[Evaluation of early and late effects of surgical treatment in multivalvular heart diseases].

AIM OF STUDY: Assessment of early and late effects of surgical treatment in multivalvular heart disease.

MATERIAL: 186 patients operated at the Department of Cardiac Surgery (Pomeranian Academy of Medicine in Szczecin) between November 1985 and December 1998, 146 (78.5%) of whom were with stage NYHA III and IV. 30 patients (16%) had a history of cardiosurgery. Number of procedures performed: DVR--136, DVR+TVS--26, AVR+MVP--17, AVR+MVP+TVS--7.

RESULTS

Early postoperative mortality was 15.6% (29 patients). The risk of early death was associated with the following factors: low cardiac output, cardiac arrest and non-rheumatic etiology of acquired valvular disease. Long-term results were complete in 100% of patients. According to NYHA, statistically significant improvement was noted (average values: 3.02 before and 2.01 after surgery; p < 0.00001). Probability of survival after 5, 7, 10, and 14 years was 77, 69, 61, and 575, respectively. Probability of survival was (1) without hemorrhagic complications 90, 77, 62, 20%, respectively; (2) without thromboembolic episodes 93, 88, 83, 73%, respectively; (3) without infectious endocarditis 98, 97, 97, 97%, respectively; and (4) without perivalvular leak 97, 96, 96, 90%, respectively. Poor long-term prognosis was associated with nonrheumatic etiology of valvular disease, III and IV degrees of NYHA before surgery, persistent atrial fibrillation before operation and low cardiac output during the postoperative period. In the group where repair of damaged valve was done, good long-term results were achieved in 75% of patients with mitral valve and 80% with tricuspid valve pathology.