title: Late results after triple-valve replacement with various substitute valves.
abstract: The purpose of this study was to determine what influence various combinations of mechanical and bioprosthetic valves in the aortic, mitral, and tricuspid positions had on late morbidity and mortality of 40 hospital survivors of triple-valve replacement. At operation the patients ranged in age from 27 to 69 years; 73% were women. The mean postoperative follow-up interval was 8.3 years, with a total follow-up of 331 years (100% complete). At 12 months after operation, functional class decreased from 3.3 to 1.6 (p < 0.05), cardiac index increased from 2.0 to 2.6 L.min-1 x m-2 (p < 0.05), and pulmonary artery pressures decreased from 59/27 to 40/17 mm Hg (p < 0.05). There were no differences in preoperative variables between groups. Actuarial survival for the 40 patients (exclusive of 30-day or in-hospital mortality, which was 31%) was 78% and 74% at 5 and 10 years. At the same milestones, freedom from reoperation was 96% and 54%, freedom from combined thromboembolism and anticoagulant-related hemorrhage was 68% and 56%, and freedom from all late valve-related morbidity and mortality was 64% and 25%. Comparison of the patients with two or more mechanical prostheses with the patients having two or more bioprostheses indicated no significant differences in actuarial freedom from late death, thromboembolic events, or anticoagulant-related hemorrhage. However the actuarial freedom from reoperation in the groups with two or more mechanical valves was lower than that of the groups with two or more bioprosthetic valves (0/10 versus 13/30; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Surgery Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: P S
authors.initials: PS
authors.lastname: Brown
authors.forename: C S
authors.initials: CS
authors.lastname: Roberts
authors.forename: C L
authors.initials: CL
authors.lastname: McIntosh
authors.forename: J A
authors.initials: JA
authors.lastname: Swain
authors.forename: R E
authors.initials: RE
authors.lastname: Clark
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D013923:Thromboembolism / Q000209:etiology
chemical_list: D000925:Anticoagulants