RESUMO
OBJECTIVE: To study the diagnostic contribution of repeated transthoracic (TTE) and transoesophageal echocardiography (TOE) among patients with suspected infective endocarditis. METHODS: 262 patients with 266 episodes of suspected infective endocarditis were referred for TTE and TOE over three years in a 423 bed university cardiology hospital. Patients were a mean (SD) of 47.6 (17.9) years old. 139 (52.3%) episodes occurred in men and 127 (47.7%) in women. The diagnostic information obtained from repeated TTE and TOE examinations was evaluated relative to the diagnosis of endocarditis. RESULTS: TTE examinations were repeated in 192 (72.2%) and TOE examinations were repeated in 49 (18.4%) of 266 episodes. A mean of 2.4 TTE and 1.2 TOE examinations were performed for each episode of suspected endocarditis. The second and third TTEs added diagnostic information in 34 (26.7%) and the second and third TOEs added diagnostic information in 25 (19.7%) of 127 episodes with definite endocarditis. After the third TTE or TOE no additional diagnostic information was obtained. CONCLUSIONS: The diagnostic contribution of repeated TTE or TOE for the diagnosis of endocarditis decreased as the number of repetitions increased. In this setting, the data do not substantiate more than three TTE or TOE examinations as an efficient strategy to increase the diagnostic yield for all but selected patients with suspected endocarditis.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Adulto , Estudos de Coortes , Ecocardiografia/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: The sensitivity and specificity of non-invasive methods--specifically single-photon emission computed tomography (SPECT) dipyridamole-thallium myocardial perfusion--for detecting coronary artery disease (CAD) in patients with severe aortic stenosis remains unclear. Occasionally, these patients present with atypical angina. Therefore, a CAD diagnosis must be excluded to prevent unnecessary cardiac catheterization. METHODS: To determine the diagnostic value of SPECT dipyridamole-thallium imaging in this population, we compared the effectiveness of the imaging procedure with that of coronary angiography by prospectively analyzing patients who underwent both procedures. Group 1 included 59 patients who were asymptomatic or had atypical angina; group 2; 51 preoperative aged-matched patients with typical angina. SPECT acquisition was performed 15 min after 0.142 mg/kg/min of dipyridamole infusion completion, and redistribution images were performed 4 h after thallium injection. Two cut-off values of luminal diameter narrowing, >50 and >70%, defined significant CAD. RESULTS: Coronary angiography with significant CAD (>50%) was present in 15 (25%) group 1 patients and in 16 (32%) group 2 patients (P=NS). The sensitivity was greater in group 2 than in group 1 (56 versus 26%; P=0.001). The specificity, positive and negative predictive value, and accuracy in the groups were similar. CAD of >70% luminal stenosis was present in 11 (19%) group 1 patients and in 12 (23%) group 2 patients (P=NS). The positive predictive value was greater in group 2 than in group 1 (75 versus 43%; P=0.001) but similar sensitivity, specificity, negative predictive value, and accuracy. The likelihood ratio for abnormal test increased in patients with CAD of >70%. CONCLUSIONS: symptoms of typical angina had significant impact on test sensitivity, positive predictive value and likelihood ratio for abnormal test. Furthermore, SPECT dipyridamole-thallium imaging was a useful non-invasive method to exclude the diagnosis of significant CAD (high specificity) in asymptomatic and symptomatic patients with isolated severe aortic stenosis.
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico , Dipiridamol , Inibidores de Fosfodiesterase , Cintilografia , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Estudos de Coortes , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Tálio , UltrassonografiaRESUMO
OBJECTIVE: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous 1/4-inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS: The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION: Mini-sternotomy proved to be better than the conventional sternotomy because it provided more comfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages.
Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esterno/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30+/-1 years (control group) and 14 asymptomatic patients with severe aortic regurgitation aged 29+/-2 years and left ventricular ejection fraction of 0.61+/-0.02 (radioisotope ventriculography) were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS: No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78+/-3 versus 48+/-1mmHg, P<0.01). Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0+/-0.8 versus 8.1+/-0.7 10(-10) N-1 m4, P=0.01 e and 39.3+/-2.6 versus 31.1+/-2.0 10(-6) N-1 m2, P=0.02, respectively). CONCLUSION: Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling.
Assuntos
Insuficiência da Valva Aórtica/fisiopatologia , Artérias/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Artérias/diagnóstico por imagem , Estudos de Casos e Controles , Doença Crônica , Elasticidade , Feminino , Humanos , Masculino , UltrassonografiaRESUMO
BACKGROUND: Late prognosis after infective endocarditis has not been systematically studied in large series of patients with different underlying heart conditions in recent years. METHODS: We studied an inception cohort study of 420 patients discharged after treatment of endocarditis from a university tertiary care hospital. The patients were aged 34.2+/-17.2 years (mean +/- SD), ranging from 2 months to 83 years; 270 (64.3%) were men and 150 (35.7%) were women. Mean follow-up was 6.1+/-4.3 years for survivors and 3.7+/-3.7 years for the patients who died during the follow-up. We studied the frequency and risk factors for relapses and recurrences of endocarditis, cardiac valve replacements, and deaths during the follow-up. Statistical analysis was performed through comparison of groups, of event-free survival, and risk ratios. RESULTS: Relapses were observed in 14 (3.3%) patients. There was one recurrence of endocarditis in 48 (11.4%) patients, two (0.5%) in 2 patients, three in 1 patient (0.2%), and five (0.2%) in 1 patient. Valve replacement was performed in 83 (19.7%) patients. Ninety-eight (12.3%) patients died. Risk factors for recurrent endocarditis were increasing age (risk ratio 1.02) and male sex (risk ratio 1.61). Risk factors for valve replacement were recurrent endocarditis (risk ratio 1.62) and prosthetic valve endocarditis (risk ratio 1.61). Risk factors for death were increasing age (risk ratio 1.03) and recurrent endocarditis (risk ratio 2.06). CONCLUSIONS: The long-term event-free survival for patients who survived their first episode of endocarditis was low. Recurrent endocarditis, prosthetic valve endocarditis, and increasing age contributed to the high rate of events during the follow-up.
Assuntos
Endocardite/mortalidade , Endocardite/cirurgia , Próteses Valvulares Cardíacas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Endocardite/microbiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de TempoRESUMO
Hypercholesterolemia has been related to aortic valve stenosis (AS). Polymorphisms of apolipoproteins (apo) AI, B, and E are associated with variable levels of plasma lipids, but the association between these polymorphisms and AS is unknown. In a case-control study of groups matched by age, sex, comparable body mass index, hypertension, triglycerides, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol, we analyzed the distribution of apo AI A/G mutation, apo B signal peptide insertion/deletion, apo B XbaI restriction fragment length. and apo E polymorphisms in 62 non-diabetic patients with severe aortic valve stenosis and 62 control subjects. All patients underwent echocardiographic analysis. Univariate analysis showed a higher prevalence of the XbaI X + /X + genotype (p = 0.007) of apo B and the apo E2 allele (p = 0.034) in patients with severe AS. Apo polymorphisms were not associated with lipid levels, left ventricular mass, or the aortic gradient.
