scholarly journals Multiparametric evaluation of coronary flow predicts long-term outcome in heart transplantation: from coronary flow velocity reserve to its newly introduced companion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Cecere ◽  
P.L.M Kerkhof ◽  
A Angelini ◽  
A Gambino ◽  
A Fraiese ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Predictors Of Mortality ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Coronary microvascular dysfunction (CMD) leads to a worse prognosis in heart transplantation (HT) patients. Coronary flow velocity reserve (CFVR) estimates the physiologic impact of allograft disease on the coronary circulation. Purpose Our aim was to determine the prognostic role of CFVR and its companion (CFVRC) on long-term survival of HT patients with a follow-up of 28 years. Methods 134 HT patients, surviving at least 5 years after HT, with normal systolic ventricular function and no evidence of angiographic allograft vasculopathy or symptoms/signs of rejection were included. The enrolled population underwent echocardiographic evaluation of microvascular function by the assessment of both the ratio of hyperemic to rest diastolic peak velocity (DPVh and DPVr). These measurements yield CFVR and its associated companion, defined as CFVRC = √{(DPVr)2 + (DPVh)2}, as well as basal and hyperemic coronary microvascular resistance (BMR and HMR). A CFVR≤2.5 was considered abnormal; the median value of DPVh (75 cm/s) and CFVRC (80 cm/s) were utilized to dichotomize the population. Results Based on CFVR and DPVh, HT patients can be assigned to four groups: group 1 (n=32), discordant with preserved CFVR (3.1±0.4); group 2 (n=60), concordant with preserved CFVR (3.4±0.5); group 3 (n=31), concordant with impaired CFVR (1.8±0.3) and group 4 (n=11), discordant with impaired CFVR (2.0±0.2). Survival for each patient group is presented in the Figure (panel A). Specifically, survival was similar in group 1 when compared to group 3 (p=0.8), but significantly lower when compared to group 2 (p=0.03). Therefore, a normal CFVR (>2.5) may not be able to predict the unfavourable long-term outcome. CFVR in fact is an incomplete dimensionless ratio; if the paired velocities are low with high BMR and HMR (group 1), the use of CFVR alone may miss some events, that are yet captured by CFVRC. Differences between survivors and no survivors are presented in the Table. At multivariable survival analysis, CMD, DPVh<75 cm/s, CFVRC<80 cm/s were independent predictors of mortality in HT patients. Consequently, we evaluated the added role of the CMD, DPVh<75 cm/s and CFVRC<80 cm/s to prognostic models including the clinical (Figure, panel B) predictors of mortality. The inclusion of CFVRC<80 cm/s to model with clinical predictors of mortality permitted better prediction of survival in HT patients, compared to only adding CMD or DPVh<75 cm/s. Conclusions This study is the first to demonstrate that the CFVR alone, even representing a determinant of survival in long-term HT patients, is not sufficient to completely predict long-term survival in HT patients. In comparison to CMD and DPVh, the CFVRC provides a significant improvement in survival prediction in long-term HT patients. Thus, the proposed multiparametric approach offers a more comprehensive evaluation of prognosis in HT patients, just by applying available data without the need to perform additional measurements. Funding Acknowledgement Type of funding source: None

scholarly journals The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
YR Kim
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Volume Estimation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group 2 ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF). Methods We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein  anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration.  Results The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p < 0.0001) but  LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1  (LA volume < 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group  1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume >160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045) Conclusion Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.

scholarly journals Alterations in ALK/ROS1/NTRK/MET drive a group of infantile hemispheric gliomas

