[Bioprosthesis degeneration in the aortic and mitral valve position. Results and problems from the cardiosurgical viewpoint].
38 patients (20 men, 18 women) underwent reoperation between July 1989 to September 1992 because of degeneration of bioprosthetic valves implanted in aortic or/and mitral position. Retrospective analysis revealed a mean implantation time of 116.5 +/- 31.5 months for the bioprostheses (median 116). At reoperation 63.2% of them had a single valve replacement, 36.8% a more complex cardiac procedure (double or triple valve replacement, valve replacement and coronary bypass grafting). 50% (n = 9) of the reoperation cohort were symptomatic (NYHA III), 16 (42.1%) were serious symptomatic (NYHA IV). All deaths were NYHA IV preoperatively. Early mortality was 18.4% (n = 7). Mean age at the time of first operation was 51 +/- 10.7, mean age at reoperation was 60.5 +/- 10.6. There was a significantly longer aortic clamp time (AKT, p = 0.0005) and bypass time (BPT, p = 0.0000) compared to first operation, also a significantly longer BPT of the deads confronted with the survivors (p = 0.0075). Bioprosthetic valves in mitral position were significantly longer implanted (p = 0.0416) than in aortic position. But there was no difference in implantation time of commercially available Carpentier-Edwards- or Ionescu-Shiley grafts. At reoperation we changed more than 95% of the degenerated valves to mechanical devices--corresponding to international tendencies. We discuss the early tissue degeneration of bioprosthetic valves and their increasing problem during reoperation.
Antretter
H
H
Abteilung für Herzchirurgie, I. Universitätsklinik für Chirurgie, Innsbruck.
Cottogni
M
M
Falbesoner
C
C
Furtwängler
W
W
Mair
P
P
Falk
M
M
Hutter
J
J
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D015996:Survival Rate
Bioprothesendegeneration in Aorten- und Mitralposition. Ergebnisse und Probleme aus kardiochirurgischer Sicht.