Assuntos
Estenose da Valva Aórtica/genética , Apolipoproteína A-I/genética , Apolipoproteínas B/genética , Apolipoproteínas E/genética , Polimorfismo Genético/genética , Estenose da Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , UltrassonografiaRESUMO
BACKGROUND: There is controversy regarding the role of reparative techniques for rheumatic-mitral valve disease. We have analyzed the late results of mitral valve repair in a group of patients with rheumatic mitral valve insufficiency. METHODS: From March 1980 to December 1997, 201 patients with rheumatic fever underwent mitral valve repair at the Heart Institute, Hospital das Clínicas, Medical School, University of São Paulo. The mean age of patients was 26.9 +/- 15.4 years, with 59.7% of the patients being female. Other diagnoses were present in 67.7% of patients; the most common was tricuspid regurgitation (31.3%). Mitral valve repair techniques included: 1) Carpentier ring annuloplasty in 75 patients (37.3%); 2) posterior annuloplasty with bovine patch in 68 patients (33.8%); 3) posterior segmental annuloplasty in 16 patients (7.9%); 4) quadrangular resection of the posterior leaflet with ring plication in 11 patients (5.5%); 5) partial resection of the anterior leaflet in 6 patients (3%); 6) De Vega's annuloplasty in 6 patients (3%); 7) Kay's annuloplasty in 5 patients (2.5%); 8) Reed's annuloplasty in 4 patients (2%); and 9) miscellaneous techniques in 10 patients (4.9%). Combined techniques were used in 94 patients (46.8%), the most frequent of which was chordal shortening (48 patients, 23.9%). Other non-mitral cardiac procedures were performed in 113 patients (56.2%). Actuarial survival and event-free curves (Kaplan-Meier method) were compared by linear regression analysis. RESULTS: The in-hospital mortality rate was 2.0% (four patients). The causes of death were multiorgan failure in two patients and low cardiac output in the other two patients. In the late postoperative period, 83.9% of the patients were in New York Heart Association (NYHA) functional class 1. The actuarial survival was 93.9% +/- 1.9% at a mean of 125 months. Twenty-three patients were reoperated in the postoperative period at a mean interval of 35.7 months. Survival free from reoperation was 43.3% +/- 13.7% at 125 months. When analyzing the patients according to age, actuarial survival was 91.3% +/- 3.8% in the group of patients younger than 16 years (Group 1), compared with 95.6% +/- 2.7% in the group older than 16 years (Group 2), with a statistically significant difference of p < 0.0001. Survival free from reoperation was 50.8% +/- 16.9% in Group 1 and 47.0% +/- 14.9% in Group 2 (p < 0.0001). CONCLUSIONS: Late results obtained with mitral valve repair for rheumatic mitral valve insufficiency were satisfactory and exceeded those reported for mitral valve replacement in the same population.
Assuntos
Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Adolescente , Adulto , Idoso , Brasil , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Ecocardiografia Doppler , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/mortalidade , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: To realize if cardiac surgery could interfere with the evolution of HIV infected patients to the acquired immunodeficiency syndrome (AIDS). METHODS: The study group consisted of 30 HIV positive patients (0.21%) among 14,785 who underwent cardiac surgery at the Heart Institute of University of Sao Paulo Medical School (Incor-FMUSP) from November 1988 to December 1994. Patients were followed up until they were discharged from hospital and a new contact was kept at the end of the first semester of 1995. RESULTS: All patients were asymptomatic at the time they were operated. Two patients progressed to death during hospitalization due to non-infectious complications and other three patients could not be traced. After all 25 patients had their progression evaluated. Six patients (24%) died within a period ranging from 1 to 46 months (average=17 months): 2 due to bacterial pneumonia and 04 due to AIDS-related complications. The average follow-up period for the 19 surviving patients was 33.6 months (ranging from 13 to 74 months), and only one of them (5.3%) saw the infection progress to AIDS. In summary, 5/25 (20%) saw HIV infection progress to AIDS within a maximum period of 74 months. CONCLUSIONS: Data available up to now show no conclusive evidence of acceleration of HIV into AIDS associated with cardiac surgery.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Síndrome da Imunodeficiência Adquirida/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Causas de Morte , Infecções por HIV/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Taxa de SobrevidaAssuntos
