Resultados tardios da plastia mitral em pacientes reumáticos

Severino, Elaine Soraya Barbosa de Oliveira; Petrucci, Orlando; Vilarinho, Karlos Alexandre de Souza; Lavagnoli, Carlos Fernando Ramos; Filho, Lindemberg da Mota Silveira; Oliveira, Pedro Paulo Martins de; Vieira, Reinaldo Wilson; Braile, Domingo Marcolino

doi:10.5935/1678-9741.20110045

Cited by 15 publications

(10 citation statements)

References 15 publications

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“…The results in this study may differ from those found in the literature due to the sample size, as well as the age: the younger the sample, the higher the mortality rate and the higher the early rate of valve failure. [15][16][17] In addition, postoperative TI was also a predictor of univariate analysis in this study, both in the immediate postoperative period and in the late postoperative period, but it lost significance in the multivariate analysis. No associations were found in the literature reviewed, but, like PH, TI is a criterion that should be valued.…”

Section: Discussionmentioning

confidence: 48%

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease

Cruz

Santos

et al. 2019

Arquivos Brasileiros De Cardiologia

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Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results.Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease.Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant.Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion:The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.

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Section: Discussionmentioning

confidence: 48%

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease

Cruz

Santos

et al. 2019

Arquivos Brasileiros De Cardiologia

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“…With that policy, the incidence of recurrent moderate or severe MR has been low, although we often must accept smaller final effective orifice areas (around 1.8 - 2.5 cm 2 ) in patients with mixed lesions. In our country, Severino et al [ 24 ] and Pomerantzeff et al [ 25 ] have also shown the apparent feasibility and advantages of MVR in rheumatic patients. On the other hand, it must be emphasized that most rheumatic patients in this study had the so-called "burn-out" disease, that is less susceptible to newer acute inflammatory bursts of rheumatic fever, besides being carefully oriented and controlled with lifelong antibiotic prophylaxis against the disease [ 11 ] .…”

Section: Discussionmentioning

confidence: 94%

Long-Term Results of Mitral Valve Repair

Costa¹,

Colatusso²,

Martin³

et al. 2018

Braz J Cardiovasc Surg

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IntroductionCurrent guidelines state that patients with severe mitral regurgitation should be treated in reference centers with a high reparability rate, low mortality rate, and durable results.ObjectiveTo analyze our global experience with the treatment of organic mitral regurgitation from various etiologies operated in a single center.MethodsWe evaluated all surgically treated patients with organic mitral regurgitation from 2004-2017. Patients were evaluated clinically and by echocardiography every year. We determined early and late survival rates, valve related events and freedom from recurrent mitral regurgitation and tricuspid regurgitation. Valve failure was defined as any mitral regurgitation ≥ moderate degree or the need for reoperation for any reason.ResultsOut of 133 patients with organic mitral regurgitation, 125 (93.9%) were submitted to valve repair. Mean age was 57±15 years and 52 patients were males. The most common etiologies were degenerative disease (73 patients) and rheumatic disease (34 patients). Early mortality was 2.4% and late survival was 84.3% at 10 years, which are similar to the age- and gender-matched general population. Only two patients developed severe mitral regurgitation, and both were reoperated (95.6% at 10 years). Freedom from mitral valve failure was 84.5% at 10 years, with no difference between degenerative and rheumatic valves. Overall, late ≥ moderate tricuspid regurgitation was present in 34% of the patients, being more common in the rheumatic ones. The use of tricuspid annuloplasty abolished this complication.ConclusionWe have demonstrated that mitral regurgitation due to organic mitral valve disease from various etiologies can be surgically treated with a high repair rate, low early mortality and long-term survival that are comparable to the matched general population. Concomitant treatment of atrial fibrillation and tricuspid valve may be important adjuncts to optimize long-term results.

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“…Several groups from Brazil, South Africa, and other southern hemisphere countries have similarly reported excellent long-term survivals and good survival free from reoperation. 21 Remenyi et al, from Auckland, New Zealand, recently reported their experience with patients with rheumatic heart disease under 20 years of age, with a follow-up to 19 years. They concluded that “repair offers a survival advantage, greater freedom from valve-related morbidity, and long-term durability that equals that of mitral valve replacement”.…”

Section: Current Resultsmentioning

confidence: 99%

Challenges in rheumatic valvular disease: Surgical strategies for mitral valve preservation

Antunes

2015

Global Cardiology Science and Practice

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In developing countries, rheumatic fever and carditis still constitutes a major public health problem. Patients have special characteristics that differ from those with rheumatic mitral valve disease we still see in developed countries. They are usually young, poor, uneducated, and have low compliance to prophylaxis / therapy. In addition, they usually have great difficulty in accessing medical care. In these situations, the rate of complications associated to valve replacement is significantly increased. Alternatively, mitral valve repair is now known to achieve better long-term results in this pathology, but this was not widely recognized three or four decades ago, when first reports showed worse results after repair of rheumatic regurgitation than with degenerative valves. This has been reported by several groups in developing countries in different continents, with high incidence of repairs and excellent long term results. It is, therefore, becoming increasingly clear that, although, the results may not compare to those obtained with degenerative pathology, repair of rheumatic valves, when feasible, is the procedure of choice, especially in these underprivileged populations.

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Resultados tardios da plastia mitral em pacientes reumáticos

Cited by 15 publications

References 15 publications

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease

Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease

Long-Term Results of Mitral Valve Repair

Challenges in rheumatic valvular disease: Surgical strategies for mitral valve preservation

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