Substituição valvar mitral com papilopexia cruzada e constrição anular em pacientes com insuficiência cardíaca

Abstract

Substituição valvar mitral com papilopexia cruzada e constrição anular em pacientes com insuficiência cardíacaMitral valve replacement with crossed papillopexy and annular constriction in heart failure patients Abstract Objective: To analyze the short-term and mid-term followups of patients with heart failure and moderate to severe mitral valve insufficiency and who have undergone mitral valve replacement with crossed papillopexy and annular constriction.Methods: Thirteen patients in NYHA functional class III or IV, with a mean age of 54.1 years and with idiopathic etiology, underwent mitral valve replacement with ring constriction and crossed papillopexy. Echocardiograph parameters, functional class and survival actuarial curve were analyzed.Results: There were no deaths during surgery or in the postoperative period. The mean left ventricular diastolic diameter was reduced from 71 ± 8.6 mm to 65.3 ± 8.6 mm (p=0.049) and the mean left ventricular systolic diameter was reduced from .1 ± 8.5 mm to 50.4 ± 11.1 mm (p=0.002). The atrial diameters varied from 49.4 ± 6.4 mm to 44 ± 5.9 mm (p=0.017); the percentage of the left ventricular shortening was 17 ± 4 % to 24 ± 8.3% (p=0.014); the ejection fraction varied statistically and significantly from 34 ± 9% to 45 ± 14% (p=0.008). Eleven (84.6%) patients were in FC I and II. At 1, 6 and 12 months after follow-up surgery, the survival rate was 100%, 82.6%, 71.6%, respectively. This rate was maintained at 7.6% for more than 36 months. Conclusion:The results obtained from patients with heart failure and moderate to severe mitral valve insufficiency and who underwent mitral valve replacement with crossed papillopexy and annular constriction presented evidence of improved heart remodeling and significant improvement in left ventricular performance.

Cirurgia da insuficiência mitral no tratamento da insuficiência cardíaca avançada

“…In Brazil, it is important to emphasize the studies by Gomes et al [63] and Benfatti et al [64] about the benefits of MV replacement using the technique of cross papiloplexia in patients with heart failure and moderate/ severe MI ( Figure 6). In these studies, the group found that this technique was able to promote a significant left ventricular functional improvement as well as favorable ventricular and atrial remodeling.…”

“…It is also important to highlight the original idea of Gomes et al [63], in Belo Horizonte, of association of crossed papillopexy to valve replacement in patients with DC and FMI, and have been useful in reversing at least partially, the dilation of the left atrium and ventricle, with significant functional recovery of the latter [64].…”

Circulação Extracorpórea

“…Entering the heart chambers was made possible by this discovery in an almost bloodless field and to correct birth [7][8][9][10] or acquired defects [11][12][13][14][15], which restricted the lives of those who had the misfortune to present problems in the blood propulsive organ and in their own lives.…”