Clinical outcome of double valve repalcement with or without small aortic prosthesis.
OBJECTIVE
To determine the effect of aortic prosthesis size on clinical outcome of patients undergoing double cardiac valve replacement (DVR).


METHODS
A quasi-experimental study.


METHODS
Cardiac Surgery Department, Punjab Institute of Cardiology, Lahore, Pakistan, from February 1996 to December 2008.


METHODS
One hundred and forty patients undergoing double cardiac valve replacement were divided into 2 groups. Group I, 75 (53.6%) receiving aortic prosthesis size of ² 21 mm. Group II, 65 (46.4%) having aortic prosthesis of > 21 mm size. All patients were prospectively followed-up for 12 years in order to study mortality and valve related complications.


RESULTS
There were 94 males (67.1%) and 46 females (32.9%) with a mean age of 25.5 ± 10 years. In Group I, 21 patients (28%) had aortic valve replacement (AVR) with 19 mm valve size and 54 patients (72%) had 21 mm size valves implanted. In Group II, 39 patients (60%) had AVR with 23 mm size valves implanted followed by 16 (24.6%) who received 25 mm size valves. Posterior mitral leaflet was preserved in 15 patients (20%) in Group I and 14 (21.5%) in Group II. Mortality was seen in 13 patients (9.3%); of these 5 (3.6%) were in Group I and 8 (5.7%) were in Group II. Nine patients (6.4%) had incomplete follow-up (In Group I, 2 patients died in ICU, 2 died within 30 days of admission and one was a late death. In Group II, 1 patient died in ICU, 1 within 30 days of admission and 6 within 1 year of operation).


CONCLUSIONS
Double valve replacement with implantation of small aortic prosthesis has similar overall mortality as compared to patients having larger sized aortic valves.
Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan. rajapakhtar@gmail.com
Raja Parvez
RP
Akhtar
Abdul Rehman
AR
Abid
Mumraiz Salik
MS
Nuqshband
Jawad Sajid
JS
Khan
D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D002315:Cardiopulmonary Bypass; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D011474:Prosthesis Design; D012214:Rheumatic Heart Disease / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome