Reoperations on heart valve prostheses: An analysis of operative risks and late results

Pansini, Stefano; Ottino, G; Forsennati, Pier Giuseppe; Serpieri, Giuseppe; Zattera, Giuseppe; Casabona, Riccardo; Summa, Michele di; Villani, Massimo; Poletti, G.; Morea, M

doi:10.1016/0003-4975(90)90195-c

Cited by 74 publications

(35 citation statements)

References 17 publications

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“…These include: longer survival after valvar operations, increasing life expectancy of the population and wide utilization of bioprosthesis in multiple valvar operations, ring reconstruction in endocarditis with ring abscesses, or patients with ventricular dysfunction, who need circulatory care for a longer period. The aortic cross-clamping time was also predictive of hospital mortality, giving support to various works in the literature, as in the case of BIGLIOLI et al [4] and PANSISI et al [16] This is a variable which is also directly related to the technical complexity of the operation.…”

Section: Commentssupporting

confidence: 73%

“…This variable was identified as a risk factor of mortality in other series of the literature. [14,16] The position was not a predictive factor of mortality either, although it was lower in the mitral position. ROSSITER et al [28] suggested that the disparity between the aortic and mitral positions, can be explained by the higher occurrence of endocarditis in prosthesis in the aortic position.…”

Section: Commentsmentioning

confidence: 91%

“…Several authors [14][15][16] identified FC IV as an independent predicting factor of mortality. According to HUSEBYE et al, [17] in an analysis of 552 valvar reoperations performed at the Mayo Clinic, hospital mortality was significantly higher in FC IV.…”

Section: Multivariate Analysis -Logistic Regressionmentioning

confidence: 99%

“…Several authors, such as BORTOLOTTI et al, [1] BIGLIOTI et al, [4] RIZZOLI et al, [15] PANSISI et al, [16] HUSEBYE et al [17] and AKINS et al, [19] identified the emergency character of valvar reoperations as an independent predictive factor of mortality. In our series, mortality was absent in emergency reoperations, but this situation related to only 5 cases.…”

Section: Commentsmentioning

confidence: 99%

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Risk factors to hospital mortality in valvar reoperations

Brandão¹,

Pomerantzeff²,

Souza³

et al. 2002

Rev Bras Cir Cardiovasc

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Rev Bras Cir Cardiovasc 2002; 17(4) Results: The overall hospital mortality was 8.8% (17 patients). Univariate analysis showed that the following variables were associated with higher mortality rates: advanced New York Heart Association functional class, decreased left ventricular ejection fraction, decreased prothrombin activity, increased creatinine level, longer aortic cross-clamping time, prolonged cardiopulmonary bypass time, concomitant associated procedures, and higher intraoperative bleeding volume. Logistic multivariate analysis identified advanced New York Heart Association functional class, creatinine level higher than 1.5 mg/dl, and cardiopulmonary bypass time longer than 120 minutes as independent predictors of hospital mortality.Conclusions: The variables functional class IV, creatinine level > 1.5 mg/dl and cardiopulmonary bypass time > 120 min were independent predictors of hospital mortality in valvar reoperations.

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Section: Commentssupporting

confidence: 73%

Section: Commentsmentioning

confidence: 91%

Section: Multivariate Analysis -Logistic Regressionmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

See 2 more Smart Citations

Risk factors to hospital mortality in valvar reoperations

Brandão¹,

Pomerantzeff²,

Souza³

et al. 2002

Rev Bras Cir Cardiovasc

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“…Treatment of such emergencies is a matter of controversy in the published data [4,13,14]. Its classic treatment is surgery, associated with a high perioperative mortality rate, especially in critically ill patients [11].…”

mentioning

confidence: 99%

Severe complications following thrombolytic therapy of an acute thrombosis of a prosthetic mitral valve

et al. 1994

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Thrombosis of prosthetic cardiac valves is a rare but potentially lethal complication. As emergency surgical intervention of thrombotic prosthetic cardiac valves is correlated with high mortality, fibrinolytic therapy has been recently recommended as a therapy with high efficacy and no severe side effects. We report on a patient with thrombosis of a prosthetic mitral valve who developed severe embolic complications following the administration of the thrombolytic agent. On admission the patient showed signs of incipient cardiogenic shock. The diagnosis of thrombotic obstruction of the prosthetic mitral valve was confirmed by transesophageal echocardiography. The effective valve area was 0.41 cm2. Pulmonary arterial blood pressure and wedge pressure were significantly elevated. A fibrinolytic therapy with recombinant tissue-type plasminogen activator according to the Neuhaus scheme was attempted. Within 60 min after start of treatment the effective valve area increased (1.41 cm2), and the pulmonary capillary wedge pressure decreased. However, peripheral and cerebral embolism occurred. Occlusion of the right brachial and right femoral artery was ascertained by Doppler ultrasound. Embolism into the right leg made an embolectomy with a Fogarty catheter necessary. Computed tomography revealed two lesions located in the occipital and left temporal area of the brain. Correlated with the lesions evaluated in computed tomography, right hemiplegia and complete aphasia was observed. The neurological status of the patient has only slightly improved to the present. To our knowledge no severe persistent neurological deficits following thrombolytic therapy have been reported. We therefore assume that the risk of severe neurological complications is underestimated.(ABSTRACT TRUNCATED AT 250 WORDS)

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