VALVE SURGERY - EXPERIENCE IN OVER 500 PATIENTS
N. Radovanović, S. Ničin, Lj. Petrović, J. Lavač, M. Fabri,
J. Selestiansky, B. Mihajlović, P. Kovačević, M. Mijatov,
V. Ščekić, S. Popović and B. Dobrić.
Clinic of Cardiovascular Surgery, Novi Sad, Yugoslavia
Background: The aim of this study was to evaluate
the operative risk in triple (aortic, mitral and tricuspid) valve
surgery after 16 years of experience. Methods: there were 504
patients who underwent triple valve surgery at our Clinic. All
of them were in functional classes III and IV according to NYHA
classification. Pulmonary hypertension was registered in 73% (113/504).
In the aortic position reconstructive surgery was performed in
only 9 patients (1,8%) while in mitral it was done in22% (113/504).
We routinely used transseptal approach to the mitral valve. Reconstructive
surgery of tricuspid valve was the rule (Carpentier's annuloplasty
in 76 pts, our modification of De Vega's annuloplasty in 425 pts
and resection - suture in 2 pts). In 6 pts (1,2%) an additional
tricuspid commisurotomy was done. Aortic valve replacement was
done using five different types of bileaflet prostheses (BP):
St Jude Medical, CarboMedics, Duromedics, Sorin Bicarbon, ATS
Medical in 493 pts (98%) and Star Edwards ball valve (SE) in 2
pts. For the mitral position we used SE in 196 pts (39%). BP in
180 pts (36%) and bioprostheses in 22 pts (4,4%). In only 1 patient
we have to replace the tricuspid valve by Xenomedica biological
prosthesis. Results: The 30-day postoperative mortality was 3,6%
(18/504) and the causes of death were: cardiac insufficiency in
7 pts, rhythm disturbances in 4 pts, hepatorenal insufficiency
in 3 pts, cardiopulmonary insufficiency in 3 pts and pulmonary
haemorrhage in 1 pt. Conclusion: patients with triple valve disease
can be operated with low operative risk due to good myocardial
protection, transseptal approach to the mitral valve, correct
choice of artificial heart valve and broad use of constructive
surgical procedures particularly in mitral and tricuspid position.