were comparable between the 2 groups, unlike for sternal wound complications. None of the patients included in group X had superficial or deep wound complications, whereas in group T 7 (2%) patients presented with a superficial sternal wound infection, 6 (1.7%) presented with a deep chest wound infection with sternal instability requiring re-exploration (P <.05), and 3 presented with a sternal instability caused by sternum disruption without infection. Among patients with deep wound infection and sternal instability, 1 patient died, resulting in a mortality rate of 16.7%. CONCLUSIONS: The peristernal double crisscross wiring technique achieved a greater sternal stability, resulting in a lower incidence of wound infection in association with triple-layer closure of suprasternal tissues.
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Procedimientos Quirúrgicos Cardíacos/métodos , Esternón/cirugía , Infección de la Herida Quirúrgica/diagnóstico , Técnicas de Sutura , Toracotomía/efectos adversos , Adulto , Anciano , Hilos Ortopédicos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Cuidados Preoperatorios , Probabilidad , Estudios Prospectivos , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Infección de la Herida Quirúrgica/epidemiología , Resistencia a la Tracción , Toracotomía/métodos , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Survival and prosthetic complications of patients receiving the Hancock II second-generation bioprosthesis (Medtronic, Inc, Minneapolis, Minn) in the aortic, mitral, mitral-aortic, and tricuspid positions were analyzed at 15 years' follow-up. METHODS: Between May 1983 and December 1993, 212 patients (104 men and 108 women; mean age, 63 +/- 9 years; age range, 29-81 years) received 66 aortic, 114 mitral, 26 mitral-aortic, and 6 tricuspid Hancock II valves. Thirty-one percent of patients had previous valve operations, 15% had concomitant cardiac procedures, and 87% were in New York Heart Association class III or IV. Follow-up included 1704 patient-years and was 98% complete, with a median of 9 patient-years (range, 0.013-17.4 years). Forty-six patients were at risk at 14 to 15 years, and 30 were at risk after 15 years. RESULTS: One hundred twenty-two (57%) of 212 patients died, 20 of them perioperatively. Fifteen-year actuarial Kaplan-Meier survival was 35.2% +/- 3.8%, and freedom from valve-related mortality was 84% +/- 3.5%, with no difference on the basis of position or age (<65 or >or=65 years). Percentages for freedom from thromboembolism, anticoagulant-related hemorrhage, endocarditis, and paravalvular leak were, respectively, 78.2% +/- 4%, 83.5% +/- 3.6%, 95.7% +/- 2%, and 97.3% +/- 1.4%, with no significant difference between the aortic and mitral positions. Freedom from structural valve deterioration was 71.8% +/- 5.6%: 88.9% +/- 6.2% in the aortic position versus 59.5% +/- 3.9% in the mitral position (P =.01) and 64.3% +/- 3% in the mitral-aortic position. In patients younger than 65 years, actual freedom from structural valve deterioration was less than that seen in older patients (84.5% +/- 3.5% vs 95% +/- 3.0%) and was better in the aortic versus the mitral position (92% +/- 4.5% vs 82% +/- 4.2%). CONCLUSION: The Hancock II porcine valve showed excellent 15-year durability. We recommend its use in patients 65 years of age, as well as in younger patients undergoing aortic replacement.
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Bioprótesis , Equipo Médico Durable , Prótesis Valvulares Cardíacas , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/patología , Válvula Mitral/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/terapia , Diseño de Prótesis , Reoperación , Análisis de Supervivencia , Tiempo , Factores de Tiempo , Resultado del Tratamiento , Válvula Tricúspide/patología , Válvula Tricúspide/cirugíaRESUMEN
BACKGROUND AND OBJECTIVES: The Hancock II bioprosthesis is a second-generation porcine valve xenograft treated with the detergent sodium dodecyl sulphate (T6) to retard calcification. The aim of this investigation was to study the gross and microscopic features in Hancock II explants to assess the structural changes occurring with time. METHODS: Among 1382 Hancock II bioprostheses (701 isolated aortic, 421 isolated mitral, 130 double) implanted from 1983 to 1997 in 1252 patients, 22 (16 mitral, 6 aortic) were removed at reoperation until 1999 and were available for pathological investigation: infective endocarditis occurred in 5 and structural deterioration in 8, whereas in the remaining 9 xenografts reoperation was performed for nonstructural valve deterioration (paravalvular leak in 4 and prophylactic replacement in 5). Morphological investigation consisted of gross examination and x-ray, histologic, immunohistochemistry, electron microscopic, and atomic absorption spectroscopic examination. RESULTS: The cause of structural valve deterioration was dystrophic calcification in 4 cases (1 aortic, 3 mitral; range of time graft was in place, 101 to 144 months), non-calcium-related tears in 3 cases (all mitral, range 121 to 163 months), and commissural dehiscence in 1 (aortic, range 156 months). Five of the nonstructural valve deterioration explants (range 42 to 122 months) showed only pinpoint mineralization at the commissures. Mean calcium content in nonstructural deterioration explants was 14.70 +/- 22.33 versus 99.11 +/- 81.52 mg/g in explants with structural valve deterioration. Electron microscopic examination showed early nuclei of mineralization mostly consisting of calcospherulae upon cell debris. Local or diffuse lipid insudation was observed in all but 2 explants and consisted of cholesterol clefts, lipid droplets, and lipid-laden macrophages featuring foam cells. The lipid insudation was the most plausible cause of tearing in 2 explants. CONCLUSIONS: These pathologic findings support the clinical results of a delayed occurrence of structural failure of Hancock II bioprostheses and a mitigation of mineralization by the anti-calcification treatment. However, other factors such as lipid insudation may come into play in the long term.
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Bioprótesis , Prótesis Valvulares Cardíacas , Anciano , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Calcinosis/patología , Calcinosis/cirugía , Equipo Médico Durable , Femenino , Enfermedades de las Válvulas Cardíacas/patología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Válvula Mitral/patología , Válvula Mitral/cirugía , Diseño de Prótesis/instrumentación , Falla de Prótesis , Análisis Espectral , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Leaflet escape is a mode of structural valve failure for mechanical prostheses. This complication previously has been reported for both monoleaflet and bileaflet valve models. We report 2 leaflet escape occurrences observed in 2 patients who underwent valve replacement with a TRI Technologies valve prosthesis. METHODS AND RESULTS: At the University of Padua, between November 2000 and February 2002, 36 TRI Technologies valve prostheses (26 aortic and 10 mitral) were implanted in 34 patients (12 women and 22 men) with a mean age of 59.9+/-10.3 years (range, 30 to 75 years). There were 5 deaths: 3 in hospital, 1 early after discharge, and 1 late. Two patients experienced a catastrophic prosthetic leaflet escape; the first patient was a 52-year-old man who died 10 days after aortic valve and ascending aorta replacement, and the second was a 58-year-old man who underwent a successful emergency reoperation 20 months after mitral valve replacement. Examination of the explanted prostheses showed in both cases a leaflet escape caused by a leaflet's pivoting system fracture. Prophylactic replacement was then successfully accomplished so far in 12 patients, without evidence of structural valve failure in any of them. Among other significant postoperative complications, we observed 3 major thromboembolisms, 1 hemorrhage, and 1 paravalvular leak. CONCLUSIONS: These catastrophes prompted us to interrupt the implantation program, and they cast a shadow on the durability of the TRI Technologies valve prosthesis because of its high risk of structural failure.
