Multiple valve replacement with pericardial xenograft. Clinical and haemodynamic study.

Abstract

SUMMARY Multiple valve replacement with pericardial xenografts (sizes 17 to 31) was undertaken in 76 patients. The incidence of early and late deaths was 10-5 and 3 9 per cent, respectively. Actuarially it is predicted that 94 7+3-9 per cent of hospital survivors will be alive at three and a half years after valve replacement. Though long-term anticoagulants were not used, thrombotic valve obstruction was not seen in this series. A systemic embolus occurred early in one case only (0 95 episodes/100 patient years). Mechanical dysfunction of the pericardial xenograft has not been seen.Haemodynamic studies were performed in seven patients, eight to 21 months after valve replacement. The transvalvular gradients were negligible across the aortic pericardial xenografts. Gradients across mitral and tricuspid xenografts were small. The calculated surface areas ranged from 1P0 to 1-4 cm2 for aortic, 1-7 to 2-1 cm2 for mitral, and 2-0 to 2-4 cm2 for tricuspid valves.These results after multiple valve replacement are comparable to those reported with isolated mitral or aortic pericardial xenografts over a similar period of observation.

Performance of the lonescu-Shiley Pericardial Valve in the Aortic Position: 100 Months Clinical Experience

“…It is common practice to report the linearized incidence of thromboembolism in patients with an aortic valve replacement without separating those with associated mitral valve pathology. As extensively proved in the literature, pati ents with mitral valve replacement have a higher incidence of thromboembolic episodes (3 ,8,II,12,14,18). In our series, the group of patients with associated cardiac surgery had a linearized incidence of thromboembolism of more than double that of the group undergoing isolated aortic valve replacement (0 .78 % versus 0.33 %).…”

Does the mitral valve prosthesis adversely affect the hemodynamic performance of the aortic valve prosthesis in patients with double valve replacement?

“…This is particularly true when the mitral valve is replaced by bioprosthetic valves with stents that may protrude into the LVOT if incorrectly oriented during implantation. A study 1 published in 1980 on the hemodynamic features of 7 patients who underwent combined aortic valve replacement (AVR) and mitral valve replacement (MVR), that is, double valve replacement (DVR), with pericardial bioprostheses suggested that the effective orifice areas were similar to those of historical controls of patients who underwent isolated AVR.…”