The mitral pulmonary autograft: assessment at midterm

Autor: Ryad Hariri, Abdo Hammoud, Donald N. Ross, Jawad Abou Hatab, Hisham Jamil, Nada Sabbagh, Fawzi Nabhani, Sami S Kabbani
Rok vydání: 2003
Předmět:
Male
medicine.medical_treatment
Postoperative Complications
Recurrence
Mitral valve
Atrial Fibrillation
Mitral Valve Stenosis
Child
Microwaves
Heart Valve Prosthesis Implantation
Polyethylene Terephthalates
Calcinosis
Mitral Valve Insufficiency
Atrial fibrillation
Prostheses and Implants
Middle Aged
medicine.anatomical_structure
Treatment Outcome
Child
Preschool
Heart Valve Prosthesis
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
Pericardium
Pulmonary and Respiratory Medicine
Adult
medicine.medical_specialty
Adolescent
Pulmonic stenosis
Transplantation
Autologous
Internal medicine
medicine
Electrocoagulation
Humans
cardiovascular diseases
Bioprosthesis
Mitral regurgitation
Pulmonary Valve
business.industry
Mitral valve replacement
Rheumatic Heart Disease
medicine.disease
Surgery
Transplantation
Stenosis
Pulmonary valve
business
Echocardiography
Transesophageal
Follow-Up Studies
Zdroj: The Annals of thoracic surgery. 78(1)
ISSN: 1552-6259
Popis: Background There is a dire need, especially in emergent societies, for a mitral substitute that does not require anticoagulation, and is not affected by early degeneration. Methods Between 1997 and 2003, 80 patients had successful mitral valve replacement with a pulmonary autograft. Fifty-five patients were female, and the mean age was 39.3 years. Seventy-eight patients had rheumatic mitral disease and 2 congenital. The autograft was placed inside a rigid Dacron tubing for support, and the right ventricular outflow was reconstructed with a xenograft or a homograft. Recently we have used microwave energy to ablate atrial fibrillation when present. Results Intraoperative transesophageal echocardiography revealed adequate mitral valve areas (mean area 2.76 cm 2 ) and acceptable mitral gradients (mean 4.3 mm Hg) in all 80 patients. There was no mitral regurgitation or trace amounts in 61 patients, and mild regurgitation in 19. Operative mortality was 5.0%, and late mortality clearly related to the procedure 6.25%. Follow-up was complete except for 2 lost patients, with a mean of 25 months, and echocardiographic findings were generally stable during follow-up. One patient developed uncritical mitral stenosis and another uncritical stenosis and insufficiency during 4 to 5.5 years. Four more patients had progression of mitral regurgitation from "mild" to "moderate" over a period from 8 months to 3 years. Uncritical xenograft pulmonic stenosis developed in 2 patients. Most of the surviving patients (83%) remain in class I status. Conclusions We believe the pulmonary autograft is a good mitral substitute at the disposal of cardiac surgeons, especially when patients are young and when life anticoagulation is contraindicated or impractical.
Databáze: OpenAIRE
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