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Prótesis Valvulares Cardíacas/efectos adversos , Adulto , Anciano , Válvula Aórtica/cirugía , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Reoperación , Análisis de Supervivencia , Tromboembolia/etiologíaAsunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Cardiomiopatía Dilatada/cirugía , Vasos Coronarios/patología , Trasplante de Corazón , Isquemia Miocárdica/cirugía , Derivación Arteriovenosa Quirúrgica/instrumentación , Cardiomiopatía Dilatada/etiología , Vasos Coronarios/ultraestructura , Ventrículos Cardíacos/patología , Humanos , Isquemia Miocárdica/complicacionesRESUMEN
BACKGROUND: The incidence of atrial fibrillation is similar in the clinical history of patients with atrial septal defect, either surgically corrected and uncorrected. We present an unpublished technique for treating atrial fibrillation by left endocardial radiofrequency ablation through the lone right atrium incision, coupled to atrial septal defect septum primum and secundum closure, thus reducing the surgical trauma related to paraseptal left atrium incision. PATIENTS AND METHODS: We treated 2 patients through a lone right atrium incision by radiofrequency ablation because of congenital atrial septal defect and chronic atrial fibrillation. RESULTS: The patients after defect closure were weaned off cardiopulmonary bypass in sinus rhythm. The postoperative hospital stay was uneventful and at more than 1 year of follow-up they are still in sinus rhythm. CONCLUSIONS: The radiofrequency ablation procedure is possible through the lone right atrium incision, avoiding any further incision and new source of possible bleeding when in presence of interatrial septal defects, and the technique is simple and useful.
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Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Defectos del Tabique Interatrial/cirugía , Anciano , Fibrilación Atrial/complicaciones , Enfermedad Crónica , Femenino , Defectos del Tabique Interatrial/complicaciones , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Heart valve bioprostheses for cardiac valve replacement are fabricated by xeno- or allograft tissues. Decellularization techniques and tissue engineering technologies applied to these tissues might contribute to the reduction in risk of calcification and immune response. Surprisingly, there are few data on the cell phenotypes obtained after cellularizing these naturally-derived biomaterials in comparison to those expressed in the intact valve. METHODS: Aortic valve interstitial cells (VIC) were used to repopulate the corresponding valve leaflets after a novel decellularization procedure based on the use of ionic and nonionic detergents. VIC from leaflet microexplants at the third passage were utilized to repopulate the decellularized leaflets. Intact, decellularized and repopulated valve leaflets and cultured VIC were examined by immunocytochemical procedures with a panel of antibodies to smooth muscle and nonmuscle differentiation antigens. Intact and cellularized leaflets were also investigated with Western blotting and transmission electron microscopy, respectively. RESULTS: Myofibroblasts and smooth muscle cells (SMC) were mostly localized to the ventricularis of the leaflet whereas fibroblasts were dispersed unevenly. Cultured VIC were comprised of myofibroblasts and fibroblasts with no evidence of endothelial cells and SMC. Two weeks after VIC seeding into decellularized leaflets, grafted cells were found penetrating the bioscaffold. The immunophenotypic and ultrastructural properties of the grafted cells indicated that a VIC heterogeneous mesenchymal cell population was present: fibroblasts, myofibroblasts, SMC, and endothelial cells. CONCLUSIONS: VIC seeding on detergent-treated valve bioscaffolds has the cellular potential to reconstruct a viable aortic valve.
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Válvula Aórtica/citología , Bioprótesis , Técnicas Citológicas , Animales , Western Blotting , Fibroblastos/citología , Inmunohistoquímica , Microscopía Electrónica , Músculo Liso/citología , Porcinos , Ingeniería de Tejidos , Trasplante Heterólogo , Trasplante HomólogoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Cardiomiopatía Dilatada/inducido químicamente , Cardiomiopatía Dilatada/cirugía , Enfermedad de Castleman/tratamiento farmacológico , Insuficiencia Cardíaca/inducido químicamente , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Corazón Auxiliar/normas , Choque Cardiogénico/inducido químicamente , Choque Cardiogénico/cirugía , Adulto , Biopsia , Cardiomiopatía Dilatada/diagnóstico , Ciclofosfamida/efectos adversos , Insuficiencia Cardíaca/diagnóstico , Corazón Auxiliar/efectos adversos , Humanos , Masculino , Mitoxantrona/efectos adversos , Choque Cardiogénico/diagnóstico , Resultado del Tratamiento , Vincristina/efectos adversosRESUMEN
A 41-year-old woman with recent onset of heart failure and angina due to aortic valve incompetence and critical left coronary ostium stenosis in the setting of Takayasu's arteritis is reported. The patient was successfully surgically treated by aortic valve replacement and coronary artery bypass with saphenous vein graft, showing a cardiac event-free 17 months follow-up. Takayasu's arteritis must be included among the possible causes of coronary artery disease and aortic valve incompetence in young female patients. Although chronic inflammation of the aortic wall may result in late graft occlusion, surgical therapy is effective for short and mid-term clinical improvement.
