J Heart Valve Dis
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Several studies have demonstrated a worse performance of small prostheses in the narrow aortic root. However, modern low-profile mechanical prostheses have improved hemodynamic performance, are easy to implant, and have been used increasingly in elderly patients, where narrow roots are most frequently observed. We describe our experience in patients with aortic annuli >21 mm with the use of Medtronic Hall prostheses. ⋯ The small (size 20, 21 and 22) Medtronic Hall prostheses have good hemodynamic performance and are an excellent option as valve substitutes in patients with narrow aortic roots.
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Comparative Study
Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly.
An increasing number of elderly patients are now requiring mitral valve surgery (MVS). However, due to a perceived increase in risk of morbidity and mortality following cardiac surgery, many elderly patients tend to be neglected or not referred for surgery. ⋯ Elderly patients underwent MVS, usually after a degree of clinical deterioration. Although morbidity and mortality following mitral valve surgery were high, at follow up there was a significant improvement in both symptoms and quality of life of survivors.
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Comparative Study
Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis.
Since 1986, the St. Jude Medical (SJM) mechanical heart valve prosthesis has been implanted in patients at the authors' institution. We present our experience of low-dose oral anticoagulation and antiplatelet therapy following SJM valve implantation. ⋯ Following implantation of the St. Jude Medical mechanical heart valve prosthesis, a fixed dose of 2.5 mg/day warfarin and combined dipyridamole/aspirin provided satisfactory results in terms of thrombosis, embolism and bleeding.
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Patients with ischemic mitral incompetence have a high operative risk whether the valve is repaired or replaced. The advantage of repair over replacement is unclear in this subgroup of patients. ⋯ Patients with highly impaired LV function and ischemic mitral insufficiency are at high risk during valve repair or replacement, and cardiac transplantation should be considered for this group. However, patients with ischemic mitral insufficiency and moderately impaired LV function can undergo valve repair or replacement with an acceptable prognosis. The goal of mitral valve repair should be to reduce valvular insufficiency to at least grade I. If this is not the case, then the prognosis of repair is worse than after valve replacement. Thus, the surgeon should replace the valve during the same operation.
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Patients with symptoms of right heart failure due to severe tricuspid regurgitation following a prior operation on left heart valves present a difficult problem. The outcome of tricuspid surgery in this setting is not well defined. We describe a single-center experience of isolated tricuspid valve surgery after prior left heart valve surgery, and analyze potential risk factors for a poor outcome. ⋯ Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior surgery for left-sided heart valve disease can be performed with acceptable early mortality. There remains a high late mortality that is predicted only by age and the number of previous cardiac operations. However, in this selected group of severely symptomatic patients, significant improvement in symptoms are achieved in the survivors.