• Journal of Chest Surgery
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• 제56권6호
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• pp.435-444
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• 2023

Background: Edwards Intuity is recognized as a relatively contraindicated bioprosthesis for bicuspid aortic valve disease. This study compared the early echocardiographic and clinical outcomes of rapid-deployment aortic valve replacement for bicuspid versus tricuspid aortic valves. Methods: Of 278 patients who underwent rapid-deployment aortic valve replacement using Intuity at Seoul National University Hospital, 252 patients were enrolled after excluding those with pure aortic regurgitation, prosthetic valve failure, endocarditis, and quadricuspid valves. The bicuspid and tricuspid groups included 147 and 105 patients, respectively. Early outcomes and the incidence of paravalvular leak were compared between the groups. A subgroup analysis compared the outcomes for type 0 versus type 1 or 2 bicuspid valves. Results: The bicuspid group had more male and younger patients. Comorbidities, including diabetes mellitus, hypertension, chronic kidney disease, and coronary artery disease, were less prevalent in the bicuspid group. Early echocardiographic evaluations demonstrated that the incidence of ≥mild paravalvular leak did not differ significantly between the groups (5.5% vs. 1.0% in the bicuspid vs. tricuspid groups, p=0.09), and the early clinical outcomes were also comparable between the groups. In the subgroup analysis between type 0 and type 1 or 2 bicuspid valves, the incidence of mild or greater paravalvular leak (2.4% vs. 6.7% in type 0 vs. type 1 or 2, p=0.34) and clinical outcomes were comparable. Conclusion: Rapid-deployment aortic valve replacement for bicuspid aortic valves demonstrated comparable early echocardiographic and clinical outcomes to those for tricuspid aortic valves, and the outcomes were also satisfactory for type 0 bicuspid aortic valves.

• Journal of Chest Surgery
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• 제11권3호
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• pp.303-315
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• 1978

During the full 10-year period from June 1968 through June 1978, 112 consecutive patients underwent isolated or double valve replacement. A total of 130 valves were used in aortic, mitral or tricuspid positions: 63 prosthetic valves in 56 and 67 glutaraldehyde-preserved porcine aortic valves in 56 patients. There were 31 early and 9 late deaths with a cumulative mortality rate of 35.7 percent. Eighty-five patients survived longer than 10 days postoperatively were studied for the occurrence of thromboembolism and complications related to anticoagulant therapy. At the end of follow-up period, 68 patients were on Coumadin; 74 were on Persantin with or without Coumadin; 11 were off any antithrombotic drugs with 6 of them being off electively after 6 months of tissue valve replacement. Thromboembolism occurred in 7 [8.2%] of 85 patients or 10.9%/patient-year. Embolic rates were as follows: one of 18 patients anticoagulated [5.6%] or 6.1%/patient-year and 4 of 16 patients not anticoagulated [25.0%] or 17.8%/patient-year for the prosthetic valve replacement; and one of 40 patients anticoagulated [2.5%] or 7.9%/patient-year and one of 11 patients not anticoagulated [9.1%] or 7.9%/patient-year for tissue valve replacement. Three complications of major bleeding were experienced by 3 patients during the follow-up period, being related to Coumadin therapy. The importance of proper anticoagulation were stressed for the successful management of patients after cardiac valve replacement, both prosthetic and tissue valves.

• Journal of Chest Surgery
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• 제12권4호
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• pp.355-360
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• 1979

Mitral and aortic valve replacement with tricuspid annuloplasty was undertaken in 5 patients out of 38 valvular surgery between the period from Jan. 1977 to May 1979 in the Dept. of Thoracic and Cardiovascular Surgery in Korea University Hospital. All were male patients with age ranging from 18 to 42 years, and preoperative evaluation revealed one case in Class IV, and four cases in Class III according to the classification of NYHA. Preoperative diagnosis was confirmed by routine cardiac study including retrograde aorto- and left ventriculography, and there were two cases with MSi+ASi+Ti, two cases with MSi+Ai+Ti, and one case with Mi+Ai+Ti. Double valve replacement was performed under the hypothermic cardiopulmonary bypass with total pump time of 247 min. in average ranging from 206 min. to 268 min. During aortic valve replacement, left coronary perfusion was done in the first two cases, and cardiac arrest with cardioplegic solution proposed by Bretschneider was applied in the remained three cases. Starr-Edwards, Bjork-Shiley prosthetic valves and Carpentier-Edwards tissue valve were replaced in the aortic area, and Carpentier-Edwards and Angell-Shiley tissue valves were replaced in the mitral area with each individual combination [three prosthetic and two tissue valves in the aortic, and five tissue valves in the mitral area respectively]. Postoperative recovery was uneventful in all cases except one case with hemopericardium, which was managed with pericardiectomy on the postoperative 10th day in good result. Follow-up after double valve replacement of the all five cases for the period from 6 months to 33 months revealed satisfactory adaptation in social activity and occupation with cardiac function of Class I according to the classification of NYHA In all five cases.

• Journal of Chest Surgery
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• 제27권2호
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• pp.114-121
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• 1994

St. Jude Medical cardiac valve replacement was performed in 135 consecutive patients from Aug.1986 to Dec. 1991.72 had mitral, 28 had aortic, 1 had tricuspid and 34 had double valve replacement. The hospital mortality rate was 4.4% & the late mortality rate was 3.7 %. Follow-up was done on 115 surviving patients:mean follow-up period was 29.78 $\pm$ 18.32 months. Paravalvular leakage was observed in two patients, possible prosthetic valvular endocarditis wasobserved in one patient and other specific valve-related complications were none. The overall actuarial survival rate at 6 years were 91.6% in total, 96.4% in aortic, 95.5 % in mitral and 81.9 % in double valve replacement.We concluded, therefore that good clinical results and a low complication rate could be achieved with St. Jude Medical valve in short-term follow-up & long-term follow-up was also necessary.

• Journal of Chest Surgery
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• 제11권2호
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• pp.199-212
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• 1978

One hundred cases of cardiac valve replacement were done at this Department in the period from June 1968 to May 15, 1978. Seventy-one cases of mitral, 12 aortic, and one tricuspd valve were replaced. There were 16 cases of double valve replacement, 10 aortic with mitral and 6 mitral with tricuspid valve replacement. Prosthetic valves-Beall, Bjoerk-Shiley, Starr-Edwards, Wada-Cutter, Magovern-Cromie, and Smeloff-Cutter valves-were used. But in recent years bioprosthetic valves-Hancock, Carpentier-Edwards, and Angell-Shiley valves-were used mainly due to the difficulties of postoperative anticoagulation, especially for the rural Korean patients. Over all operative mortality was 2896, 26.2% for single and 37.5% for double valve replacement cases. There were 4 postoperative thrombo-embolism cases with 2 deaths. Four postoperative subacute bacterial endocardities cases with 2 deaths were noted. Three cases of postoperative congestive heart failure succumbed. Two cases of peri valvular leakage, one of which needs reopration, were found. There were 28 operative and 9 late deaths, leaving 63 long-tel m survivors, who showed marked improvements.

• Journal of Chest Surgery
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• 제26권9호
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• pp.677-685
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• 1993

Experience with bileaflet mechanical valve replacement at the Inha Hospital in 192 patients, operated on from June 1986 until April 1993. Two hundred fourty-one prostheses [51 Duromedics, 79 St.Jude Medical, and 111 CafboMedics]were implanted during the total 195 operations. Mitral valve replacment[MVR]was done in 113 cases, aortic valve replacement[AVR]in 34, tricuspid valve replacement[TVR]in 2, and double valve replacement[DVR]in 46 cases.Of the total patients, 63.0% were women and 37.0% were men. The mean age of the patients was 40.8 years, ranged from 14 to 67years. Overall early mortality was 9.2\ulcorner%[18 out of 195]; 9.7%[11 out of 113]for MVR, 14,7% [5 out of 34]for AVR, and 4.3%[2 out of 46]for DVR. All of the operative survors were followed over a period of one to 83 months with a mean of 37 months, for total 543 patient-years. So far, eleven patients[6.7% of the long-term survivors]were lost to follov-up after a mean postoperative follow-up of 22.8 months. There were nine late deaths; three deaths due to prostetic valve endocarditis, two due to persistent heart failure, one due to cerebral hemorrhage, one due to aortic dissection after Bentall oreration, and two sudden deaths. Actuarial survival rate at 6.9 years was 94.8%, There were seventeen valve-related complications; three prosthetic valve thromboses, three thrombembolisms, three instances of prosthetic valve endocarditis, two paravalvular leakages, and six hemorrhagic complications related to anticoagulation. The actuarial rate of freedom from all valve-related complications at 6.9years was 91.3%. There were significant decreases in the heart size postoperatively that can be demonstrated by comparison of cardio-thoracic ratios on simple chest X-ray and left ventricle dimensions on echocardiography. We conclude that this midterm follow-up shows good results in terms of hemodynamics and durability although further long-term evaluations are mandatory.

