Document Detail


The mitral pulmonary autograft: assessment at midterm.
MedLine Citation:
PMID:  15223403     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is a dire need, especially in emergent societies, for a mitral substitute that does not require anticoagulation, and is not affected by early degeneration. METHODS: Between 1997 and 2003, 80 patients had successful mitral valve replacement with a pulmonary autograft. Fifty-five patients were female, and the mean age was 39.3 years. Seventy-eight patients had rheumatic mitral disease and 2 congenital. The autograft was placed inside a rigid Dacron tubing for support, and the right ventricular outflow was reconstructed with a xenograft or a homograft. Recently we have used microwave energy to ablate atrial fibrillation when present. RESULTS: Intraoperative transesophageal echocardiography revealed adequate mitral valve areas (mean area 2.76 cm2) and acceptable mitral gradients (mean 4.3 mm Hg) in all 80 patients. There was no mitral regurgitation or trace amounts in 61 patients, and mild regurgitation in 19. Operative mortality was 5.0%, and late mortality clearly related to the procedure 6.25%. Follow-up was complete except for 2 lost patients, with a mean of 25 months, and echocardiographic findings were generally stable during follow-up. One patient developed uncritical mitral stenosis and another uncritical stenosis and insufficiency during 4 to 5.5 years. Four more patients had progression of mitral regurgitation from "mild" to "moderate" over a period from 8 months to 3 years. Uncritical xenograft pulmonic stenosis developed in 2 patients. Most of the surviving patients (83%) remain in class I status. CONCLUSIONS: We believe the pulmonary autograft is a good mitral substitute at the disposal of cardiac surgeons, especially when patients are young and when life anticoagulation is contraindicated or impractical.
Authors:
Sami S Kabbani; Hisham Jamil; Abdo Hammoud; Jawad Abou Hatab; Fawzi Nabhani; Ryad Hariri; Nada Sabbagh; Donald Ross
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Review    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  78     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-06-29     Completed Date:  2005-05-05     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  60-5; discussion 65-6     Citation Subset:  AIM; IM    
Affiliation:
Damascus University Cardiovascular Surgical Center, Damascus, Syria. dam-uncv@net.sy
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Atrial Fibrillation / etiology,  surgery
Bioprosthesis*
Calcinosis / surgery,  ultrasonography
Child
Child, Preschool
Echocardiography, Transesophageal
Electrocoagulation
Female
Follow-Up Studies
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / instrumentation,  methods*,  mortality
Humans
Male
Microwaves / therapeutic use
Middle Aged
Mitral Valve Insufficiency / complications,  surgery,  ultrasonography
Mitral Valve Stenosis / surgery*,  ultrasonography
Pericardium
Polyethylene Terephthalates
Postoperative Complications / epidemiology,  mortality
Prostheses and Implants
Pulmonary Valve / transplantation*
Recurrence
Rheumatic Heart Disease / complications,  surgery,  ultrasonography
Transplantation, Autologous*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Polyethylene Terephthalates

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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