Preservation of the subvalvular apparatus during mitral valve replacement of rheumatic valves does not affect long-term survival.

OBJECTIVES: The importance of preservation of the subvalvular apparatus (PSVA) during mitral valve replacement (MVR) in non-rheumatic mitral valves is well recognized. Our aim was to analyse the impact of PSVA in MVR for rheumatic valves on long-term survival. METHODS: From January 1992 to December 2012, 605 consecutive patients with rheumatic mitral valve disease were submitted to MVR. PSVA (limited to the posterior leaflet) was achieved in 224 (37.7%) patients. Follow-up was 4259 patient-years, and complete for 97% of the patients. Propensity score analysis was introduced to reduce selection bias. RESULTS: Patients with PSVA were slightly older (61.9 vs 59.8 years, P = 0.014), with lower incidence of calcification (54.9 vs 63.0%, P = 0.05), pure mitral stenosis (29.9 vs 38.9%, P = 0.014) and history of rheumatic fever (44.6 vs 53.9%, P = 0.028). Mechanical prostheses were more frequently implanted in the Non-PSVA group (75.1 vs 65.6%, P = 0.013). Thirty-day mortality was 1.1%. Late survival rates at 5, 10 and 18 years were 86.6 ± 2.0, 70.8 ± 3.2 and 48.0 ± 5.1%, respectively, with no difference between groups. Both groups had compromised late survival when compared with the general population (age and gender matched, P < 0.001). Only age, large left atrium, pulmonary hypertension and 'pure' MR appeared as independent predictors for late mortality. There was no difference regarding adverse valve-related events between groups. CONCLUSIONS: Patients submitted to MVR for rheumatic mitral valve disease have a poor prognosis, independently of having the subvalvular apparatus preserved. PSVA did not improve late survival in this setting.

[Surgery of bronchiectasis: what have changed in the last ten years?]. / Cirurgia das bronquiectasis: O que mudou em dez anos?

Bronchiectasis is defined as chronic abnormal dilatation and distortion of the bronchi. Surgery continues to be play an important role in the treatment of this disease especially in focal disease which is both curative. The objective of this study is to characterize the patients who underwent surgical resection of bronchiectasis in 10 years and compare them with patients operated by the same pathology in the previous 10 years. We conducted a review of cases of 78 patients operated in the 2000 ' s and the results were compared with those obtained in the study by the same professional service, referring to the previous decade. We assessed sex, age, symptoms, number of years with symptoms, complementary exams performed prior to surgery, indications for surgery, previous pulmonary diseases, location of bronchiectasis, type of surgical approach, number of hospitalization days and complications of surgery. In the last decade a smaller number of patients with bronchiectasis ( 78 versus 119 ) were submitted to thoracic surgery. In both groups the right lung and the lower lobes were the most affected and the majority of patients was submitted to lobectomy. In the last decade a lower percentage of complications was registed ( 6.4 %, versus 15.0 % (. The surgery was considered to be curative in 94.9 % and only 91 % in the 90 ' s. This study would support the idea that the surgery of bronchiectasis continues to be an excellent alternative to the treatment of localized forms of the disease and its complications.