Bioprótese , Adolescente , Adulto , Bioprótese/efeitos adversos , Feminino , Humanos , Gravidez , Falha de PróteseRESUMO
BACKGROUND: Because cardiac decompensation is subtle, the best time to perform aortic valve replacement surgery may be difficult to determine. We investigated the relation of symptoms to left ventricular (LV) function and the timing of valve replacement in patients with aortic regurgitation (AR) of largely rheumatic origin. METHODS: Sixty-eight initially asymptomatic patients (mean age 29 years) with severe chronic AR were monitored for 36 months. Assessments included baseline and yearly echocardiograms and radioisotope ventriculography (resting and exercise) and clinical examinations every 6 months. RESULTS: Forty-seven patients (69%) remained asymptomatic and 21 (31%) had symptoms develop after 24 to 36 months. Compared with symptomatic patients, asymptomatic patients had significantly (P <.05) lower baseline LV end-diastolic diameter, end-systolic diameter, end-systolic stress, and volume/mass ratio but greater shortening fraction and ejection fraction (EF) at rest. These variables remained stable without statistically significant change until surgical correction in symptomatic patients. Percent variation of EF from rest to exercise increased in patients who remained asymptomatic (EF 2.8% +/- 10.6%) but decreased in those who became symptomatic (EF -4.2% +/- 13%; P <.05). Twenty symptomatic patients (New York Heart Association class III/IV, angina and/or syncope) had valve replacement surgery, after which all were in New York Heart Association class I/II and had significant decreases of LV end-diastolic and end-systolic diameters and an increase on percent variation of EF from rest to exercise (P <.0001). CONCLUSIONS: Development of symptoms did not correlate with change in any ventricular function indexes. Surgery on appearance of symptoms restored LV function to near normal.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Função Ventricular Esquerda , Adulto , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Bioprótese , Ecocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Seleção de Pacientes , Doenças Reumáticas/complicaçõesRESUMO
OBJECTIVE: To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS: Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1 +/- 11.8) years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients--12.7%). In 20 (16.9%) patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients). RESULTS: Immediate mortality was 0.9% (one patient). Long-term rates for thromboembolism, endocarditis, reoperation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8 +/- 8.6% over 12 years; survival free from re-operation was 91.8 +/- 4.3%, free from endocarditis was 99.2 +/- 0.8% and free from thromboembolism was 99.2 +/- 0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA), with a complete follow-up in 89.7% of the patients. CONCLUSION: Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.
Assuntos
Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Análise Atuarial , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Resultado do TratamentoRESUMO
OBJECTIVE - To analyze the immediate and late results of mitral valve repair with quadrangular resection of the posterior leaflet without the use of a prosthetic ring annuloplasty. METHODS - Using this technique, 118 patients with mitral valve prolapse who underwent mitral repair from January '84 through December '96 were studied. Age ranged from 30 to 86 (mean = 59.1+/-11.8) years and 62.7% were males. An associated surgery was performed in 22% of the patients, and coronary artery bypass graft was the most frequently performed surgery (15 patients - 12.7%). In 20 (16.9%) patients other associated techniques of mitral valve repair were used and shortening of elongated chordae tendineae was the most frequent one (6 patients). RESULTS - Immediate mortality was 0.9% (one patient). Long-term rates for thromboembolism, endocarditis, re-operation and death in the late postoperative period were 0.4%, 0.4%, 1.7% and 2.2% patients/year, respectively. The actuarial curve of survival was 83.8+/-8.6% over 12 years; survival free from re-operation was 91.8+/-4.3%, free from endocarditis was 99.2+/-0.8% and free from thromboembolism was 99.2+/-0.8%. In the late postoperative period, 93.8% of the patients were in functional class 1 (NYHA), with a complete follow-up in 89.7% of the patients. CONCLUSION - Patients with mitral valve prolapse who undergo mitral valve repair using this technique have a satisfactory prognosis over 12 years.
