[Clinical results of peroperative transesophageal echography in peri-valvular leaks of heart prosthesis].
Perivalvular leaks following prosthetic valve replacement are associated with significant morbidity. Management has classically consisted of valve replacement or blind surgical repair. Our study examines the results of intraoperative transesophageal echo-guided repair of perivalvular leaks (ITEGR). Between November 24, 1987 and January 1st, 1996, 23 patients (10 men, 13 women) at the Montreal Heart Institute underwent ITEGR. Ninety percent were NYHA class III-IV preoperatively. Seventy to 85% had significant cardiac insufficiency preoperatively. Eighty-six percent of the leaks were in the mitral valve location, 90% of which were mechanic prosthesis. Eighty-nine percent of patients had hemolysis with an average LDH of 720. Mean bypass time was 125 minutes with a mean clamp time of 77 minutes. Most patients were undergoing a third operation at the time of repair. Operative mortality was 8%, all due to biventricular failure. A mean follow-up of 67 months showed a late death of 10%. Of the 19 survivors, 77% were NYHA class I-II. Overall mortality was 20%. In our institution valve re-replacement in similar circumstances was associated with an operative and long-term mortality of 7% and 26% respectively. We conclude that intraoperative transesophageal echo-guided repair is an excellent management alternative in patients with perivalvular leaks with decreased late and overall mortality.
Greentree
D
D
Département de Chirurgie, Institut de Cardiologie de Montréal, Québec, Canada.
Leclerc
Y
Y
Cartier
R
R
Hébert
Y
Y
Carrier
M
M
Petitclerc
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies