J Heart Valve Dis
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The purpose of this study is to analyze treatment options for valvular regurgitation with severe left ventricular dysfunction. ⋯ It is concluded that a low EF is not a predictive factor of operative mortality but it influences late survival as do the degree of left ventricular dilatation, etiology in aortic and type of surgery in mitral regurgitation. Alternatives to valvular surgery have been envisaged but information on vasodilators in these patients is scant and results of heart transplantation are known only from a few small series.
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Expanded polytetrafluoroethylene sutures have been used for the replacement of chordae tendineae of the mitral valve since 1985 at The Toronto Hospital. This study examines the long term results of mitral valve repair with chordal replacement with this material. ⋯ Expanded polytetrafluoroethylene sutures are excellent for chordal replacement during mitral valve repair and do not fail during the first decade following surgery. This material has allowed us to increase the probability of successful mitral valve repair in patients with degenerative disease of the mitral valve and prolapse of both leaflets.
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In an attempt to overcome the problem of calcification of bioprostheses, a novel bovine pericardial tissue valve preserved with a non-aldehyde, dye mediated photo-oxidation process (PhotoFixTM) developed by CarboMedics, Inc. The device was evaluated by implantation in the mitral position of juvenile sheep with a mean age of 3.5 months. ⋯ The fact that four of six valves with photo-oxidized tissue remained free of any signs of calcification for up to 1.5 years, while none of the other valves did, suggests that photo-oxidation is a promising method of preserving and fixing tissue for use in bioprostheses. These results suggest that photo-oxidized bioprosthetic valves may be clinically valuable and warrant further study.
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Long term survival after replacement of the aortic root is improving. The most common cause of late death is progression of disease in the remaining aorta (dissection or atherosclerosis). The purpose of this study was to review our clinical experience with composite graft replacement of the aortic root with special reference to long term results. ⋯ This surgical option offers good long term results with a five-year actuarial survival of 67% or 75% when the 30-day mortality is excluded. Careful follow up of patients with Marfan's syndrome and/or aortic dissection is mandatory to increase the long term survival.
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It is commonly held that preservation of the annulo-ventricular continuity during mitral valve replacement has a beneficial effect on postoperative ventricular function. This paper presents our eight-year experience with this technique. ⋯ Preservation of the posterior leaflet during mitral valve replacement reduces the risk of early mortality and did not cause additional complications to the patients. Despite the beneficial effects of this technique in the long term this technique did not increase the long term survival in patients with associated impaired valvular and/or ventricular function.