RESUMO
PURPOSE: To analyze the results of the valve cardiac surgery in pregnant women and cardiopulmonary bypass consequences to the patients and their fetuses. METHODS: Study of 8 pregnant women who underwent cardiac surgery between January of 1986 and December of 1996. Patients' average age was 31.4 +/- 8.9 years and the gestation age ranged from 12 to 31 (average of 26.6 +/- 7.1) weeks. Fetus monitorization was performed in all patients. The temperature was always higher than 34 degrees C, as well as high flow rates during the cardiopulmonary bypass. Four surgeries of aortic valve and four of mitral valve were performed, in which two were reoperations. RESULTS: There was no mortality. There were two premature births and in one child there was neurological damage. The other children did not have growth problems. CONCLUSION: Valve cardiac surgery in pregnant women may have good results as long as care in the cardiopulmonary bypass and fetus monitorization are undertaken.
Assuntos
Circulação Extracorpórea , Doenças das Valvas Cardíacas/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Cardiotocografia , Feminino , Monitorização Fetal , Frequência Cardíaca Fetal , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de TempoRESUMO
PURPOSE: To compare immediate and late (12 months) follow-up of clinical and Doppler echocardiographic results between percutaneous mitral balloon valvuloplasty and open commissurotomy in a prospective and randomized trial. METHODS: Eighty eight symptomatic patients with severe mitral stenosis and favorable anatomy were randomized in a prospective trial comparing the two procedures. All patients were submitted to clinical and Doppler echocardiographic evaluation before the procedures and immediate and twelve months thereafter. RESULTS: Mean mitral gradient (mmHg) decreased from 12.2 +/- 5.8 to 5.80 +/- 2.7 (p < 0.001) in commissurotomy group (CG) and from 11.7 +/- 6.1 to 5.0 +/- 2.4 (p < 0.001) in the balloon valvuloplasty group (VG). Mitral valve are (cm2) increased from 0.98 +/- 0.21 to 2.52 +/- 0.46 in CG and from 1.05 +/- 0.25 to 2.18 +/- 0.40 in VG (p < 0.001). In both groups there was a slight decrease in mitral valve area at 12 month follow-up. There was no death in either group. One patient in the VG had moderate mitral regurgitation and underwent surgery. At the 12 month follow-up, all patients in CG and 97.7% of patients in VG were in New York Heart Association functional class I or II. CONCLUSION: Both procedures were safe and showed similar immediate improvement in mitral gradient and functional class. Mitral valve area had a greater increase immediately after commissurotomy, however, there was a significantly greater reduction in the CG after 12 months of follow-up, when compared to balloon valvuloplasty. In both groups, mitral gradient remained reduced and most patients did not change functional class during the follow-up.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cateterismo , Estenose da Valva Mitral/terapia , Adolescente , Adulto , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/cirurgiaRESUMO
BACKGROUND: From March 1982 to December 1995, 2,607 Fisics-Incor bovine pericardial bioprostheses were implanted in 2,259 patients. Mean age was 47.2 +/- 17.5 years, and 55% were male. Rheumatic fever was present in 1,301 (45.7%) patients. METHODS: One thousand and seventy-three aortic valve replacements, 1,085 mitral replacements, 27 tricuspid replacements, 195 mitral-aortic replacements, and 16 other combined valve replacements were carried out. Combined procedures were performed in 788 (32.9%) patients, the most frequent being tricuspid valve repair (9.2%) and coronary artery bypass grafting (7.7%). RESULTS: Hospital mortality was 8.6% (194 patients), 8.6% for the mitral group, 4.7% for the aortic group, and 12.8% for double-valve replacements. The linear rates for calcification, thromboembolism, rupture, leak and endocarditis were, respectively, 1.1%, 0.2%, 0.9%, 0.1% and 0.5% patient-year. The actuarial survival curve was 56.7 +/- 5.4% in 15 years. Survival free from endocarditis was 91.92%, survival free from thromboembolism was 95 +/- 1.7%, survival free from rupture was 43.7 +/- 9.8%, survival free from leak was 98.9 +/- 4.5%, and survival free from calcification was 48.8 +/- 7.9% in 15 years. In the late postoperative period, 1,614 (80.6%) patients were in New York Heart Association functional Class I. CONCLUSIONS: We conclude that the results with the Fisics-Incor bovine pericardial prostheses were satisfactory in our group of patients.