[Double valve replacement with mechanical prostheses--an operative results]

Area of Science:

• Cardiovascular Surgery
• Prosthetic Valve Technology
• Clinical Outcomes Research

Background:

• Double valve replacement (DVR) with mechanical prostheses is a complex cardiac procedure.
• Patient selection and prosthesis type can influence outcomes.
• Understanding long-term results is crucial for surgical decision-making.

Purpose of the Study:

• To evaluate the early and late outcomes of patients undergoing double valve replacement with mechanical prostheses.
• To identify risk factors for early mortality.
• To assess the long-term performance of St. Jude Medical (SJM) and Björk-Shiley (BS) mechanical valves.

Main Methods:

• Retrospective analysis of 68 patients who underwent double valve replacement between January 1980 and December 1993.
• Data collection included patient demographics, preoperative conditions, surgical procedures, prosthesis types (SJM vs. BS), and postoperative outcomes.
• Follow-up data were analyzed for survival rates, thromboembolism, prosthetic valve endocarditis, hemolysis, and reoperation.

Main Results:

• Early mortality was 8.8%, with MOF being the most frequent cause. NYHA class IV, infective endocarditis, longer cardiopulmonary bypass, and IABP support were risk factors for early death.
• Late survival at 14 years was 53.2% overall and 64.3% in hospital survivors.
• Linearized rates per patient-year included thromboembolism (2.8%), prosthetic valve endocarditis (0.7%), hemolysis (0.4%), and reoperation (1.1%). Nine-year freedom rates were high for all complications.

Conclusions:

• Early surgical intervention is recommended for patients with multiple valvular heart disease.
• Double valve replacement using SJM or BS mechanical prostheses demonstrates acceptable long-term outcomes.
• Risk stratification and careful patient management are essential for improving outcomes in DVR.