[The long-term results in multiple procedures on the heart valves]

In the period 1972-1988, 209 patients (81 males, 128 females, mean age 42.4 +/- 11.9, range 20-71 years) underwent surgery for multiple valve repair (MVR) at the Italian Institution of Cardiac Surgery. Ninety-five patients had previously undergone mitral commissurotomy (MC). NTHA function class was III-IV in 89% of the patients. The procedures were: aortic valve replacement (AVR) + MC (63 patients; 30.2%), mitral valve replacement (MVR) + tricuspid valvuloplasty (TRVPL) (57 patients; 27.4%), AVR + MVR (50 patients; 24%), AVR + MVR+TRVPL (22 patients; 10.5%), AVR + CM + TRVPL (6 patients; 2.8%), AVR + mitral valvuloplasty (6 patients; 2.8%), AVR-TRVPL (2 patients; 0.9%), AVR + MVR + tricuspid valve replacement (2 patients; 0.9%), AVR + MVR + TRVPL + ventriculoplasty (1 patients; 0.5%). The inserted valves were mostly (147/209) Bjork-Shiley tilting disc type. The mean cardiopulmonary bypass (CPB) time was 119.6 +/- 53.9 and the mean aortic clamp time was 69.2 +/- 31.6. A complete follow-up was possible in 158/209 patients (75%) with a mean observation time of 8.11 +/- 4.92 years (total of 778 patients years). Thromboembolism was defined as the cause of any new focal neurologic deficit. All cases of peripheral embolisation were considered to be valve-related. The valve related early and late complication are as follow: fifteen patients in NYHA class III-IV, died perioperatively (7%). We had a thrombotic encapsulation of valve in one patient who required a redo operation after 8.25 years, 6 cases of thromboembolism in patients who interrupted anticoagulants (2 deaths), 4 cases of prosthetic leak, 8 cases of prosthetic valve endocarditis (1 death) 9 cases of anticoagulant-related hemorrhage (2 deaths).(ABSTRACT TRUNCATED AT 250 WORDS)