Volume 3 - Número 3
ORIGINAL ARTICLE
Comparative study of biological and mechanical prosthesis in mitral and aortic valve replacement
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
We studied 1222 patients, who underwent isolated valve replacement; 652 had single mitral (MVR) and 570 single aortic (AVR) replacement. The patients were classified by sex, age and etiology. In the MVR group, the patients received 126 mechanical prostheses, as follow: 49 Björk-Shiley (B-S); 71 Lillehei-Kaster (L-K); 6 Hall-Kaster (H-K) and 526 IMC cardiac prosteses from bovine pericardium (PBIMC). The postoperative follow-up was 95% to 100%. The hospital mortality was 21 % for L-K and 9,5% for PBIMC. The incidence of thrombosis and thromboembolism in events per 100 patients-year was 7.7; 5.6; 6.7 and 1.0 for B-S; L-K; H-K and PBIMC, respectively. The incidence of calcification and tears was 1.8 per 100 patients-years for PBIMC, and did not occur with mechanical prostheses. Only the patients with mechanical prosteses were anticoagulated. In the AVR group, the patients received 336 mechanical prostheses: 92 B-S; 112 L-K; 113 H-K and 234 PBIMC. The postoperative follow-up was 97% to 100%. The hospital mortality was 5.5% for mechanical group, and 2.6% for biological. The incidence of thrombosis and thromboembolism in events per 100 patients-year was 3.0 for B-S; 2.3 for L-K; 2.5 for H-K and 0.3 for PBIMC. Calcification, tear and mechanical failure was 0.54 per 100 patients-year for PBIMC and 0.38 per 100 patients-year for H-K. In the mechanical group, the patients received aspirin and dipiridamole, and 30% of them oral anticoagulants. The authors concluded that the survival, in general manner, isn't related with the type of prosthesis. The incidence of thrombosis and thromboembolism in higher with mechanical valves, and the rate of complications is lower with biological valves. Oral anticoagulation is forceable with mechanical prosthesis in MVR, but unessential in AVR. The bioprosthetic valves don't need anticoagulation. For these reasons, the authors employ by routine, mechanical prostheses for AVR, unless there were counterindications, and biologycal prostheses for MVR.
Keywords: heart valves, biologic; heart valves, mechanical; heart valves prostheses, surgery; heart valves, surgery
Multicentric study of the results with implanted bioprosthesis Biocor in the state of Minas Gerais
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
From March 1981 to March 1988, 2324 bioprostheses were implanted in 2016 patients in 5 centers in the State of Minas Gerais. This study includes only the analysis of patients undergoing isolated aortic (n = 603) or mitral (n = 1110) valve replacement. The hospital mortality in this group (n = 1713) was 104 patients (6.1%). From the remaining 1609 patients, that were discharged from the hospital, we were able to obtain a follow-up in 1101 or 64.3%. This analysis related to a period ranging from 1 to 84 months, mean = 48 and a cumulative follow-up in the aortic group (n = 385) equal to 1230 patients/year; the mitrals (n = 716) equal to 3018 patients/year. There were 102 late complications in 716 patients (14.24) and 51 in the aortic group (13.2). In relation to the age or the patients, 220 were under 20 years of age (mitrals = 176/aortics = 44) and in this subgroup the intrinsic valve failure was 43% of the mitral patients and 29% of the aortic group. The prosthetic endocardite was more frequent in the aortic group (45%) in compararison with the mitrals (29.7%). There were 62 reoperations in 1101 patients, with hospital mortality of 12.6%. The reoperations were more frequent in the mitral group, in patients below 20 years of age. Survival, considering only deaths related to the bioprosthesis, was 97.1% (32/1101). In the aortic group, 96.9% of patients were free of valve disfunction at the end of 7 years; among the mitrals, 95.2%. The major incidence of valve failure was encountered in the mitral patients, below 20 years of age; 85.3% were free of this complication at 7 years of follow-up. At the end of this study, the majority of the alive patients was functional classes I and II of the NYHA. Although the incidence of reoperation is significant, these findings are acceptable, specially because bioprosthesis offers a safer alternative than mechanical prosthesis. The present results suggest the continuation of research to obtain the ideal bioprosthesis, although current data is comparable to results abtained with similar bioprosthesis in the world literature.