• Journal of Chest Surgery
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• 제16권4호
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• pp.458-469
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• 1983

Between October, 1978, and December, 1982, Glutaraldehyde-stablized pericardial xenografts [Ionescu-Shiley valve] were used for heart valve replacement in 409 patients.[251 mitral, 49 aortic, 11 tricuspid, and 98 multiple valve replacement]. There were 31 early deaths [7.6%], and 371 operative survival were observed for a total of 507.6 years over a period of 1 to 44 months. [mean 17 months]. Actuarial analysis of late results indicates an excepted survival rate at 4 years of 86.25.4% for patients with mitral, 79.37.1% for patients with aortic valve replacement. Actuarial survival rates for total patients at 4 years was 77.88.2%. The rate of systemic embolism has been 1.6% per patient-year for mitral and 1.8% per patient-year for aortic group in the presence of anticoagulation treatment. Among the 6 embolic episodes, 2 patients were died. The incidence of hemorrhagic complication was 1.3% per patient-year for anticoagulated patients. There were 6 confirmed valve failures, five in mitral and one in aortic position. Re-replacement of destructed valve was performed in one patient and others were treated medically. Among the 6 episodes, 3 occurred in children [Below 15 years], it account almost 9 times higher than adult. Our clinical data compare very favorable with those obtained with other available prostheses and tissue valves, but it should be considered to give short-term anticoagulation therapy to hemodynamically stable patients and aortic valve patients, and other prosthetic valve must be considered to use in children.

• Journal of Chest Surgery
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• 제10권2호
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• pp.315-326
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• 1977

From 1958 to October 1977, 294 cases of acquired heart disease were operated. There were 68 cases of pericardium, 3 trauma, 2 foreign body, one cardiac thrombus, 3 atrial myxoma, 2 left atrial and 1 right atrial, 2 Budd-Chiari syndrome, and 214 valvular heart disease. Out of 214 cases of valve operation 73 valves were replaced in 64 patients. Male to female ratio was 1.46: 1. The youngest age was 14 years in male and 18 in female. The oldest was 54 years in male and 52 in female. Fifty-five cases of single valve were replaced, consisting of 47 mitral and 8 aortic valves. There were 9 double valve replacement cases which consist of 7 mitral and aortic and 2 mitral .and tricuspid valves. Six varieties of prosthetic valves, 3 ball and 3 disc types and 3 kinds of xenograft tissue valves were utilized. Beall, BjSrk-Shiley and Starr-Edwards prosthetic valves and Hancock valves were used mainly. For single valve 34. 5% and for double valve replacement 44% mortality were noted. There were 23 operative deaths out of 64 patients, over all mortality rate of 36.9%. Mortality for mitral valve replacement was 29.5%. But in recent 12 consecutive cases one death occurred, showing 8.3% mortality. In earlier days thrombocyte anti-adhesive drug dipyramidole-persantin-aspirin and/or SP 54 were adminstered. But in recent cases after heparinization, coumadin and Persantin were prescribed routinely.

• Journal of Chest Surgery
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• 제30권8호
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• pp.815-818
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• 1997

Prosthetic valve endocarditis(PVE), although uncommon, is associated with significant mortality if the infection spreads into the paravavular structures with later abscess formation. However, combined antibiotic and surgical treatment is often successful. Accurate diagnosis by on echocardiography, effective myocardial protection during operation and increased surgical experience have improved the short-term and long-term outcomes for patients with PVE. A 35-year-old male had a history of replacement of aortic and mitral valve, and tricuspid annuloplasty on August 1994, was admitted due to sudden onset of aphasia, leftward deviation of both eyeballs and spiking fever and diagnosed of having PVE by echocardiography. Reoperation was done after 6weeks of antibiotic treatment. On the operative field, we could notice circumferential vegetation along aortic valve annulus, paravalvular leakage and abscess pocket. The mitral valve amlulus was healthy. The patient underwent redo aortic valve replacement using cryopreserved aortic homograft after radical debridement of infected issue. During the follow up of 7 months period the homograft was well functioning without recurrence of symptoms.

• Journal of Chest Surgery
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• 제33권8호
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• pp.643-647
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• 2000

From March 1988 to June 1994, 275 CarboMedics cardiac valve prostheses(199 mitral, 70 aortic and 3 tricuspid) were implanted in 226 consecutive patients(mean age 39 years, male/female 90/136) by one surgical team operating on adult cardiac patients at Kyungpook University Hospital. Total follow up represented 16,848 patient-months(mean 76 months) and follow up rate was 96%. One hundred and forty-nine patients(66%) wer in NYHA functional class III or IV preoperatively, and 204 patients(99.5%) were in class I or II postoperatively. Early mortality was 4.9% and late death was 9.3%. The actuarial survival at 81 months was 86.l2$\pm$3.1%. The linearized incidence of valve-related death, prosthetic valve thrombosis, anticoagulation-related hemorrhage, non-structural dysfunction and reoperation were 0.71%, 0.43%, 0.07%, 0.21%, and 0.14% respectively. The 81-month rate of freedom from all valve related complications and deaths including hospital mortality was 88.1$\pm$2.5%. Thee facts suggest that the CarboMedics cardiac valve has excellent result, low incidence of valve-related complications and no structureal deterioration.