Late results of valve replacement experience of the National Heart Institute Imbaba Cairo Egypt

ABSTRACT

A randomized retrospective study of 5 years follow up of all valve replacement of a series inserted in The National Heart Institute has been done to evaluate the late results of such a procedure. Between January 1st 1984 and December 31st 1988 a total number of 958 valve prosthesis were inserted in 685 patients, The immediate post-operative mortality is 46 patients [6,71%] of different causes. This work concerns the long term results of the 639 patients discharged from hospital after the post-operative period. A follow up of these patients between 32 months and 81 months [mean period of 47,23 months] showed that 496 pts are living [survival rate 77,62%]. None of the patients of this series were lost to follow up. Out of the 496 pts, 322 pts have improved post-operatively the quality of their life; 82 pts are living postoperatively in stage II NYHA and 92 in stage III NYHA living on digitalo-diuretic therapy and vasodilators. The pre-operative state of the heart, the quality of myocardial protection which were standardized in all patients of the series and the wall stress of LV played an important role in post-operative results. Out of the 143 dead patients, 82[57,34%] died of anticoagulation problems, 23 pts [16,08%]from endocarditis, 6[4,19%] from aseptic detachment of prosthesis; 10 [6,99%] valve prosthesis dysfunction; 22 [15,38%] the cause of death is unknown. No haemolysis occurred as a late complication. Apart from the Wessex and the Ionescu valve prosthesis, there was no significant difference between the different prostheses used in this series. From the above results one may conclude, that valve replacement is not the ideal treatment. All efforts should be directed to preserve the patients native valve as long as possible. anticoagulation problems and endocarditis are the main complications of valve replacement in Egypt. Well selected patients for valve replacement improve considerably the post-operative functional results: