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  • Factors Determining In-Hospital or Late Survival after Aortic Valve Replacement

myocardial infarction, cardioplegia, aortic cross-clamp time, aortic valve replacementTo determine factors affecting in-hospital or late survival of patients following AVR, a retrospective analysis was undertaken in a group of patients undergoing AVR with a single type of valve substitute. The findings are the basis of this presentation.
Two hundred and forty patients underwent AVR between February 1977 and December 1983. There were 147 male and 93 female patients (1.6:1 ratio), ranging in age from 17 to 86 years of age. The predominant valvular lesion was aortic stenosis in 155 patients (65 percent), aortic regurgitation in 40 patients (17 percent), and a mixed valvular lesion in 45 patients (19 percent). When categorized according to the criteria set forth by the NYHA, three patients were in class 1 (1 percent), 73 patients (30 percent) in class 2, 129 patients (54 percent) in class 3, and 35 patients (15 percent) in class 4. Twenty-two patients had undergone previous cardiac procedure(s). my canadian pharmacy.com

The AVR was performed as an elective procedure in 116 patients (48 percent), as an urgent intervention in 101 patients (42 percent), and as an emergency procedure in 23 patients (10 percent). The prosthesis inserted in all patients was a standard Ionescu-Shiley bovine pericardial valve. Sizes of valves ranged from 17 to 31 mm; 137 patients (57 percent) received a valve sized 17, 19, or 21 mm. Concomitant procedures were performed in 110 patients (46 percent). Of these, 67 patients (28 percent or 67/240) had AVR and procedure(s) for ischemic heart disease. An additional 33 of the 240 patients (14 percent) had a second valve replacement, some of whom also underwent procedure(s) for ischemic heart disease. Ten other patients had miscellaneous concomitant procedures (4 percent). Pump time ranged from 60 to 333 minutes (mean, 126.2 ±3.3 minutes); aortic cross-clamp time ranged from 40 to 180 minutes (mean, 83.9 ± 1.7 minutes). Initially, single-dose crystalloid cardioplegia was used in all cases; later, multidose cardioplegia was instituted for the more complex procedures. Patients with isolated AVR were not routinely given anticoagulants; those having undergone a concomitant procedure were initially heparinized and then received long-term prophylactic sodium dicumarol.

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