RESUMEN
From March 1971 through April 1975, one hundred twenty patients underwent mitral valve replacement with a Hancock "stabilized glutaraldehyde process" porcine aortic xenograft. A simultaneous canine experimental series was also carried out. In the clinical series, the early mortality was 8.3%. Actuarial analyses of all patients predicts survival at two years of 81.0% and at four years of 70.0%. The predicted survival for patients without coronary disease or prior prosthetic valve replacement is 87.5% at two years and 77.5% at four years. There were four thromboembolic episodes, a rate of 2.4% per patient-year. None were fatal. No valve failure were noted. Histologic examination and shrink temperature analysis of recovered valves show excellent tissue preservation at 40 months. The data indicate that the Hancock valve is durable, enjoys a low incidence of thromboembolism, and may be the valve of choice for mitral valve replacement.
Asunto(s)
Aldehídos , Válvula Aórtica/trasplante , Glutaral , Válvula Mitral/cirugía , Trasplante Heterólogo , Adulto , Anciano , Animales , Encefalopatías/inducido químicamente , Procedimientos Quirúrgicos Cardíacos/mortalidad , Enfermedad Coronaria/complicaciones , Perros , Endocarditis Bacteriana/etiología , Estudios de Evaluación como Asunto , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Hematoma/inducido químicamente , Humanos , Masculino , Métodos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Complicaciones Posoperatorias , Porcinos , Tromboembolia/etiología , Tromboflebitis/prevención & control , Warfarina/efectos adversos , Warfarina/uso terapéuticoRESUMEN
The low mortality of isolated mitral valve (MV) replacement permits attention to be focused on those valve-related factors which affect the quality of life after operation. Comparison of a number of MV prostheses indicates that all perform satisfactorily from the hemodynamic standpoint. An asset of the "stabilized glutaraldehyde process" (SGP) Hancock bioprosthesis (H-B) is the significantly lower incidence of thromboembolism encountered in patients who have not been permanently anticoagulated. While additional time is required before meaningful durability comparisons can be made, the absence of valve failure and the low incidence of tissue dysfunction in H-B over 6 1/2 years is encouraging. Although the ideal device for replacing the MV is not yet available, the Hancock SGP bioprostheses represent the best compromise of available choices.
Asunto(s)
Aldehídos , Glutaral , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Coagulación Sanguínea , Presión Sanguínea , Estudios de Evaluación como Asunto , Frecuencia Cardíaca , Prótesis Valvulares Cardíacas/efectos adversos , Humanos , Válvula Mitral/citología , Tromboembolia/etiología , Factores de TiempoAsunto(s)
Prótesis Valvulares Cardíacas , Animales , Válvula Aórtica/trasplante , Bovinos , Fascia/trasplante , Rechazo de Injerto , Hemodinámica , Humanos , Válvula Mitral/trasplante , Pericardio/trasplante , Diseño de Prótesis , Ovinos , Porcinos , Trasplante Heterólogo , Trasplante Homólogo , Válvula Tricúspide/patología , Válvula Tricúspide/trasplanteAsunto(s)
Cardiopatías Congénitas/cirugía , Prótesis Valvulares Cardíacas , Ventrículos Cardíacos/anomalías , Arteria Pulmonar/anomalías , Arteria Pulmonar/cirugía , Válvula Pulmonar/cirugía , Adolescente , Adulto , Animales , Válvula Aórtica/cirugía , Válvula Aórtica/trasplante , Cateterismo Cardíaco , Niño , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Humanos , Métodos , Tereftalatos Polietilenos , Porcinos , Tetralogía de Fallot/cirugía , Factores de Tiempo , Trasplante Heterólogo , Transposición de los Grandes Vasos/cirugíaRESUMEN
The development of the prosthetic heart valve has led to the evolution of cardiac intensive care units, a better understanding of cardiac function and biocompatible materials, and new surgical procedures. Initial efforts with formaldehyde-fixed valves did not have long-term success. They led to the development of the stabilized glutaraldehyde process (SGP) valve and the flexible stent. The safety and efficacy of a heart valve bioprosthesis has been demonstrated through laboratory and animal experiments. Data on long-term clinical implants are needed to validate the results of these experiments.
Asunto(s)
Prótesis Valvulares Cardíacas/métodos , Válvulas Cardíacas/trasplante , Animales , Glutaral , Humanos , Porcinos , Conservación de Tejido , Trasplante HeterólogoRESUMEN
Collagen from the cardiovascular system is extremely resistant to proteolytic digestion, in contrast with the proteoglycans of these connective tissues. In particular this is true for the heart valves, which contain the largest proportion of collagen. The tensile strength of aortic tissue incubated at 37 degrees C declines rapidly unless fixed with aldehydes. Stabilized glutaraldehyde gives rise to the most stable form of cross-link and renders the tissue structurally intact after more than 4 years of incubation at 37 degrees C in physiological solution. Formaldehyde, on the other hand, gives rise to transcient cross-links.