Small Prostheses Research Articles

Testicular Implant Complications after Transmasculine Gender Affirming Surgery.

Complications from testicular implantation in transgender men can cause significant distress, repeat visits to the emergency department, and require reoperation for explantation. Outcomes for these implants have not been well described in the literature. This study compares patient and surgery specific factors with complications from testicular implants in transgender men. We performed a retrospective review of patients who underwent testicular implantation. Surgery was standardized across patients with placement through incisions at the top of the labia majora or medially during metoidioplasty. Complication rates, including infection, erosion, migration, and pain requiring removal was compared with patient factors, including body mass index (BMI), smoking status, and implant size. Of the 116 testicular implants, 12% had a complication requiring removal. The most common reason for removal was erosion of the prosthesis, which occurred in 6 instances. Migration was a relatively frequent complaint, with 10% of patients noting relocation of an implant. However, only 4 implants ultimately underwent reoperation for migration. Four implants caused enough pain to require reoperation. On logistic regression of BMI, age, smoking status, and immunocompromised state on removal of prosthesis, no factor was found to be a significant predictor of removal. Increasing implant size was not associated with an increased likelihood of removal. Complications after testicular implants in transgender men are not uncommon events. Although there appears to be a growing trend toward smaller prostheses in the literature, our data suggest that implant size is not a significant predictor of complications requiring prosthetic removal.

Long-Term Effects of Pulmonary Valve Implantation and Prosthesis Evolution in Patients with Repaired Tetralogy of Fallot.

Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow - regurgitant flow) / R V end-diastolic volume ] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.

Efeitos de Longo Prazo do Implante Valvar Pulmonar e Evolução da Prótese em Pacientes com Tetralogia de Fallot Corrigida

Abstract Background Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). Objective This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. Methods A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. Results After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p &lt; 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p &lt; 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow − regurgitant flow) / R V end-diastolic volume] from 23% to 35% (p &lt; 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient &gt; 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). Conclusion As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.

Rapid deployment versus its conventional counterpart in aortic valve replacement: comparison of early hemodynamic outcomes.

Edwards Intuity is designed for rapid deployment based on the structure of Magna Ease. This study was conducted to compare early hemodynamic performance between the two valves. Patients who underwent aortic valve replacement (AVR) using Edwards Intuity or Carpentier-Edwards PERIMOUNT Magna Ease in our institution from June 2016 to July 2021 were enrolled. Intuity valve was used in 215 patients, and Magna Ease valve was used in 198 patients, respectively. Early postoperative echocardiographic data were available in 99.0% (409/413) of the patients. The transvalvular mean pressure gradient, effective orifice area, and effective orifice area index were compared between the valves stratified by prosthesis size. There were no differences in the proportion of female patients or body surface area between the groups. Mean pressure gradient on early postoperative echocardiography was significantly lower in Intuity valve than Magna Ease valve for 19, 21, 23, and 25 mm valves (15.5±5.0 vs. 20.8±9.1 mmHg, P=0.004; 12.7±4.2 vs. 15.6±5.3 mmHg, P=0.001; 11.5±3.3 vs. 13.4±5.8 mmHg, P=0.034; and 9.9±3.1 vs. 12.3±4.0 mmHg, P=0.029; respectively). Effective orifice area was larger in Intuity valve than Magna Ease valve for 19 mm valve (1.45±0.38 vs. 1.19±0.28 cm2, P=0.002), and effective orifice area index was also larger in Intuity valve than Magna Ease valve for 19 mm valve (0.96±0.26 vs. 0.80±0.20 cm2/m2, P=0.005). Early clinical outcomes, including operative mortality and postoperative complications, demonstrated no significant differences between the groups. Edwards Intuity demonstrated superior early hemodynamic performance compared with Magna Ease in a size-by-size comparison, and this superiority was more definite for small prostheses.

Implant selection in natural and stable direct-to-implant reconstruction with ten steps at nipple-sparing mastectomy.

Direct-to-implant reconstruction is one of the breast repair techniques after mastectomy. Implant selection is critical in the short- and long-term success of direct-to-implant reconstruction after nipple-sparing mastectomy. In this study we developed a 10-step algorithm that we use before and during surgery. We aimed to obtain natural and stable breast reconstruction with this algorithm. In addition, we also aimed to evaluate which implants were selected using this algorithm and their short- and long-term outcomes. This retrospective study included 218 patients aged 27 to 60 years who underwent mastectomy and direct-to-implant reconstruction between November 2018 and December 2021. The patients were assigned into 4 groups according to amount of breast tissue removed. We developed a 10-step algorithm and these included: breast base, amount of breast tissue removed, evaluation of mastectomy skin flap, breast projection, ptosis, unilateral/bilateral reconstruction, chest wall deformity, patient's request, comorbid conditions and stabilization and arrangement of novel sulcus. The evaluation was made when the patient's photographs were taken at least 1 year after the surgery. The highest number of patients was recorded in group 3; in addition, mean age was also highest in group 3. The lowest number of patients was recorded in group 4. The body mass index showed a progressive increase from group 1 to group 4. Medium height moderate profile prosthesis was used in 81.7% while medium height moderate plus profile prosthesis was used in 18.3% of breasts included. We used larger prosthesis up to 58.1% when compared to the tissue removed in group 1 while we used smaller prosthesis by 25.6% in group 4. In the anterior view, the medial and lateral arch of the lower pole of the breast was obtained in all patients. Obvious asymmetry developed in 4 patients. In lateral and oblique views, upper and lower pole natural breast images were obtained in all patients, except for 5 patients. There was no sulcus inferior displacement in any patient. Implant extrusion did not occur in any patient. This algorithm is an easy to use and effective method to obtain a stable and natural breast image in the long-term.

Materials for ossicular chain reconstruction: History and evolution (Review).

The middle ear represents the anatomic space between the external auditory canal and the inner ear (Cochlea). It is comprised of the tympanic membrane, the ossicular chain [malleus (hammer), incus (anvil) and stapes (stirrup)] with the corresponding muscles and ligaments and the cavity of the middle ear. The main function of the middle ear is to convey vibratory energy (sound pressure) from the air to the cochlear fluids of the internal ear via the ossicular chain. Tympanoplasty represents a number of procedures used to re-establish the continuity of sound transmission from the tympanic membrane to the inner ear. Ever since the beginning of otologic surgery, various materials have been tested for ossicular chain reconstruction (OCR). The present review aimed to present, in a chronological sequence, the evolution of knowledge regarding this field of medicine, and to also discuss the advantages and disadvantages of different materials and designs of ossicular prostheses. The constant search for more efficient, easily tolerated and lighter materials has improved the acoustic rehabilitation process and has markedly reduced the rate of functional failure of these small prostheses.

The hemodynamic performance of balloon-expandable aortic bioprostheses in the elderly: a comparison between rapid deployment and transcatheter implantation

BackgroundSurgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. The aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. MethodsBE-THVs and BE-RDVs were implanted in 138 and 47 patients, respectively, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and six months later. ResultsAt discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDVs showed lower peak (14.69 vs. 20.86 mmHg; p < 0.001) and mean (7.82 vs. 11.83 mmHg; p < 0.001) gradients, and larger iEOA (1.05 vs. 0.84 cm2/m2; p < 0.001). Similar findings were also shown considering only small-sized valves. Moderate-to-severe paravalvular leakage was more prevalent in BE-THVs at discharge (14.49 vs. 0.00%; p = 0.032) and, considering exclusively small prostheses, at six months too (57.69 vs. 15.00%; p = 0.014). Nevertheless, BE-THVs determined amelioration in left ventricular ejection fraction (53.79 vs. 60.14%; p < 0.001), pulmonary artery systolic pressure (35.81 vs. 33.15 mmHg; p = 0.042), and tricuspid regurgitation severity (40.58 vs. 19.57%; p = 0.031), from discharge to mid-term follow-up. ConclusionsBE-RDVs showed better hemodynamic performance, especially when implanted in small annuli. Despite their worse baseline conditions, transcatheter patients still exhibited a greater improvement of their echocardiographic profile at mid-term follow-up.

Results of long-term patency of small-diameter biodegradable vascular prostheses with atrombogenic drug coating of sheep model

Background. Preclinical tests of biodegradable small diameter vascular prostheses on a sheep model have been carried out.Aim. To assess the results of long-term patency and remodeling of biodegradable vascular prostheses based on polyhydroxybutyrate / valerate and polycaprolactone with an atrombogenic drug coating in a large laboratory animal model.Methods. We researched vascular prostheses made of polyhydroxybutyrate / valerate and polycaprolactone (PHBV/PCL) 4 mm in diameter with layer-by-layer vascular endothelial growth factor incorporated into the polymer framework, the main fibroblast growth factor, chemoattractant molecule containing SDF-1a (GFmix) surface, and additional modifying drug surface heparin and iloprost (PHBV/PCL/ GFmix/Heparin/Iloprost). Animals with implanted synthetic Gore-Tex vascular grafts with a diameter of 4 mm were included into a comparison group.Results. After one day of implantation it was revealed that the patency of biodegradable PHBV/PCL/GFmix/Heparin/Iloprost prostheses was 62.5%, while synthetic Gore-Tex prostheses were thrombosed in 100% of cases. At the same time, after 18 months of implantation, the patency of biodegradable vascular PHBV/PCL/ GFmix/Heparin/Iloprost prostheses decreased to 50%. Passable drug-eluting polymer grafts were completely resorbed after 18 months of implantation, and aneurysmically expanded newly formed vascular tissue was formed in their place.Conclusion. Vascular prostheses made of polyhydroxybutyrate/valerate and polycaprolactone showed better long-term patency results than synthetic prostheses used in the clinical practice. However, the strengthening of the external framework of the prostheses is required in order to prevent the formation of aneurysms.

Mid-term outcomes of rapid deployment aortic prostheses in patients with small aortic annulus.

The Edwards Intuity valve is a rapid deployment aortic prosthesis that favours less invasive approaches. However, evidence about the clinical behaviour of their smaller sizes is scarce. Herein, we studied haemodynamic behaviours and clinical outcomes of small Intuity prostheses (19-21 mm) in comparison to larger Intuity prostheses (>21 mm). This is an observational study including patients implanted with an Edwards Intuity rapid deployment aortic prosthesis. Patients with prosthesis sizes 19-21 and >21 mm were included. Baseline and perioperative variables, as well as adverse events during the follow-up were recorded and compared between groups. A total of 122 patients (37% female, mean age 75 ± 4.5 years) were included, of whom 54 (45%) were implanted with a small prosthesis and 68 (55%) with a prosthesis >21 mm. There were no significant differences between patients with small Intuity prostheses and patients with larger prostheses regarding in-hospital mortality (2% vs 4%, P = 0.43) or mortality during the follow-up (3.41 vs 2.45 per 100 patients-years; P = 0.58). Survival in the small Intuity valve group was 95% at 1 year and 83% at 6 years, whereas in the larger Intuity valve group was 96% at 1 year and 78% at 6 years. The presence of a small prosthesis did not influence mid-term survival (log-rank P-value = 0.62). This study showed good clinical performance of Intuity aortic prostheses with appropriate mid-term survival in patients with the small aortic annulus. Thus, the Edwards Intuity rapid deployment aortic prosthesis may be considered as a potential option in patients with the small aortic annulus.

Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis

Background: The long-term performance of prostheses in the small aortic root is still unclear. Methods: Patients who received a 21 mm or smaller aortic valve between 2000–2018 were retrospectively analyzed. Propensity matching was used in order to account for baseline differences in 19 mm vs. 21 mm valve subgroups. Results: Survival at 10 years was 55.87 ± 5.54% for 19 mm valves vs. 57.17 ± 2.82% for 21 mm ones in the original cohort (p = 0.37), and 58.69 ± 5.61% in 19 mm valve recipients vs. 53.60 ± 5.66% for 21 mm valve subgroups in the matched cohort (p = 0.55). Smaller valves exhibited significantly more patient–prothesis mismatch (PPM) than larger ones (87.30% vs. 57.94%, p < 0.01). All-cause mortality was affected by PPM at 10 years (52.66 ± 3.28% vs. 64.38 ± 3.87%, p = 0.04) in the unmatched population. This difference disappeared, however, after matching: survival at 10 years was 51.82 ± 5.26% in patients with PPM and 63.12 ± 6.43% in patients without PPM. (p = 0.14) Conclusions: There is no survival penalty in using 19 mm prostheses in the small aortic root in the current era. Although PPM is more prevalent in smaller sized valve recipients, this does not translate into reduced survival at 10 years of follow-up.

All in one procedure Versus classical procedure for Hernioplasty in Patients With Inguinal Hernia

Background: Hernia is an unusual bulging of the intra-abdominal viscera through a weak area of the abdominal wall or groin region. Inguinal hernia repair is one of the most frequently performed surgical procedures. In recent years, inguinal hernia (IH) repair was changed from pure tissue repair to prosthetic laparoscopic repair. Objective: we propose to find a new application for the well-known surgical open mesh inguinal hernia in the treatment of inguinal hernias in adults aiming to improve patients' comfort and to reduce the incidence of chronic neuralgia. Patients and Methods: . A comparative study was designed to study the outcome of different sizes of mesh used in the hernia operations. In the present study, patients diagnosed with primary unilateral inguinal hernia (n=130) were enrolled from May 2019 to March 2020 at Baquba teaching hospital in Diyala governorate. Enrolled patients were divided into two groups. Group A include patients who have inguinal hernia operated with all in one procedure (n=65) and group B included patients with inguinal hernia operated by the classical method (n=65). Spinal and general anaesthesia were used. Before incision for the patient, ceftriaxone (1gm, intravenously) was administrated over 30 min. The process was accomplished on a one-day surgery basis .According to the devised technique, a new smaller prosthesis was placed on the floor of the inguinal canal in order to strengthen all areas of weakness from which hernias may originate. The mesh was enveloped by a fibro-cremasterico sheath avoiding contact with neural structures. Follow-up was carried out at 1week, 1month, 3months for evaluation of postoperative pain using numbering scale score, need of medication, patients' comfort, and postoperative complications. Results: all patients operated by all in one procedure were discharged within 24 h from surgery. Slight pain was reported by the majority of patients and (07.69%) of them required pain medication at home. After the 1st postoperative week (95.36%) reported no pain and (04.62%) show bruising genitaliao, (01.54%) had seroma and no wound infection recorded. No relevant limitation of normal activities was reported. There have been no postoperative neuralgias. Conclusion: This new hernioplastyo technique respects the anatomy of the inguinal canal, uses a smaller mesh, and seems to avoid neuralgias with maximum comfort for the patients. We recommended to all in one technique o because gives better results and fewer complications. Keywords: Hernia ;Open mesh inguinal hernia; patients

Clinical and Hemodynamic Results of Rapid Deployment Aortic Prostheses in Patients With Small Aortic Ring

Objective: The Edwards Intuity valve is a rapid deployment biological aortic prosthesis. It is another option to treat aortic stenosis. It favors less aggressive approaches and shortens surgical times. Little is known about the hemodynamic and clinical behavior of their smaller sizes. We present our experience with Intuity prostheses Nos. 19 and 21. Methods: From September 2012 to May 2020, 122 Intuity prostheses were implanted, 54 (45%) were no. 19 or 21 (69% women, 76 (72-78) years). Results: One patient (1.8%) died in the hospital and six in the follow-up (3.4%). Mean pressure gradient at the discharge of 11.3 ± 4.3, at one year of 10.9 ± 3, and two years of 9.2 ± 3.5 mm Hg. Survival of 95% at 1 year and 83% at 5 years. Twenty-five patients (46%) had a prosthesis-patient mismatch, but with no impact on long-term survival (log-rank: 0.66). Three patients (6%) required a permanent pacemaker in the hospital. Patients with small Intuity prostheses did not present higher in-hospital mortality than patients with larger prostheses (1.8% vs 4.4%, p = 0.430) or higher mortality during follow-up (15% vs 10%; p = 0.430). Having a small prosthesis did not influence long-term survival (log-rank: 0.623). Conclusions: Edwards Intuity Aortic Prosthesis size 19-21 have shown excellent clinical and hemodynamic results with good medium-term survival. The patient prosthesis mismatch had no prognostic influence in this group. The Edwards Intuity aortic prosthesis is an option to consider in patients with a small aortic ring, especially if they are elderly.

Sex differences in patients undergoing transcatheter aortic valve replacement in Asia

ObjectivesTranscatheter aortic valve replacement (TAVR) is increasingly performed. Physically small Asians have smaller aortic root and peripheral vessel anatomy. The influence of gender of Asian patients undergoing TAVR is unknown...

The Hip in Juvenile Idiopathic Arthritis

The hip joint is commonly affected in Juvenile Idiopathic Arthritis (JIA), especially in cases of systemic polyarticular disease. Chronic synovitis of the hip leads to joint destruction, therefore, systemic and local control of the disease is of paramount importance. Non-steroidal anti-inflammatory drugs, Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologics, intra-articular corticosteroid injections, and physical therapy are the mainstay for controlling ongoing inflammation and hip joint contractures. Synovectomy with soft tissue releases is useful in the early stages of the disease, when the joint cartilage is largely preserved. Total joint arthroplasty (THA) is successful in relieving pain, and improving function, ambulation and range of motion in end-stage degenerative arthritis. With improved designs of smaller prostheses and modern bearing couples, it is hoped that the longevity of THA will facilitate a more normal and enduring lifestyle.

Aortic Root Enlargement In Case of Double Valve Replacement

Rheumatic valvular heart disease is quite common in Bangladesh. It affects most commonly mitral and aortic valve. As a result of annular fibrosis, aortic root become smaller in some patients. So, if smaller prosthesis is implanted, there is gross patient prosthesis mismatch (PPM), poor LV regression, increase overload, and ultimately low survival rate. Its' to report our experience in aortic root enlargement in case of double valve replacement where a patient of severe mitral stenosis and aortic regurgitation with small aortic annulus requiring aortic root enlargement (ARE).Weaning from Cardiopulmonary bypass (CPB) was uneventful, perioperative and post operative period was satisfactory. Post-operative echocardiography revealed normally functioning prosthesis. In case of small aortic root, aortic root enlargement (ARE) can be safely done by double valve replacement to overcome the prosthetic patient mismatch (PPM).&#x0D; KYAMC Journal Vol. 11, No.-2, July 2020, Page 108-110

A study on safety and efficacy of Otaki technique in very small aortic root

Aortic stenosis tends to pose a challenge to the surgeon when it is associated with a small size annulus. The conundrum as to whether to use a small prosthesis with a borderline effective orifice are index(EOAI) or go for a technically challenging root enlargement procedure in these cases remains. Various such techniques have been described by Kono and associates, Otaki, Nicks and colleagues, Manouguian &amp; Seybold-Epting, and Nunez and associates. In this paper, we describe our experience with the bidirectional enlargement technique described by Yamaguchi and Otaki

Comparison of compressive fracture strength of small dog dental prosthesis along the direction of bite force

Comparison of compressive fracture strength of small dog dental prosthesis along the direction of bite force

In vitro comparison of everting vs. non-everting suture techniques for the implantation of a supra-annular biological heart valve.

