Combined Mitral and Aortic Valve Replacement with the Björk-Shiley Prosthesis

Rufilanchas, Juan J.; Maroñas, J; Agostí, J; Miranda, A. L.P.; Juffé, Alberto; Téllez, Gabriel; Figuera, D

doi:10.3109/14017437609167792

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…The operative risk of double valve replacement is moderate, and the surgical mortality of 8 % in the present series is quite similar to the results in other recent reports using the Björk-Shiley disc valve prosthesis (23,26). This mortality is only slightly higher than in patients with single mitral valve replacement (1,21,25).…”

Section: Discussionsupporting

confidence: 92%

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

Rostad

Simonsen

Nitter-Hauge

1979

Thorac cardiovasc Surg

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The present series was comprised of 48 patients, 25 of whom received the Björk-Shiley (B-S) and 23 the Lillehei-Kaster (L-K) disc valves. The 2 groups were comparable with regard to age, and to preoperative clinical and hemodynamic status. The randomized selection was carried out at the beginning of the operation. The total mortality in the B-S and L-K groups was 16% and 21% respectively. All surviving patients were restudied 13-40 months (mean 27) after surgery. Late thromboembolic complications occurred in 2 patients with B-S and in 3 with L-K valves, all leaving minor neurological sequelae. There was a relatively large number of patients in the L-K group with unmeasurable values of haptoglobin, indicating more hemolysis in these patients. However, the difference was not statistically significant. The clinical and hemodynamic status was improved in both groups. In the aortic position a significant gradient was found across the L-K valve, while no significant obstruction in the flow was found in the B-S valve. The pulmonary arteriolar resistance was significantly higher in patients with B-S than in those with L-K valves. Otherwise, there was no significant differences between the 2 groups, neither with regard to clinical nor to hemodynamic status.

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Section: Discussionsupporting

confidence: 92%

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

Rostad

Simonsen

Nitter-Hauge

1979

Thorac cardiovasc Surg

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“…Rufilanchas et al (1976) studied a total of 42 patients (mean age 36.6 years) after combined aortic and mitral valve replacement with this type of prosthesis. The hospital mortality was 9.5 % with 4 late deaths within a mean follow-up period of 21.…”

Section: Discussionmentioning

confidence: 99%

“…These qualities are considered to be of major importance in multiple valve replacements. Information concerning the extent of the clinical changes that follow combined valve replacement with this type of prosthetic valve has been published recently (Rufilanchas et al, 1976;Aberg, Henze & Bjork, 1977). Very little information about the late haemodynamic results of multivalvular surgery with this disc valve has hitherto been published, we are now publishing an analysis of the late haemodynamic results of combined aortic and mitral replacement in 25 consecutive patients.…”

mentioning

confidence: 98%

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

Nitter-Hauge

Frøysaker

Enge

et al. 1979

Scandinavian Journal of Thoracic and Cardiovascular Surgery

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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.

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“…The operative mortality was 18% for this series. Others have reported mortality rates after combined mitral and aortic valve replacement ranging between 3-4 and 52-5%['- 8 ). Clinical and hemodynamic data were not significantly different between operative survivors and operative deaths.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular function before and following double valve replacement by Björk-Shiley prostheses

Schwarz¹,

Sesto²,

Schlepper³

et al. 1981

European Heart Journal

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Postoperative survival and cardiac function were studied in 45 patients who underwent combined mitral and aortic valve replacement by Bjork-Shiley prostheses between 1971 and 1977. The average follow-up was three years. Pre-operative left ventricular ejection fraction ranged from 28 to 78% (mean 57%). The hospital mortality rate for the entire series was 18%, the five year survival rate 58%. Hospital mortality decreased from 22% in 1971/72 to 8% in 1976/77. Sixteen patients were restudied 12 to 60 months after operation. In these patients functional class improved significantly, pulmonary arteriolar resistance decreased (255 to 122 dynes s cm" 5 , P < 0-05), left ventricular enddiastolic volume (159 to 103 ml/m*, P < 0-01), muscle mass (198 to 134ml/m 2 , P < &05) and ejection fraction improved (50 to 61%, P < 0-05). Postoperatively, mean pulmonary artery pressure increased with exercise (23 to 41 mm Hg, P < 0-001), and pulmonary artery pressure during exercise was linearly related to pulmonary arteriolar resistance at rest (r=0~72, P < &05). Patients with successful repair of mitral and aortic valve without a paravalvular leak achieved normal pulmonary arteriolar resistance, left ventricular end-diastolic volume, muscle mass and ejection fraction, but cardiac index remained slightly reduced as compared to a control group (2'8 v. 3 3 l/min m 2 , P < 0-05). This study shows (I) early and late mortality rates remained high after double valve replacement by Bjork-Shiley prostheses, but hospital mortality decreased in the time period analysed, and (2) late survivors revealed normalization of left ventricular dilation, hypertrophy and ejection fraction when the prosthesis functioned well. Operative management of combined mitral and function before and following double valve replaceaortic valve disease by use of various types of ment. Thus, it is unknown which adaptive changes prostheses has been shown to improve clinical of the left ventricle occur after unloading by double symptomst 1 " 8 ], but the hemodynamic response of valve replacement. This study compares prethe left ventricle to operation has been rarely operative and postoperative angiographic findings studied. Mason et a/.l'l reported data of patients to answer the question whether left ventricular who showed an abnormal function of the left dilatation and dysfunction recover after double ventricle during exercise after operation. Nitter-valve replacement. Hauge et a/.['°l studied patients after double valve replacement by Lillehei-Kaster prosthesis and found normalization of cardiac output and pul-Methods monary arteriolar resistance. However, none of the previous studies reported data regarding left ven-PATIENTS tricular dilatation, hypertrophy and contractile We studied 45 patients who underwent combined mitral and aortic valve replacement between May

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Combined Mitral and Aortic Valve Replacement with the Björk-Shiley Prosthesis

Cited by 9 publications

References 6 publications

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

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

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

Left ventricular function before and following double valve replacement by Björk-Shiley prostheses

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