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Ana S. Guerreiro Stucklin ◽  
Scott Ryall ◽  
Kohei Fukuoka ◽  
Michal Zapotocky ◽  
Alvaro Lassaletta ◽  
...  
Keyword(s):  
Tyrosine Kinases ◽  
Receptor Tyrosine Kinases ◽  
Therapeutic Strategies ◽  
Low Grade ◽  
High Grade ◽  
Term Survival ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Infant gliomas have paradoxical clinical behavior compared to those in children and adults: low-grade tumors have a higher mortality rate, while high-grade tumors have a better outcome. However, we have little understanding of their biology and therefore cannot explain this behavior nor what constitutes optimal clinical management. Here we report a comprehensive genetic analysis of an international cohort of clinically annotated infant gliomas, revealing 3 clinical subgroups. Group 1 tumors arise in the cerebral hemispheres and harbor alterations in the receptor tyrosine kinases ALK, ROS1, NTRK and MET. These are typically single-events and confer an intermediate outcome. Groups 2 and 3 gliomas harbor RAS/MAPK pathway mutations and arise in the hemispheres and midline, respectively. Group 2 tumors have excellent long-term survival, while group 3 tumors progress rapidly and do not respond well to chemoradiation. We conclude that infant gliomas comprise 3 subgroups, justifying the need for specialized therapeutic strategies.

Abstract 13347: Effect of Severe Anemia (hemoglobin < 10g/dl) on Short- and Long-term Outcome in Acute Coronary Syndrome: Insights of a Terciary Centre

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isabel Campos ◽  
Cátia Oliveira ◽  
Paulo Medeiros ◽  
Carla Marques Pires ◽  
Rui Flores ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Morbidity And Mortality ◽  
Severe Anemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Short And Long Term ◽  
Group 2 ◽  
Group 1

Introduction: Although invasive strategies are the generalized approach in the management of ACS pts, their benefits in pts with significant anemia are unclear, as anemia is strongly associated with increased risk of morbidity and mortality. Aim: To determine the incidence and the impact of severe anemia (hemoglobin<10g/dL) on short- and long-term outcome in pts hospitalized with ACS. Methods: We analyzed retrospectively 2905 ACSpts admitted for 6 years in our CCU. Pts were divided into two groups: group 1-pts with severe anemia(hemoglobin < 10g/dL) (n=257,8.8%); group 2-pts without severe anemia (hemoglobin >=10g/dL) (n=2648,91.2%). Primary endpoint was the occurrence of a composite of death and adverse cardiovascular events (stroke, reinfarction, and rehospitalization of cardiovascular etiology) at 6 months; FU was completed in 96%pts. Results: The sample consisted in 77.9% men and 22.1% women, with mean age of 64±13 years. The incidence of severe anemia was 8.8%. Group1 pts were older (p<0.001), had a higher proportion of women (p<0.001), diabetes (p<0.001), CKD (p<0.001) and AF (p<0.001). During hospitalization, group 1 had more HF (p<0.001), angor (p<0.001), refarction (p=0.006), bleeding (p<0.001) and transfusion (p<0.001). Group 1 had a higher proportion of NSTEMI (p=0.009) as opposed to group2 which had more STEMI (p=0.031). During hospitalization, group 2 pts were more likely to undergo revascularization (p<0.001). A multivariate analysis identified age [OR 1.06, 95%CI 1.04 to 1.07; p<0.001] and feminine sex [OR 2.61, 95%CI 1.89 to 3.61; p<0.001] as independent predictors of severe anemia during hospitalization. Pts with severe anemia had higher 6-month mortality (32.1%vs6.9%;p<0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts with severe anemia had higher occurrence of a composite of death and MACE at 6months [OR5.04,95%CI 1.21 to 21.04;p=0.026]. Conclusion: Severe anemia was strongly associated with increased risk of morbidity and mortality in ACS pts. However, pts with severe anemia who were double antiaggregated had no worse outcomes than those who had simple antiaggregation after 6months. Therefore, there was no significant difference regarding revascularization in these pts.

scholarly journals Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome?

