Use of bovine pericardial tissue for aortic valve and aortic root replacement: long-term results.

BACKGROUND AND AIMS OF THE STUDY: The study aimed to determine the clinical performance of bovine pericardial aldehyde-treated products alone or in combination with aortic leaflets of porcine origin. These included a composite porcine stentless aortic valve attached to a scalloped pericardial tube (BSAV), and valved and non-valved bovine pericardial conduits for use in left-sided heart lesions (BPG). METHODS: For BSAV grafts, between January 1990 and August 1996, 163 patients (119 males) had their aortic valves replaced by SJM Biocor BASV. Mean age was 37.9 +/- 17.6 years (range: 1 to 76 years). Rheumatic heart disease sequelae (n = 72) and replacement of a prosthetic heart valve (n = 46) were predominant. Preoperative NYHA functional class showed 90 patients (55.2%) in class III and 50 (30.7%) in class IV. BPVC and NVPC grafts were used in 166 patients: acute aortic dissection was the main indication in 52 (31.3%) and chronic in 36 (21/7%). The ascending aorta was involved in 141 patients (84.9%); grafts were seldom used at other sites. In most patients the graft implanted was either a non-valved (n = 79) or a valved (n = 75) pericardial conduit. Twelve patients had a localized lesion and required a patch repair. RESULTS: For BASV grafts, the non-valve-related hospital mortality rate was 4.9%. There were 14.7% non-fatal complications with full recovery of all patients. Mean follow up in 141 patients was 3.0 +/- 1.4 years (range: 1 month to 7.2 years); 14 patients were lost to follow up. Late, non-conduit-related, mortality occurred in seven patients (4.9%). Eight patients underwent reoperation. The current clinical follow up of 127 patients has shown 118 (92.9%) with competent valves and nine (7.0%) with mild stable aortic insufficiency. For BPVC and NVPC grafts, hospital mortality rate was 16.9%, death being related to poor preoperative clinical condition. Postoperative follow up was accomplished in 125 patients; reoperation was necessary in seven patients. Histology showed good tissue preservation up to five years; echocardiography revealed satisfactory findings. No valved conduit had to be reoperated for valve or pericardial tissue wear. CONCLUSIONS: Clinical results of left-sided heterologous pericardial grafts have shown excellent performance over time. The BASV (over seven years) and BPVC and NVPC (eight years) have demonstrated superior results as aortic valves alone or in combination with a pericardial conduit.

Retrospective clinical analysis of stented vs. stentless porcine aortic bioprostheses.

OBJECTIVE: The study was designed to compare hemodynamic performance, structural failure and survival of patients undergoing aortic valve replacement (AVR) with a composite aortic stented or stentless porcine bioprosthesis. METHODS: From January 1990 to June 1999, the clinical data of 725 patients undergoing AVR with stented porcine aortic bioprosthesis were reviewed. We defined two groups of patients with similar clinical characteristics: 202 patients receiving aortic stented and 205 patients stentless valves. The two patients groups were similar in age, sex, valve lesion, valve size, preoperative New York Heart Association (NYHA) class status and follow-up. RESULTS: The number of patients available for follow-up, excluding hospital and late mortality, reoperations and patients lost to follow-up, was 157 for the stented and 175 for the stentless group. There was a higher incidence of rheumatic heart disease in the stented (59%) vs. stentless group (44%), (P=0.003). Fewer patients had prior aortic bioprosthetic dysfunction in the stented (7.6%) compared to the stentless group (25%) (P<0.001). The mean intensive care unit stay, hospital mortality and late mortality were similar (P, NS). The total complication rate was higher in the stented (12%) than the stentless (3.4%)(P=0.005). Valve related death was higher in the stented (2.5%) than the stentless (0%) (P=0. 049). Postoperatively, the aortic effective orifice area (AEOA) was larger (P<0.001) and the transvalvular peak and mean gradients were lower in the stentless group (P<0.001). The leaflet tissue degeneration analysis was 8.0% in patients at risk for stented and 0. 6% for stentless (P=0.001). Actuarial analysis disclosed no statistical difference in patient survival between groups (P=0.18). Reoperations were less frequent in the stentless group (P=0.010). CONCLUSIONS: Hemodynamic benefits in the stentless group were evident and expressed by larger AEOA, lower gradients, better left ventricular remodeling with significant decrease of the left ventricular mass. Lower complication rates, lower reoperation rates, less leaflet tissue degeneration, and lower valve related mortality rates were seen in the stentless group. A controlled clinical comparison trial with longer follow-up will be required to confirm these clinical and hemodynamic benefits.

[Congenital absence of left pericardium simulating tumor of the anterior mediastinum]. / Agenesia de pericárdio esquerdo simulando tumor de mediatino anterior.

The authors report a case of a patient presenting atypical dyspnea symptom. The physical examination, the chest roentgenogram and EKG were abnormal; the echocardiogram showed an abnormal mass compressing the outflow tract of the right ventricle (RV). These data were confirmed by a computerized tomography. The cardiac catheterization showed a heart deviation to the left and a RV outflow tract gradient of 10 mmHg. Consequently a surgery was necessary. The surgical findings presented an absence of the left pericardium and no tumor was found. This is a rare entity that may be misdiagnosed as other heart diseases but this is the first case in which a tumor of the anterior mediastinum was suspected.