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Brazilian Journal of Cardiovascular Surgery

Print version ISSN 0102-7638

Rev Bras Cir Cardiovasc vol.4 no.3 São José do Rio Preto Dec. 1989

https://doi.org/10.1590/S0102-76381989000300003 

Substituição isolada da valva aórtica em pacientes com função ventricular deprimida

 

Aortic valve replacement in patients with depressed left ventricular ejection fraction

 

 

Gilberto Venossi BarbosaI; Blau F. de SouzaII; Nei A. ReyII; Orlando Carlos WenderIII; Pedro Pimentel FilhoII; Sílvia Regina Rios VieiraI; Hilário WolmeisterI; Waldomiro C. ManfroiIII; Paulo P. WestphalenI

IDo Hospital de Clínicas de Porto Alegre e Hospital Nossa Senhora da Conceição
IIDo Hospital Nossa Senhora da Conceição
IIIDo Hospital de Clínicas de Porto Alegre

Endereço para separatas

 

 


RESUMO

Para avaliar o valor prognóstico da fração de ejeção do ventrículo esquerdo, entre 210 pacientes com lesões da valva aórtica operados, consecutivamente, entre maio de 1981 e outubro de 1988 e que receberam as próteses Omniscience e Meditronic-Hall, foram selecionados 112 e divididos, de acordo com a fração de ejeção do ventrículo esquerdo, em dois grupos: o G1 = FE > 40%, ficou com 52 pacientes com médias de idade 39 ± 12 anos, FE = 58 ± 10% e classe funcional (NYHA) = 2,8; o GE = FE < 40% ficou com 60 pacientes com médias de idade 48 ± 17 anos, FE = 27 ± 13% e (NYHA) = 3,6. Nas cirurgias, foram utilizados hipotermia e hemodiluição moderadas, oxigenador de bolhas, infusão cardioplégica St. Thomas. As médias dos tempos de circulação extracorpórea e parada cardíaca foram: no G1 =8 2 ± 18 e 49 ±7 minutos, e 96 ± 11 e 55 ± 6 minutos, no Grupo 2; o tamanho das próteses foi 25,2 ± 1,8 milímetros. No Grupo 1, a mortalidade imediata foi 3,8% no G1 e 5,8 no G2, e a tardia 4% no G1, e no G2 foi 8,7%. No G1 houve significante associação entre a mortalidade e a função ventricular sistólica. Clínicamente, no G1, 65% dos pacientes estão na (NYHA) I, 28% na II, 5% na III e 2% na IV. No G2, 46% estão na (NYHA) I, 25% na II, 13% na III, e 16% na IV. A sobrevida atuarial em sete anos foi 88 ± 2% no G1 e 76 ± 4% no G2. Portanto, os pacientes com FE < 40% apresentaram mortalidade mais elevada, menor sobrevida a curto e longo prazo e resultados clínicos menos satisfatórios. Para obtermos melhores resultados, devemos operar antes que a FE em repouso e exercício se torne deprimida, ou que apareça intolerância ao exercício moderado.

Descritores: função ventricular; valva aórtica, cirurgia.


ABSTRACT

To evaluate the prognostic value of resting left ventricular ejection fraction (LVEF) a series of 210 consecutive patients with aortic valve disease operated upon between May 1981 and October 1988 was studied retrospectively. All patients had their aortic valve replaced by Omniscience or Meditronic prosthesis; 112 formed the study group because they have complete follow up and cineangiocardiographic data. Based on pre-operatory left ventricular ejection fraction the patients were divided in two groups: Group 1 = 52 patients with LVEF > 40%, 39 ± 12 years, NYHA functional class 2.8, and EF 58 ± 10%. Group 2 = 60 patients with LVEF < 40, 48 ± 17 years, NYHA functional class 3.6, and LVEF of 27 ± 12%. During surgery moderate hypothermia and hemodilution were utilized, with dubble oxygenator and cardioplegia With St. Thomas cardioplegic solution. Mean extracorporeal circulation and cardiac arrest time were respectively 82 ± 18 and 49 ± 7 minutes in Group 1 and 96 ± 11 and 55 ± 6 minutes in Group 2. The size of the prosthesis were 25.2 ± 1.8 mm in Group 1. The short term mortality was 3.8% in Group 1 and 5.8 in Group 2. The long-term mortality was 4.0% in Group 1 and 8.7% in Group 2. In Group 1 there was a significant association between mortality and left ventricular systolic function. In the follow-up evaluation, among patients in Group 1, 65% were in class I, 28% were in functional class II, 5% in class III, and 2% in class IV. Among patients in group II 46% were in class I, 25% in class II, 13% in class III, and 16% in class IV. The 7 year survival rate was 88 ± 2% in Group 1 and 76 ± 4% in Group 2. Thus, patients with LVEF less than 40% had higher short and longterm mortality and worse clinical course. For better surgical results patients with aortic valve disease should be operated upon before the reduction of left ventricular systolic function.

Descriptors: ventricular function; heart valves, aortic, surgery.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Endereço para separatas:
Gilberto Venossi Barbosa
Rua Saul Monnemacher, 52
91700 Porto Alegre, RS, Brasil

 

 

Trabalho realizado nos Serviços de Cirurgia Cardiovascular do Hospital de Clínicas de Porto Alegre e Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil.
Apresentado ao 16º Congresso Nacional de Cirurgia Cardíaca. São Paulo, 7 e 8 de abril, 1989.

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