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Estenosis de la Válvula Aórtica/etiología , Enfermedad Coronaria/etiología , Arteritis de Takayasu/complicaciones , Adulto , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/cirugía , Angiografía Coronaria , Enfermedad Coronaria/patología , Enfermedad Coronaria/cirugía , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas , Humanos , Arteritis de Takayasu/patología , Arteritis de Takayasu/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Prosthetic cardiac valves have increased life expectancy of patients (pts) with valvular heart disease. Bioprosthetic complications required devices replacements within 10 years of implantation; structural valve deterioration (SVD) has emerged as the major cause of reoperation. We reviewed survival and prosthetic complications of Biocor porcine bioprostheses implanted in mitral, aortic and mitro-aortic position. METHODS: Between January 1991 and January 2001 446 pts (192 males; 254 females; mean age 73.4+/-6.7 year, range 40-91) received 258 aortic, 138 mitral and 50 mitro-aortic Biocor porcine valves; of these 83 pts have previous different types of prosthetic devices (15 aortic, 53 mitral and 15 double). Concomitant cardiac procedures, namely myocardial revascularization, were performed in 91/446 pts (20.5%). All explanted bioprostheses (BPS) were available for pathologic investigation. Follow-up included 1319 pt.-years and was 98% complete with a median time of 36 pt.-months. RESULTS: Perioperative mortality was 6.8% (30/446 pts; 12 aortic, 17 mitral and 1 double) and was mostly related to reoperations. At the end of follow-up 18.5% of pts died (77/416), 12 deaths were valve-related with freedom from valve related mortality of 94% at 9 years. Survival was 54% at 9 years. It was 63%, 41% and 62% for aortic, mitral and double valve replacement, respectively. At follow-up 87% of pts. were in NYHA I-II class and 13% were in III-IV class; 55% were in sinus rhythm, 36% in atrial fibrillation and 9% had a pace-maker. Eighty-five percent of pts were anticoagulated. There were 6 thromboembolic and 5 anticoagulant-related haemorrhagic episodes with no significant difference between aortic and mitral position (p=0.7). The event freedom was respectively 92% and 98.5% at 9 years. Prosthetic valve endocarditis (PVE) and non-SVD freedom were 96% and 93% at 9 years. SVD due to tissue degeneration, calcification and cusp's tears affected 2 pts with 94% freedom at 9 years. Overall freedom from all valve-related complications was 80% at 9 years and freedom from reoperation was 92% at 9 years. CONCLUSIONS: (1) Our intermediate-term follow-up of the Biocor porcine valve (BPS) showed excellent durability in all positions. (2) The aortic patients and especially the oldest group had better results than the mitral patients (41% vs. 63% 9 years survival, p=0.0004). (3) Higher mitral risk was related to higher prevalence of reoperations. (4) The incidence of anticoagulation-related complications is low in both aortic and mitral position without significant difference (p=0.7). 4) A longer follow-up is required to get more information about SVD timing.
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Bioprótesis/efectos adversos , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/efectos adversos , Adulto , Anciano , Válvula Aórtica/cirugía , Femenino , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
A 77-year-old woman was found accidentally to be in atrial fibrillation. Two-dimensional echocardiography revealed the presence of a mass attached to the anterior papillary muscle of the mitral valve. She was mildly symptomatic for dyspnea and asthenia. The patient was successfully operated on to excise the left ventricular mass and preserve the mitral valve apparatus. Morphological examination of the excised tissue led to a diagnosis of papillary fibroelastoma. Surgical treatment must be considered when such a tumor is diagnosed, even though asymptomatic, and especially if left-sided because of the high risk of systemic embolization.