Clinical and Haemodynamic Observations after Combined Aortic and Mitral Valve Replacement with the Björk-Shiley Tilting Disc Valve Prosthesis: Early and Late Results in 25 Patients

Abstract

Combined mitral and aortic valve replacement with the Björk-Shiley tilting disc valve (pyrolite) was performed in 25 unselected patients characterized by markedly impaired functional capacity, hypokinetic central circulation and cardiomegaly before operation. Surgery was performed during extracorporeal circulation with deep hypothermia. The mitral valve was replaced first in all cases. There were no intra-operative deaths, but 2 patients died while still in hospital (8.0%). One patient died 2 months postoperatively due to progressive heart failure. The remaining patients--with the exception of one who had died of cancer of the ovary--were re-examined in average 28.7 (18-40) months postoperatively. Most patients had improved symptomatically and were in functional classes I-II (N.Y.H.A.). The haemodynamic findings indicated restoration to normal resting values of cardiac output, pulmonary artery pressure and pulmonary vascular resistance, but with an increase in left ventricular end-diastolic pressure (LVEDP). The mean diastolic gradient across the mitral prosthesis varied from 0 to 11 mmHg, while simultaneous pressure recordings from the left ventricle and the aorta, with one exception, disclosed no systolic pressure gradients (peak) across the aortic valve. Postoperative arterial thrombo-embolic complications occurred in 2 patients, resulting in only minor neurological sequelae.

Multiple valve replacement with pericardial xenograft. Clinical and haemodynamic study.

“…'7 20 22 This low incidence of embolism is comparable with that encountered in patients having single valve replacement with pericardial xenografts and observed for a similar duration of follow-up, as shown in Fig. 4 The incidence of endocarditis in this series (19 episodes/100 patient years) is similar to that reported with other types of valve replacement. '2-'4 16 20 All patients derived considerable benefit from the operation, 60 per cent being in New York Heart Association class I and 40 per cent in class II at the most recent follow-up.…”

“…Previous cardiac surgery 26 34 Valve replacement and repair 6 Closed mitral valvotomy 19 Mitral and aortic valve replacement 1 * All patients in sinus rhythm had mitral and aortic valve disease.…”

“…All valve replacement operations were performed using total body hypo- 14 Mitral, aortic, and tricuspid 8 Total 76 17 22 Rhythm: Sinus 20 26* Atrial fibrillation 56 74 Previous cardiac surgery 26 34 Valve replacement and repair 6 Closed mitral valvotomy 19 Mitral and aortic valve replacement 1 * All patients in sinus rhythm had mitral and aortic valve disease.…”

Long-term follow-up in 54 patients after combined mitral and aortic valve replacement with the Lillehei—Kaster prosthesis. Overall results and prosthesis-related complications

“…3). This effect is noted in other studies' 1 " 410 "' 31 and is obviously related to the improvement of the haemodynamic abnormalities' 2 * 3 ' 2 ' 29 '. An associated feature is the significant decrease of the radiological heart volume at the early follow-up (Table 3).…”

Combined Aortic and Mitral Valve Replacement. A Randomized Study Comparing the Björk-Shiley and Lillehei-Kaster Disc Valve

“…Some aspects of the results of surgical replacement of either the aortic or the mitral valve have been described previously (10,17). Combined aortic and mitral valve replacement has been the subject of 2 recent reports dealing with the B-S and L-K valve prostheses used separately in a randomized series of patients (18,19). The aim of the present communication is to present a direct comparison between the clinical and hemodynamic results in this randomized group of patients.…”