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Brazilian Journal of Cardiovascular Surgery

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.3 no.3 São José do Rio Preto Dec. 1988

http://dx.doi.org/10.1590/S0102-76381988000300002 

Estudo multicêntrico dos resultados das trocas valvares com o uso da bioprótese Biocor no Estado de Minas Gerais

 

Multicentric study of the results with implanted bioprosthesis Biocor in the state of Minas Gerais

 

 

Mário Osvaldo VrandecicI; Bayard Gontijo FilhoI; João Alfredo Paula e SilvaII; Fernando Antônio FantiniI; Juscelino Teixeira BarbosaII; Márcio C. São José; Carlos Álvaro dos Santos PintoIII; Gilberto Lino VieiraIV; Homero Geraldo OliveiraIV; Renato R. RabeloIV; Sebastião Correa RabelloIV; Alexandre V. BrickV; Eduardo PeredoI; Adelson A. PedrosaI; Antônio Luiz O. Azevedo SobrinhoIII; Maurício BarbosaIII; Heberth César MiottoI; Maria Aparecida BragaIV; Marco Antônio SalumII; Júnia F. BragaI; Guilherme H. MoreiraI; Osvald Hely MoreiraI; Carlos Alberto de OliveiraIII; Flávio Justo MacielI

IDo Biocor Hospital de Doenças Cardiovasculáres
IIDa Santa Casa de Misericórdia de Belo Horizonte
IIIDo Prontocor
IVDo Hospital Vera Cruz
VDa Santa Casa de Juiz de Fora

Endereço para separatas

 

 


RESUMO

No período de março de 1981 a março de 1988, foram implantadas 2324 biopróteses, em 2016 pacientes, em 5 Centros do Estado de Minas Gerais. Este estudo inclui somente a análise dos pacientes submetidos a troca valvar aórtica (n = 603) e mitral ( n = 1110), isoladamente. Neste grupo (n = 1713), a mortalidade hospitalar foi de 104 pacientes (6,1%). Dos 1609 pacientes que receberam alta do hospital, conseguimos o seguimento de 1101 pacientes (64,3). Esta análise corresponde a um período de 1 a 84 meses, com média de 48 meses e com um seguimento cumulativo de: aórticas (n= 385) = 1230 pacientes/ano; mitrais (n = 716) = 3018 pacientes/ano. Foram registradas 102 complicações tardias em 716 pacientes mitrais (14,24%) e 51 complicações no grupo aórtico (13,2%). Com relação à faixa etária, encontramos 220 pacientes menores de 20 anos (mitrais = 176/aórticos = 44) e, neste subgrupo, as disfunções valvares incidiram em 43% dos pacientes mitrais e em 29% dos pacientes aórticos. A endocardite protética foi mais encontrada nos aórticos (45%) do que nos mitrais (29,7%). Dos 1101 pacientes, 62 foram reoperados, com mortalidade hospitalar de 12,6%. A reoperação por disfunção valvar foi mais freqüente no grupo mitral com idade inferior a 20 anos. A curva atuarial livre de mortalidade relacionada à bioprótese foi de 97,1% (32/1101 pacientes). No grupo aórtico, 96,9% estiveram livres de disfunção valvar ao final de 7 anos, enquanto que, no grupo mitral, este índice foi de 95,2%. Nos pacientes menores de 20 anos do grupo mitral, encontramos o maior índice de falência valvar (85,3% livre após 7 anos). Ao final deste estudo, a maior parte destes pacientes encontrava-se em classe funcional I e II. Embora a incidência de reoperação seja expressiva, esta é aceitável, tendo em vista que as biopróteses oferecem uma alternativa mais segura do que as próteses mecânicas, durante este mesmo período do seguimento. A análise destes resultados sugere a continuação de pesquisas que tornem possível a fabricação de um substituto valvar ideal. Todavia, estes resultados comparam-se, de modo favorável, a resultados com biopróteses semelhantes da literatura mundial.

Descritores: próteses valvulares cardíacas, biológicas; próteses valvulares cardíacas, cirurgia; valvas cardíacas, cirurgia.


ABSTRACT

From March 1981 to March 1988, 2324 bioprostheses were implanted in 2016 patients in 5 centers in the State of Minas Gerais. This study includes only the analysis of patients undergoing isolated aortic (n = 603) or mitral (n = 1110) valve replacement. The hospital mortality in this group (n = 1713) was 104 patients (6.1%). From the remaining 1609 patients, that were discharged from the hospital, we were able to obtain a follow-up in 1101 or 64.3%. This analysis related to a period ranging from 1 to 84 months, mean = 48 and a cumulative follow-up in the aortic group (n = 385) equal to 1230 patients/year; the mitrals (n = 716) equal to 3018 patients/year. There were 102 late complications in 716 patients (14.24) and 51 in the aortic group (13.2). In relation to the age or the patients, 220 were under 20 years of age (mitrals = 176/aortics = 44) and in this subgroup the intrinsic valve failure was 43% of the mitral patients and 29% of the aortic group. The prosthetic endocardite was more frequent in the aortic group (45%) in compararison with the mitrals (29.7%). There were 62 reoperations in 1101 patients, with hospital mortality of 12.6%. The reoperations were more frequent in the mitral group, in patients below 20 years of age. Survival, considering only deaths related to the bioprosthesis, was 97.1% (32/1101). In the aortic group, 96.9% of patients were free of valve disfunction at the end of 7 years; among the mitrals, 95.2%. The major incidence of valve failure was encountered in the mitral patients, below 20 years of age; 85.3% were free of this complication at 7 years of follow-up. At the end of this study, the majority of the alive patients was functional classes I and II of the NYHA. Although the incidence of reoperation is significant, these findings are acceptable, specially because bioprosthesis offers a safer alternative than mechanical prosthesis. The present results suggest the continuation of research to obtain the ideal bioprosthesis, although current data is comparable to results abtained with similar bioprosthesis in the world literature.

Descriptors: heart valves, biologic; heart valves prostheses, surgery; heart valves, surgery.


 

 

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Endereço para separatas:
Mário Vrandecic
Rua Prof. Antônio Aleixo, nº 307
30180 Belo Horizonte, MG, Brasil

 

 

Trabalho realizado na Santa Casa de Misericórdia de Belo Horizonte, no Hospital Vera Cruz, Prontocor, Biocor Hospital de Doenças Cardiovasculares de Belo Horizonte e na Santa Casa de Juiz de Fora, MG, Brasil.
Apresentado ao 15º Congresso Nacional de Cirurgia Cardíaca. Rio de Janeiro, RJ, 8 e 9 de abril, 1988.

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