Article

lock Open Access lock Peer-Reviewed

444

Views

ORIGINAL ARTICLE

Clinical results with a new "Stentless" aortic bioprosthesis

Bayard Gontijo Filho; Mário O Vrandecic; Mário Morea; Kjell Radegran; João Alfredo de Paula e Silva; Fernando Antônio Fantini; Juscelino Teixeira Barbosa

DOI: 10.1590/S0102-76381992000300008

ABSTRACT

From May/1990 to March/1992, 81 "Stentless" porcine bioprosthesis were implanted in the aortic position in three Centers: Biocor Institute (34 patients), University of Torino (31 patients) and Karolinska Hospital (16 patients). The age ranged from 14 to 85 years, with a mean age of 51. There were 48 male patients and 33 femele; the post operative follow-up ranged from 1 to 22 months (mean = 7 months). The main indication was aortic stenosis. There were 5 patients with acute endocarditis of the native aortic valve, with significant hemodynamic impairment, and presence of annular abscesses in 3 of them. All patients were operated on under moderate hypothermia and myocardial protection, with cristalloid cardioplegia. The "Stentless" bioprosthesis was inserted using two layers of a 4-0 Prolene running suture. All patients survived the operation; there were 4 early deaths (4.93%) and one late death secundary to pulmonary embolism (16 th months post. op.). The major hospital complication was complete AV block in 7 patients. All patients are in regular clinical follow-up, including hemodynamic assessment by echodopplercardiography. The preliminary data show an excellent hemodynamic performance of the "Stentless" bioprosthesis.

RESUMO

No período de maio de 1990 a março de 1992, 81 pacientes foram submetidos a implante de urna bioprótese aórtica sem suporte Stentlessem três centros: Biocór Hospital (34 pacientes), Universidade de Turim (31 pacientes) e Hospital Karolinska (16 pacientes). A idade variou de 14 a 85 anos, com média de 51 anos. Quarenta e oito pacientes eram do sexo masculino e 33 do sexo feminino. O período de acompanhamento pré-operatório variou de 1 a 22 meses. A principal indicação para a cirurgia foi a estenose aórtica, destacando-se 5 pacientes que apresentavam endocardíte aguda da valva aórtica com presença de severo comprometimento do anel em 3 deles. Todos os pacientes foram operados sob hipotermia moderada e proteção miocárdica com cardioplegia cristalóide. A técnica básica do implante da bioprótese foi com duas camadas de chuleio contínuo de Prolene 4 zeros. Todos os pacientes sobreviveram à cirurgia. Houve 4 (4,93%) óbitos no pós-operatório imediato e 1 (1,23%) óbito tardio no 16º mês de pós-operatório secundário a trombo-embolismo pulmonar. A principal complicação pós-operatória foi o bloqueio AV total, em 7 pacientes. O estudo ecocardiográfico realizado em todos os pacientes mostrou gradientes que variaram de 6 a 12 mmHg. Todos os pacientes encontra-se em controle clínico, incluindo avaliação hemodinâmica pela ecodopplercardiografia. Os resultados preliminares desta nova bioprótese são promissores com relação à sua performance a longo prazo, sendo a observação tardia fundamental na confirmação dos excelentes resultados iniciais.
Full text available only in portuguese PDF format.

REFERENCES

1. ANGELL, W. W.; ANGELL, J. D.; OURY, J. H.; LAMBERTI, J. J.; GREHL, T. M. - Long term follow-up of viable aortic homografts: a viable homograft bank. J. Thorac. Cardiovasc. Surg., 93: 815-822, 1987. [MedLine]

2. BAILEY, C. P.; GLOVER, R. P.; O'NEIL, T. J. E.; RAMIREZ, R. H. P. - Experiences with the surgical relief of aortic stenosis. J. Thoracic. Cardiovasc. Surg., 20: 516-541, 1950.

3. BARRAT-BOYES, B. G. - Homograft aortic valve replacement in aortic imcompetence and stenosis. Thorax., 19: 131-150, 1964. [MedLine]

4. CARPENTIER, A.; LEMAIGRE, C. G.; ROBERT, L.; CARPENTIER, S.; DUBOST, C. - Biological factors affecting long term results of valvular heterografts. J. Thorac. Cardiovasc. Surg., 58: 467-483, 1969. [MedLine]

5. CURRIE, P. J.; SEWARD, J. B.; REEDER, G. S.; VLIETSTRA, R. E.; BRESNAHAN, D. R.; BRESNAHAN, J. F.; SMITH, H. C.; HAGLER, D. J.; TAJIK, A. J. - Continous wave Doppler ecocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler catheter correlative study in 100 adult patients. Circulation, 71: 1162-1169, 1985. [MedLine]

6. DAVID, T. E. & POLLICK, J. - Aortic valve replacement with Stentless porcine aortic bioprosthesis. J. Thorac. Cardiovasc. Surg., 99: 113-118, 1990. [MedLine]

7. DURAN, G. M. G.; MANLEY, G.; GUNNING, A. J. - The behaviour of homo-transplanted aortic valves in the dog. Br. J. Surg., 52: 549-552, 1965. [MedLine]

8. GOFFIN, Y. A.; BLACK, M. M.; LAWFORD, P. V. - The stability and performance of bioprosthetic heart valves. Curr. Pespectives Implant. Devices, 2: 65-120-126, 1990.

9. MURRAY, G.; ROSCHLAU, W.; LOUGHEED, W. - Homologous aortic and mitral insufficiency. Angiology, 7: 466-471, 1956. [MedLine]

10. ROSS, D. N. - Homograft replacement of the aortic valve. Lancet, 2: 487-488, 1962.

11. SKJAERPE, T. & HEGRENAES, L. - Non-invasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation, 72: 810-818, 1985. [MedLine]

12. TEMPLETON, T. Y. & GIBBON, J. H. - Experimental recontruction of cardiac valves by venous and pericardial grafts. Ann Surg., 129: 161-176, 1949. [MedLine]

13. WILLAM, V. L.; ZAFIRACOPOULOS, P.; HANLON, C. R. - Replacement of mitral valves with homograft aortic valve. In: Prosthetic valves for cardiac surgery. Springfield, Charles C. Thomas, 1961. p. 142.

CCBY All scientific articles published at www.bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY