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ORIGINAL ARTICLE

Replacement of heart valves prostheses

Pablo M. A Pomerantzeff; Mário César S. de Abreu; Marisa Amato; Miguel Moretti; José Otávio C Auler Júnior; Max Grinberg; Flávio Tarasoutchi; Alfredo Mansur; Altamiro Ribeiro Dias; Delmont Bittencourt; Noedir A. G Stolf; Geraldo Verginelli; Adib D Jatene

DOI: 10.1590/S0102-76381987000300005

ABSTRACT

Replacement of valvular prosthesis is an increasingly frequent procedure in heart surgery. Better results are attained with the observation of correct indication and improved surgical technique. In the period of January 1984 to June 1986, 145 patients were submitted to prosthesis replacement, at our Institution. These patients received a total of 157 prostheses and 4 had their Starr-Edwards valve ball replaced due to ball variance. Six patients were submitted to a third valvular replacement in the mitral position, withouth deaths. Nine patients had a third valvular replacement in the aortic position with 1 death in the immediate postoperative period. Rupture or calcification of the dura mater leaflets were the main reason for the indication of prosthetic replacement. In the mitral position 41 patients presented rupture of the leaflets and 19 showed calcification. In the aortic position 32 bioprostheses underwent rupture and 12, calcification. Bio-prostheses were utilized in the majority of cases of replace the dysfunctioning prostheses. Porcine bioprostheses were implanted in 63 cases and bovine pericardial bioprostheses, in 35. Immediate mortality was 8.3% (12 patients); low cardiac output was the main cause of death. The most frequent immediate complications were low cardiac output, arrhythmias and bleeding. In the preoperative period 90% of the patients were in functional classes III and IV (NYHA). After the replacement, 89% of the aortics and 82% of the mitral were in functional classes I an II.

RESUMO

A reoperação de próteses valvulares tem sido realizada, com freqüência cada vez maior, nos vários Serviços de cirurgia cardíaca. Os detalhes do tratamento, a indicação e a técnica operatória melhoraram os resultados. No período de janeiro de 1984 a junho de 1986, no Instituto do Coração, foram submetidos a retroca valvular 145 pacientes, num total de 157 próteses, e 4 trocas da bola de válvula de Starr-Edwards. Em posição mitral, 6 pacientes foram submetidos a terceira troca valvular, sem óbito imediato. A insuficiência valvular e a calcificação do tecido biológico de dura-máter foram as principais causas de indicação da reoperação. Quarenta e um pacientes apresentavam roturas e 19 pacientes, calcificação de bioprótese em posição mitral; em posição aórtica, 32 pacientes tinham rotura e 12, calcificação de bioprótese. Quanto à prótese implantada, foram utilizadas principalmente as biopróteses, sendo 63 porcinas e 35 de pericárdio bovino. A mortalidade imediata global foi de 8,3% (12 pacientes), sendo a principal causa de óbito o baixo débito cardíaco. As principais complicações imediats foram: baixo débito cardíaco, arritmias e sangramento. Noventa por cento dos pacientes encontravam-se em classe funcional (NYHA) III e IV no pré-operatório, evoluindo para as classes funcionais I e II em 89% das trocas aórticas de 82% das trocas mitrais. A curva atuarial de sobrevida.em 5 semestres, foi, para a posição mitral, de 85,7% e, para a aórtica, de 91,3%. Os autores concluem que os cuidados de técnica, a proteção miocárdica e o tipo de prótese utilizada foram os responsáveis pelos resultados bastante satisfatórios.
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