Keywords: heart valves, biologic; heart valves prostheses, surgery; heart valves, surgery
Multicenter study with porcine bioprosthetic Labcor valve
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
Between 1984 and 1988, we studied 514 patients who underwent surgery for valve replacement using Labcor's porcine bioprosthetic valve. Two hundred and eighty-eight patients were female and 226 were male with a mean age of 36.8 ± 16.5 years. There was 64% of mitral valve replacement; 21.6% of aortic valve replacement; 2.1 % of mitral-tricuspid replacement and 0.2 of mitral-aortic-tricuspid replacement. In the pre-operatory period 1.6% of the patients were in the functional class II (NYHA); 63.7% in class III and 34.7% in class IV. After surgery 77.2% of the patients were in functional class I; 21.5% in class II; 0.3% in class III and 1% in class IV. The sizes of the bioprosthetic valve more often used were in order of frequency: 29 (33.3%); 27 (21.7%) and 31 (15.2%). There was a 7.6% incidence of hospital deaths and 3.2% of late deaths. The overall mortality was 10.1%. The mortality rate was 6.3% patients-year. There was a 4 years follow-up with 13 late deaths, 34% of them related to the bioprosthetic porcine valve. A second replacement ocurred in 17 (3.6%) cases and was due to paravalvar leaking in 4 cases, infective endocarditis in 2 cases, calcification in 1 and in 10 cases was not related to the bioprosthetic valve. Thus, the Labcor's bioprosthetic porcine valve, during the 4 year follow-up, showed a low incidence of complications (5 of 475 patients who survived surgery).
Keywords: heart valves, biologic; heart valves prostheses, surgery; heart valves, surgery
Eight years follow-up of the Medtronic-Hall aortic prosthesis: influence of oral anti-coagulation on embolism incidence
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
One hundred and sixty five survivors of isolated Medtronic-Hall aortic prosthesis operated on from September 1979 to September 1987 were studied. Ages varied from 14 to 68 years (m = 35.2) and 129 patients were male, 36 female. Preoperative diagnosis were 70 aortic insuficiency, 37 aortic stenosis and 39 double lesions. There were additionally 8 prosthetic dysfunctions, 8 acute infective endocarditis and 3 interventricular septal defects plus aortic insufficiency. One hundred and sixty three patients were followed (98.72), 9 of them being lost during the observation period. There were 45 late deaths, 59% SE 10.9% being the actuarial survival probality in 8 years. Twenty one patients suffered 26 embolic episodes, 69.8 SE 11.7% the probability of freedom from embolism and 39.7% SE 10.4% the chance of survival free from embolism. The rate of embolism episodes was 3,5% per patients/year in the entire series, 6 of them being lethal. In relation to the use of oral anticoagulation patients were divided into three sub-groups. Sub-group A included 144 patients, with a linearized incidence of 3.2% episodes per patients/year. Sub-group B included 21 patients who used anticoagulants after surgery, with an incidence of 1.9% per patients/year. Sub-group C comprised 9 patients who were put on anticoagulants after the occurence of an embolic episode. This sub-group presented 8.1 episodes per patients/year. It is concluded that it was not possible to doccument the influence of anticoagulation in the conditions prevailing during the observation of this series. After the occurence of one embolic episode the institution of oral anticoagulation was not effective in decreasing chance of its reccurence.
Keywords: embolism, heart valves prostheses; anticoagulation, heart valves prostheses; heart valves prostheses, surgery
Surgical management of the left coronary ostial stenosis
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
The surgical management of the left coronary mitral stenosis can be achieved by revascularizing individually its main branches (LAD, Cfx), or duing a direct approach over the stenosed area. The purpose of this paper is to present the results of the surgical enlargement of this lesion in 4 patients. All cases were males, aging 56, 59, 61 and 68 years old. Three cases had risk factors for coronary disease (hypertension, diabetes, heavy smokers), and 1 had syphilis. Two patients were in unstable angina, 1 presented stable angina, and the last one was assymptomatic, with a positive ergometric test. All patients showed obstructions more than 70% at the cinecoronariography, with no significant peripheral lesions. The operations were performed with the use of moderate hypothermia and crystaloid cardioplegic solution. A transverse aortotomy was made, extending posteriorly to the left coronary sinus, dividing the ostium, and entering 1 cm through the left main artery. In 3 cases, a saphenous vein patch was used for the enlargement, and bovine pericardium on the other one. The immediate postopertive period was uneventful, asn all patients were discharged from the hospital. The late follow-up at 20 months shows assymptomatic patients with normal life. The authors emphasize that the surgical widening of the coronary ostium seems to be a good technical option to treat coronary ostial stenosis, with no peripheral lesions.
Keywords: coronary ostial stenosis, surgery
Sequential hemodynamic evaluation in heart transplantation
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
heart transplantation has been widely employed in treatment of end stage cardiomyopathy. Great interest exists in the study of early and late hemodynamic alterations following the procedure. Fourty three patients submited to heart transplantation were studied with this aim. The data obtained were: cardiac index, pressure in the heart chambers, capillary wedge pressure, aorta and pulmonary artery pressure, systolic volume and ejection fraction of left ventricle, pulmonary and systemic vascular resistances; left and right work systolic indexes; triple product. The data were compared in groups with and without rejection and in groups with higher and lower transpulmonary gradients. It was observed that in the immediate period there was impairment of ventricle function due to several factors. The cardiac index is maintained in adequate levels through several mechanisms, adaptation of the ventricles occur earlier in the right than in the left ventricle; lately hemodynamic alterations depend on the appearance of systemic arterial hypertension and coronary atherosclerosis. The presence of rejection and higher values for transpulmonary gradient had no statistically significant influence in hemodynamic condition.