BackgroundThe aim of this study was to evaluate the hemodynamic effect of different suturing techniques for aortic valve replacement (AVR) in vitro. Whether or not the applied suturing technique impacts the outflow tract diameter by narrowing the annulus diameter was examined.MethodsThe commonly applied non-everting pledget forced suture technique (NE, n=13) was compared with an everting pledget forced suture (ET, n=13) for AVR using the 25 mm St. Jude Trifecta aortic valve. Hemodynamic parameters were obtained in a pulsatile flow simulator. A high speed camera captured the visual aspects of the suturing technique.ResultsDespite some kind of left ventricular outflow narrowing due to protruding pledgets using the NE suture technique, mean pressure gradients of both techniques were nearly similar (NE 5.88±2.7 mmHg, ET 5.23±1.31 mmHg, P=0.44). Closing volume (NE 3.16±0.48 mL; ET 3.51±0.68 mL; P=0.14) and the leakage volume (NE: 8.09±2.53 mL; ET: 8.35±3.65 mL; P=0.83) also showed no differences.ConclusionsAVR using either suturing techniques leads to a similar hemodynamic performance in vitro. The impact of the suturing technique may be higher in a smaller annulus. Therefore, further studies using smaller prostheses are necessary.

Determinants of Aortic Prosthesis Mismatch in a Brazilian Public Health System Hospital: Big Patients or Small Prosthesis?

BackgroundProsthesis-patient mismatch (PPM) is associated with worse outcomes.ObjectiveDetermine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care.MethodsA total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05.ResultsiEOA was obtained in 176 patients. The frequency of severe and moderate PPM was 33.4% and 36.2%, respectively. Severe PPM patients were younger and had larger BMI, but smaller left ventricular outflow tract diameter (LVOTD). The independent variables used to predict severe PPM were male gender, BMI > 25 kg/m2, age < 60 years, LVOTD < 21 mm, and rheumatic etiology with an area under the ROC curve of 0.82.ConclusionThe frequency of severe PPM is high in a Brazilian population representative of the Public Health System, and it is possible to predict PPM from preoperative variables such as rheumatic valvular disease, gender, BMI, age and LVOTD.

Outcomes of mitral valve replacement with bileaflet mechanical prosthetic valve in children.

We examined the outcomes following mitral valve replacement with bileaflet mechanical prosthetic valve in children and identified the predictors for mortality and reoperation. Medical records from 49 children who underwent mitral valve replacement between 1982 and 2015 were reviewed retrospectively. Median age and body weight at initial mitral valve replacement were 2.4years and 9.7kg, respectively. The median follow-up was 13years. Surgical results and predictors for mortality and reoperation were investigated. There was no operative mortality; eight late deaths occurred. The actuarial survival rates were 89.5%, 84.2%, and 80.7% at 5, 10, and 15years, respectively, after initial mitral valve replacement. The actuarial freedom rates from related complications were 89.5%, 78.3%, and 70.7% at 5, 10, and 15years, respectively. Nineteen patients required 1st re-mitral valve replacement at a median of 5.9years; six of these 19 required 2nd re-mitral valve replacement at a median of 8.9years after 1st re-MVR. The actuarial freedom rates from re-mitral valve replacement were 86.0%, 56.8%, and 44.2% at 5, 10, and 15years, respectively. No predictor for death was determined; however, the predictor for re-mitral valve replacement was initial valve diameter less than 19mm. Survival outcomes among children after mitral valve replacement with bileaflet mechanical prosthetic valve in biventricular heart were satisfactory. However, complications, including re-mitral valve replacement, were frequent and the predictor was of a small prosthesis size.