ABSTRACT
BACKGROUND AND AIMS OF THE STUDY: The study aim was to present immediate and late results of a modified technique for mitral valve repair--the 'double-Teflon technique'. This consists of quadrangular resection of the posterior leaflet, annulus plication with 'pledgetted' stitches over a Teflon patch, and leaflet suture. METHODS: Seventy-two patients (41 males, 31 females; mean age 60.5+/-11.9 years) with mitral insufficiency due to myxomatous degeneration and ruptured or elongated chordae tendineae underwent mitral valve repair with this technique. Fifteen patients (18%) had associated cardiovascular disease including coronary artery disease, aortic insufficiency, aortic stenosis and atrial septal defect. Operative, immediate postoperative and late operative echocardiographic data of the first 29 patients were analyzed. Actuarial survival was assessed using the Kaplan-Meier method. RESULTS: There was one operative death (1%). By the late postoperative period, 95% of survivors were in NYHA functional class I. There were no episodes of hemolysis or endocarditis; the linearized rate for thromboembolism was 1.4%/patient-year. Actuarial survival at 72 months was 94.5+/-3.2%. Doppler echocardiography showed a significant decrease in mean left atrial diameter (p = 0.0001) and left ventricular diastolic diameter (p = 0.0003). CONCLUSION: Mitral valve repair with the 'double-Teflon technique' is associated with low operative mortality, satisfactory survival rates, and good clinical outcome.
Subject(s)
Heart Valve Prosthesis Implantation , Heart Valves/pathology , Heart Valves/surgery , Polytetrafluoroethylene/therapeutic use , Adult , Aged , Aged, 80 and over , Biocompatible Materials/therapeutic use , Echocardiography, Doppler , Female , Follow-Up Studies , Heart Valves/diagnostic imaging , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/mortality , Mitral Valve Insufficiency/surgery , Postoperative Complications/etiology , Postoperative Complications/mortality , Postoperative Complications/surgery , Reoperation , Severity of Illness Index , Survival Analysis , Treatment OutcomeABSTRACT
Os autores relatam a experiência com o tratamento de aneurisma e dissecçao da aorta descendente associada ou nao ao comprometimento do arco aórtico com o uso de prótese intraluminal auto-expansível introduzida cirurgicamente através do arco aórtico. foram operados 11 pacientes, 9 do sexo masculino e com idades variando de 49 a 78 anos. O diagnóstico era de aneurisma em 6, sendo 2 rotos e dissecçao em 5, sendo aguda em 2. Quatro doentes apresentavam afecçoes cirúrgicas associadas: aneurisma de aorta ascendente (1), aneurisma de arco (1), insuficiência coronária (1) e insuficiência da valva aórtica (1). Os pacientes foram operados com colocaçao de prótese intraluminal auto-expansível cirurgicamente através do arco aórtico sob hipotermia profunda e parada circulatória total. Em 4 pacientes foram realizadas operaçoes associadas: troca da valva aórtica (1), substituiçao da aorta ascendente (2), troca do arco aórtico (1) e revascularizaçao miocárdica (1). Houve um óbito intra-operatório por dissecçao da aorta ascendente e dois óbitos hospitalares por associaçao de complicaçoes. Oito pacientes tiveram alta sendo que 1 faleceu no terceiro mês de pós-operatório. Os sobreviventes estavam bem clinicamente e o estudo por imagem mostrou adequada correçao da doença. Os autores concluem que o uso da prótese intraluminal simplifica e corrige adequadamente as afecçoes da aorta descendente. A morbimortalidade observada nessa série deve-se a outros fatores indenpendetes da técnica.