Keywords: heart transplantation, hemodynamics; heart transplantation
Distant donor procurement for heart-lung and lung transplantation
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
In special situations, clinical heart-lung and lung transplantation are today established methods of therapy for end stage cardiopulmonary and pulmonary disease. Adequate donor availability remains a major problem and distant organ procurement is today a necessity. Although many methods of lung preservation can be used, for periods of up to 5 hours, hypothermic storage with cardioplegic arrest and pulmonary artery flush with modified Collins solution has proven to be a simple and reliable method of heart-lung preservation. We here describe our current method of heart-lung block protection, in which heart-lung and double lung transplantation were performed followed by excelent cardiac and pulmonary function.
Keywords: cardiopulmonary transplantation, donors; cardiopulmonary transplantation; pulmonary transplantation, donors; pulmonary transplantation
Anatomy of the left atrio-ventricular valve: I. The cusps
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
A review of the left atrio-ventricular valve anatomy is compared to a clinical oriented morphological study on 30 normal adult heart, preserved in formalin. The results will be presented in five separated sections: I. The cusps; II. The comissures; III. The chordae tendinae; IV. The papilary muscles; V. The valvar annulus. The present publication will deal with the cusps. The terms "left atrio-ventricular valve" and "cusps" are to be prefered to the more descriptive and traditional "mitral valve" and "leaflets". The anterior cusp, in continuity with the aortic annulus, and a group of posterior cusps, attached to the posterior left wall, are described. An ordinal numerical designation for the posterior cusps is proposed in order to facilitate ultrasonic and/or surgical references. The dimensions encountered for the cusps night, including the "rough" and "clear" zones are superposed to those from others authors, but those refered to the extensions, are slightly small, probably due to more fixed, natural curvature of the fixed hearts.
Keywords: heart valves, cusps, anatomy; heart valves, anatomy
Oxygenated cardioplegia in myocardial protection during cardiac surgery: a clinical and enzymatic study
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
Cardioplegia has been recognized as a very important factor in myocardial protection. Today we know that even the arrested heart at 15ºC wastes oxygen. "In vitro" it was already shown that release of oxygen was higher in cristalloid than in blood solution. In this study we analized the hemodinamic, electrocardiographic and enzimatic variations in 26 patients, divided into two groups in whom cardioplegia with the Gomes solution was used. Group I: 12 patients (control group - non oxygenated solution). Grupo II: 14 patients (oxygenated solution). The evaluation of the patients included hemodynamic recovery after arrest, the use of vasoactive drugs, cardiac rhythm and aspect of the ECG, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and enzymes SGOT and CPK-MB in the following times: pre and postoperatory period and after 6, 12, 24, 48 and 72 hours of postoperatory period. Hemodynamic recovery was similar in both groups, the use of vasoactive drugs was greater in Group II. In the ECG was seen more sinus bradycardia in Group II that also needed more electric defibrilation. Heart rate, mean arterial prossure and central venous pressure showed no significant difference between the two groups in the postoperative period. The enzymes SGOT and CPK were higher in Group I than in Group II. In conclusion, data suggested that both solutions had similar results in the hemodynamic recovery end vital parameters. An higher incidence of bradycardia was seen in Group II, probably related to the longer cardiac arrest, with more infusions of the cardioplegic solution. The variation of the enzimes suggested that oxygenated cardioplegia was more effective than the non-oxygenated solution to assure the preservation of the myocardium.
Keywords: myocardial protection, cardioplegia
CASE REPORT
Resection of descending aorta due to thoracic trauma: successful surgical treatment
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
The case of a 33 year-old woman victim of an automobile accident whith a descending aorta transection due to thoracic blunt trauma surgically treated in described. The early diagnosis and treatment were responsible for the excellent postoperative results.
Keywords: thoracic trauma; aorta rupture, surgery
Superinfection and rupture of abdominal aortic aneurysm after Salmonella dublin septicemia: a case report
Braz J Cardiovasc Surg 3;
Publish in: 8/2/2025
The authors present a case of a 66 year-old woman with a dissection and rupture of abdominal aortic aneurysm after Salmonella dublin septicemia. Endovascular infection and rupture of atherosclerotic aneurysm is a substantial risk in patients older than 50 years of age who have bacteremia or sepsis due to Salmonella sp. The high mortality is the resultant of Salmonella aortitis due either to septicemia or rupture. Tissue anywhere may be seeded, but damage tissues appear to be particularly susceptible to abscess and chronic destructive lesions. The significance of early diagnosis to decrease the fatal outcome is discussed.
Keywords: abdominal aortic aneurysm, rupture, Salmonella dublin; abdominal aortic aneurysms, surgery