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[Emergencies in valvular surgery]
Insights
Emergency cardiac valve surgery is critical for patients with native or prosthetic valve issues, despite high perioperative mortality. Long-term results are satisfying, underscoring the necessity of timely surgical intervention for these critical cardiac conditions.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Medicine
Context:
- Study retrospectively analyzes 90 patients undergoing emergency cardiac valve surgery between 1976 and 1981.
- Patients divided into two groups: native valve surgery (Group I) and prosthetic valve reoperation (Group II).
- Investigates etiologies and indications for emergency surgery in both native and prosthetic valve disease.
Purpose:
- To evaluate the outcomes of emergency cardiac valve surgery in patients with native and prosthetic valves.
- To determine the necessity and long-term efficacy of urgent surgical intervention.
- To analyze perioperative mortality and long-term survival rates in this patient cohort.
Summary:
- Group I (native valves) had 57 patients with various etiologies including rheumatic heart disease and endocarditis, with emergency indications like cardiogenic shock and pulmonary edema. 26 perioperative deaths.
- Group II (prosthetic valves) had 33 patients, primarily due to leakage (27 cases) and malfunction (6 cases). 17 perioperative deaths.
- Mean follow-up showed better long-term survival in Group I (2 deaths among 27) compared to Group II (6 deaths among 15), despite initial high mortality.
Impact:
- The study emphasizes that emergency cardiac valve surgery is mandatory for achieving satisfactory long-term results.
- Findings support surgical intervention even with high perioperative mortality rates.
- Highlights the importance of addressing valve dysfunction urgently for improved patient outcomes.
Abstract:
Ninety patients who underwent emergency cardiac valve surgery from January 1976 to December 1981 are reported. Patients were divided in two groups: those operated on native valves are included in group I; patients with prosthetic valves operated because of leakage or malfunction, in group II. In group I (57 patients) the aetiology was: rheumatic heart disease (34 cases); acute endocarditis (16 cases); sequelae of recent endocarditis (2 cases); luetic infection (1 case); sequelae of myocardial infarction (1 case); rupture of mitral chordae in mixomatous valve (3 cases). The emergency operation was prompted in 22 patients by cardiogenic shock, in 13 patients by intractable pulmonary edema, in 21 patients by low output syndrome, in one case by ventricular arrhythmias. In group II (33 cases) the causes of reoperation were: in 27 cases leakage (in 13 due to active endocarditis); in 6 cases variance of the occluder or thrombosis. The emergency originated in 12 cases from cardiogenic shock, in 11 cases from intractable pulmonary edema, in 9 cases from low output syndrome, in 1 case from ventricular arrhythmias. Twenty-six patients died perioperatively in group I and 17 in group II. Mean follow-up in group I was 26 months. Among 27 patients there were two deaths; 25 patients are alive and well (one has been reoperated again). Mean follow-up in group II was 21 months. Among the 15 patients observed there were 6 deaths (3 after re-reoperation); 9 patients are alive and well (one has been re-reoperated).' The Authors feel that surgery is mandatory in all such patients to ensure satisfying long term results, in spite of high perioperative mortality rate.