RESUMO
BACKGROUND: We sought to determine the incidence of hospital death due to surgical compromise of the coronary ostia in aortic valve replacement. The mechanism of coronary ostium blockage was also investigated. METHODS: A retrospective review was conducted of prospectively collected clinical data and autopsy findings in 322 patients who died in hospital after aortic valve replacement with or without concomitant procedures in a single institution from January 1998 to March 2013. RESULTS: Over the 15-year period, more than 17 surgeons performed 7507 aortic valve replacements with or without other procedures. The mean age of the patients was 70.8 ± 11.78 years and 63% were male. Bioprosthetic valves were used in 75%, mechanical valves in 24.7%, and homografts in only 0.3%. Early mortality for all patients (combined, emergency, and redo procedures) was 4.29% (mean logistic EuroSCORE 10.7). There were 322 deaths after procedures involving the aortic valve. Autopsy examinations were carried out in all patients and showed that 3.4% (n = 11) of deaths were at least partly attributed to encroachment on one or both coronary ostia. Causes of ostial compromise included the valve sutures, the valve sewing ring, and the aortotomy suture line. CONCLUSIONS: Coronary ostial compromise in aortic valve replacement is a very rare but real problem occurring in at least 0.15% of aortic valve replacements and contributing to or directly causing one in every 29 aortic valve replacement deaths. Surgeons should have a high level of awareness of the risk of this rare but fatal and avoidable complication.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Estenose Coronária/etiologia , Implante de Prótese de Valva Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/métodos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Estenose da Valva Aórtica/mortalidade , Autopsia , Estenose Coronária/mortalidade , Estenose Coronária/patologia , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/patologia , Estudos RetrospectivosAssuntos
Tubos Torácicos/efeitos adversos , Traumatismos Cardíacos/etiologia , Ventrículos do Coração/lesões , Hemopneumotórax/cirurgia , Sucção/efeitos adversos , Idoso , Procedimentos Cirúrgicos Cardíacos , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/cirurgia , Hemopneumotórax/diagnóstico por imagem , Humanos , Masculino , Radiografia , Sucção/métodos , Resultado do TratamentoRESUMO
Mortality and quality of cardiac surgery are inextricably linked. Mortality can be a suitable measure of the quality of the service as long as risk is taken into account, using one of a variety of available risk models. The measurement of risk-adjusted mortality can provide the tools with which to improve cardiac surgical outcomes, as well as open up an exciting area of future study to identify where further improvements can be made.