Related Experiment Videos
Results of multiple valve repair. A clinical study of 81 patients
V Rantakokko1, M Janatuinen, E Vänttinen
1Department of Surgery, University Hospital, Turku, Finland.
Insights
Multivalvular cardiac disease surgery using Björk-Shiley prostheses showed acceptable late complication rates in 81 patients. Proper anticoagulant therapy is crucial for managing risks like bleeding and valve issues after these complex heart valve surgeries.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomaterials Science
Background:
- Multivalvular cardiac disease affects a significant patient population requiring complex surgical intervention.
- The Björk-Shiley prosthetic valve has been historically used in cardiac valve replacements.
Purpose of the Study:
- To evaluate the long-term outcomes and complication rates associated with multivalvular reconstruction using Björk-Shiley prostheses.
- To assess the safety and efficacy of this surgical approach in patients with severe valvular heart disease.
Main Methods:
- Retrospective analysis of 81 patients (50 men, 31 women) undergoing multivalvular surgery between 1973 and 1987.
- Focus on procedures including aortic and mitral valve replacement, with or without coronary artery bypass grafting or tricuspid valvuloplasty.
- Utilized Björk-Shiley disc prostheses in 95% of cases, with a mean follow-up of 4.5 years.
Main Results:
- The most common procedure was aortic + mitral valve replacement (81%).
- Perioperative mortality was 11% (9/81), with major causes including myocardial infarction and low cardiac output.
- Late complication rates per 100 patient-years included: thrombotic valve encapsulation (0.6), anticoagulant-related hemorrhage (0.9), prosthetic valve endocarditis (1.2), and paraprosthetic leakage (1.2).
Conclusions:
- Multivalvular reconstruction with Björk-Shiley prostheses can achieve acceptable late complication rates.
- Effective anticoagulant therapy is paramount in minimizing risks associated with these prosthetic valves.
- The study highlights the importance of careful patient selection and management in complex cardiac valve surgery.
Abstract:
A report is presented of 50 men and 31 women, mean age 50.3 years, who underwent surgery for multivalvular cardiac disease in 1973-1987. NYHA function class was III-IV in 88% of the patients. The most common procedures were aortic + mitral valve replacement (81%), aortic + mitral valve replacement + coronary artery bypass grafting (5%), aortic valve replacement + tricuspid valvuloplasty (5%) and mitral valve replacement + tricuspid valvuloplasty (5%); 95% of the implanted valves were of Björk-Shiley disc type. Nine patients died perioperatively, six due to myocardial infarction and/or low cardiac output. Postoperative bleeding necessitated resternotomy in three cases. Follow-up was complete, with a mean observation time of 4.5 years (a total of 323 patient years). The incidence of thrombotic valve encapsulation was 0.6/100 patient years. Corresponding figures for anticoagulant-related haemorrhage, prosthetic valve endocarditis and paraprosthetic leakage were 0.9, 1.2 and 1.2. In our experience, the rate of late complications after multivalvular reconstruction using Björk-Shiley prosthesis is acceptable if anticoagulant therapy is correctly employed.