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BACKGROUND: This report reviews the initial clinical experience with the AB-180 ventricular assist device. METHODS: Between Dec 1997 and July 2000, the AB-180 was implanted in 17 patients at five institutions. The mean age was 52 years (range 21 to 68 years) and 14 of 17 were male. The indications for implantation were postcardiotomy shock (12 of 17, 70%), decompensated cardiomyopathy (2 of 17, 12%), viral myocarditis (2 of 17, 12%), and acute myocardial infarction (1 of 17, 6%). RESULTS: The mean duration of support was 8.5 days (range 1 to 28 days). In the group of 17 patients, 8 were weaned from the device and 2 underwent transplantation. Four of the weaned patients (4 of 8, 50%) and 1 of the transplant patients (1 of 2, 50%) survived. The overall weaning and survival rates were 58% (10 of 17) and 29% (5 of 17). There were no major device-related complications and no major device malfunctions. CONCLUSIONS: The AB-180 provides reliable circulatory support for reversible forms of heart failure.
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Cardiopatías/cirugía , Corazón Auxiliar , Adulto , Anciano , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
This prospective study evaluated the clinical performance of a novel stentless quadrileaflet bovine pericardial mitral valve implanted at one center since December 1996. After giving informed consent, patients were included in the study if they required isolated mitral valve replacement. All underwent comprehensive clinical evaluation, as well as transthoracic M-mode, two-dimensional and Doppler (pulsed, continuous, and color) echocardiography preoperatively and postoperatively at 1 month, 3 months, and annually thereafter. Mitral valve area was derived by planimetry, the pressure half-time method, and the continuity equation. The degree of mitral regurgitation was semi-quantitated using color Doppler. In all 38 patients with rheumatic valvular heart disease (mean age 35+/-13 years) were monitored for 13.8+/-7.5 months (range, 1 to 29 months). All but three patients are alive and symptomatically improved (functional New York Heart Association class I or II). One valve was explanted because of early prosthetic valve endocarditis. There were no episodes of thromboembolism or anticoagulation-related hemorrhage. Left ventricular function was maintained with increased cardiac output and low transmitral pressure gradients. The mitral valve area was larger when measured by pressure half-time and planimetry than by the continuity equation (P<.05). In an independent clinical evaluation of a subset of 30 patients, mitral stenosis was considered absent in 33%, mild in 30%, mild to moderate in 26%, and moderate in 10% of cases. No or less than or equal to mild mitral regurgitation was noted in the majority of patients postoperatively, both clinically and echocardiographically. We are encouraged by the clinical performance of the quadrileaflet mitral valve and with patient outcome. Long-term follow-up data are needed to assess durability.
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Bioprótesis , Prótesis Valvulares Cardíacas , Válvula Mitral , Cardiopatía Reumática/cirugía , Adulto , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Estudios Prospectivos , Diseño de Prótesis , Cardiopatía Reumática/diagnóstico por imagen , UltrasonografíaRESUMEN
A previous study from this unit showed that only 19% of children with mitral bioprostheses were free from complications after 7 years and prompted us to review the performance of new-generation mechanical prostheses implanted in the same population group. In a 5-year period (1980-1985), 352 patients 20 years old and younger (mean age 15.3 +/- 4 years) with rheumatic valvular disease had 177 mitral, 62 aortic and 113 double (mitral + aortic) valve replacements with Medtronic-Hall or St. Jude prostheses. The overall early mortality was 6.3%. All survivors, followed up for a total of 1171 patient-years, received oral anticoagulation. The late mortality for mitral, aortic and double valve replacement was 4.1% per patient-year, 4.3% per patient-year and 8.0% per patient-year, respectively (P less than 0.05), and was valve-related in 46% of the cases. Twenty-nine patients, all but 2 in the mitral and double valve replacement groups, were reoperated upon (2.5% per patient-year), mainly for infective endocarditis (34%), for prosthetic thrombosis (33%) and for bland periprosthetic leak (31%). The incidence of thrombotic obstruction was 1.1% per patient-year: mitral valve replacement, 1.0% per patient-year; aortic valve replacement 0.5% per patient-year; and double valve replacement, 1.7% per patient-year; P less than 0.05) and was fatal in 33% of the cases. Major systemic thromboembolism occurred at the rate of 1.4% per patient-year, similar in the three groups. The incidence of prosthetic endocarditis was 0.9% per patient-year.(ABSTRACT TRUNCATED AT 250 WORDS)