The challenge of valve surgery in a developing population.
Between August 1988 and October 1992, 1,052 patients underwent 1,522 valve procedures in our institution. Their mean age was 32.69 years (range 1-90). The etiology was rheumatic in 724 (68.8%), congenital in 120 (11.4%), degenerative in 99 (9.4%), infective in 58 (5.5%) and ischemic in 17 (1.6%). The mean preoperative functional class (NYHA) was 2.95 and 780 (74.1%) were in sinus rhythm. Repair was possible in 885 (58.1%) valves. The rate of repair versus replacement was 94.5% for the tricuspid, 56.2% for the mitral and 43.6% for the aortic valve. The total hospital mortality was 4.18%. For isolated mitral surgery it was 2.94%, for isolated aortic 4.12% and for isolated tricuspid 15%. Double valve surgery carried a mortality of 3% and triple valve surgery 13%. Hospital mortality for isolated mitral and isolated aortic surgery was lower for repair than for replacement (1.5% vs. 5% and 0 vs. 6.8%). The follow-up was 94.65% complete. The total incidence of embolic events was 2.93% with an actuarial freedom at 48 months of 92.71 +/- 5.35% for repair, 88.22 +/- 6.26% for replacement and 90.31 +/- 5.65% for patients with repair and replacement. Late mortality was 4.5%. The actuarial survival excluding hospital deaths was 94.89 +/- 2.10% for repair, 86.84 +/- 2.84% for replacement and 91.33 +/- 2.73% for the mixed group. The reoperation rate was higher for repair (13%) than for replacement (0.1%). This rate was highest for the rheumatic mitral patients with an age below 20 years (25.2%).(ABSTRACT TRUNCATED AT 250 WORDS)
Gometza
B
B
Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Kumar
N
N
Prabhakar
G
G
Gallo
R
R
Kandeel
M
M
Duran
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012086:Reoperation; D012529:Saudi Arabia / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery