Factors associated with operative risk in mitral valve replacement

Litwak, Robert S.; Silvay, J; Gadboys, Howard L.; Lukban, Salvador B.; Sakurai, Hideki; Castro-Blanco, Jaime

doi:10.1016/0002-9149(69)90513-x

Cited by 47 publications

(5 citation statements)

References 23 publications

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“…As we (Mary et al,I974a) and others (Kittle et al, I969;Litwak et al, I969;McGoon et al, I973;Yacoub, Towers, and Somerville, 1972) had previously found, advanced preoperative cardiac disability was the main factor influencing early postoperative death. Valve-related deaths were due only to infective endocarditis and the incidence was not statistically significant.…”

Section: Discussionmentioning

confidence: 51%

Tissue valves in the mitral position. Five years' experience.

Mary¹,

Pakrashi²,

Catchpole³

et al. 1975

Heart

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Between April 1969 and November 1973 103 patients underwent isolated mitral replacement with three-cusp stented tissue valves. Autologous fascia lata was used in 50 patients, homologous fascia lata in 21, and heterologous pericardium in 32. The early mortality rate (14.6%) was influenced by age, the extent of preoperative cardiac disability, and low cardiac output. The survivors were followed up for periods varying from 8 to 60 months (average 37 months). In general, a factor in late death (13.6%) was high preoperative pulmonary artery pressure. In the autologous fascial series valve failure and infective endocarditis were significantly related to late mortality. The results with homologous fascia and pericardium were better than with autologous fascia valves. The incidence of postoperative mitral regurgitation was singificantly lower in the homologous fascial and pericardial series and none of these grafts had to be removed. The incidence of thromboembolism was low without anticoagulants. Actuarial analysis showed a survival rate at five years of 82.2 per cent. We no longer use autologous fascial valves. Though better results have been obtained with both homologous fascia and pericardium we prefer the physical characteristics of heterologous pericardium and it is easy to obtain.

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Section: Discussionmentioning

confidence: 51%

Tissue valves in the mitral position. Five years' experience.

Mary¹,

Pakrashi²,

Catchpole³

et al. 1975

Heart

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“…Excessive blood loss constitutes an important risk factor during and after open heart surgery (Litwak et al, 1969;Gomes and McGoon, 1970;Proskey et a]., 1970). Inadequate neutralization of heparin, fibrinolysis, decreased plateiet count and alterations in coagulation factors have been observed to occur, but these vary greatly from one patient to another (Perkins et al, 1959;Gans and Krivit, 1962;Kendall and Lowenstein, 1963;Douglas et al, 1966;Woods et al, 1967).…”

Section: Discussionmentioning

confidence: 99%

The effect of Premarin on blood loss attending open heart surgery

Mary

Abid

Pohlner

et al. 1976

Journal of British Surgery

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Premarin was administered prophylactically to every other patient in a series of 148 consecutive cases of open intracardiac surgery. Of these, 132 patients were matched to analyse the results of Premarin administration and postoperative blood loss. There were 67 patients who were given Premarin and 65 who did not receive this drug; both groups were identical in respect of age and sex. Matching was undertaken according to history of previous cardiac operations and anticoagulation, type of valve surgery or repair of congenital anomaly, duration of perfusion, platelet count and the use of fresh blood and epsilon-aminocaproic acid in the postoperative period. The prophylactic use of Premarin was not associated with a reduction in postoperative bleeding.

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“…Die zahlreichen Komplikationen nach Herzklappenersatz geben Veranlassung, intensiv nach neuen Typen von Prothesen zu suchen. Am häufigsten werden künstliche Klappen benutzt (8,11,14); die Anzahl der thromboembolischen Komplikationen einerseits, bedingt durch Unzulänglichkeiten der Konstruktion und des Materials, und hämorrhagische Komplikationen andererseits infolge übermäßiger Anwendung von Antikoagulantien sind für viele Mißerfolge, die erst bei langfristiger Beobachtung manifest werden, verantwortlich zu machen. Aus diesen Gründen wurden homologe Ersatzklappen (5,12), heterologe Transplantate (1,3,10) und Klappen aus Fascia lata (4, 13) verwendet, bei welchen das Auftreten von thromboembolischen Komplikationen ohne Anwendung von Antikoagulantien bedeutend seltener ist.…”

Section: Klinische Anwendung Heterologer Aortenklappentransplantate* unclassified