2015 ◽  
Vol 9 (7-8) ◽  
pp. 248 ◽  
Author(s):  
Mohamed A. Elkoushy ◽  
Ahmed M. Elshal ◽  
Mostafa M. Elhilali
Keyword(s):  
Adverse Events ◽  
Prostate Volume ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Prostate Size ◽  
Group 2 ◽  
Transurethral Incision ◽  
Group 1

Introduction: We determine the impact of prostate size on the long-term outcome of holmium laser transurethral incision of the prostate (Ho-TUIP) for bladder outlet obstruction (BOO) secondary to benign prostate enlargement (BPE).Methods: A retrospective review of prospectively collected data was performed for patients undergoing Ho-TUIP by a single surgeon for patients presenting with lower urinary tract symptoms (LUTS) secondary to BOO. Patients were stratified into 2 groups: Group 1 included patients with prostate ≤30 cc and Group 2 included patients with prostate >30 cc. Demographic, operative and followup data were recorded and analyzed. In addition, intraoperative and long-term adverse events were included.Results: In total, 82 patients underwent surgery between March 1998 and March 2013, including 9 (11%) reoperated patients. Only prostate size independently predicted reoperation after Ho-TUIP (adjusted odds ratio [aOR], 95% confidence interval [CI] 7.12 [2.92–9.14], p = 0.01). The receiver operating characteristic (ROC) analysis showed an optimal cutoff value of prostate volume of 29 cc to characterize long-term reoperation after TUIP, with area under the curve (AUC) of 0.96, sensitivity of 89.7 and specificity of 88.9. Group 1 included 51 patients and Group 2 included 31 patients. The international prostate symptoms score (IPSS) and peak flow rate (Qmax) significantly improved in both groups at different follow-up points. At the 12-month follow-up, the percent change in IPSS and Qmax were comparable between both groups. However, after 12 months, the degree of improvement in all voiding parameters was significantly higher in Group 1 (p < 0.001 at all points of follow-up). After a median follow-up of 5.3 years (range: 1–13), both groups had comparable early and late adverse events with significantly higher reoperation rate in Group 2 (3.9% vs. 22.6%, p = 0.02). Overall retrograde ejaculation was detected in 25.6% of sexually active men and it was comparable between both groups (23.5% vs. 29%, p = 0.61). On multivariable analysis, patients with prostate volume >30 cc were associated with significantly higher reoperation for BOO (aOR 95% CI 5.72 [2.83– 8.14], p = 0.02), significantly higher IPSS (aOR 1.72), higher quality of life index (aOR 1.72) and lower Qmax (aOR 0.28).Conclusion: Ho-TUIP is a durable, safe and efficient treatment of BOO secondary to a small-sized prostate. The long-term outcome could be improved and the re-operation rate could be minimized with appropriate selection of cases, with prostate glands no bigger than 30 cc.

scholarly journals Evaluation of long term outcome of congenital diaphragmatic hernia survivors: a single centre 8 years’ experience in a developing nation with limited facilities

2020 ◽  
Vol 7 (5) ◽  
pp. 1366
Author(s):  
Natasha L. Vageriya ◽  
Rasik Shah ◽  
Shivaji B. Mane ◽  
Taha Daginawala ◽  
Prathamesh More
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Developing Nation ◽  
Group 2 ◽  
Group 1

Background: The objective of the study was to find out incidence of long term complications in congenital diaphragmatic hernia (CDH) survivors in a developing nation with limited facilities.Methods: A retrospective study was done on patients who underwent CDH repair at our institution from 2012 to 2019. 71 patients were identified of these 55 patients operated in neonatal age were considered. After applying exclusion criteria 42 patients included in the study were then divided in 2 groups. Group 1 (26 patients): neonates requiring ventilation within 6 hrs of birth and group 2 (16 patients): not requiring ventilation or intubated after 6hrs of birth. Data from medical records were supplemented by a questionnaire regarding perceived physical function and medical follow up till date. Respiratory, central nervous, musculoskeletal and gastrointestinal systems were concentrated upon and questionnaire set. These were then compared with respect to their long term outcomes. Also, overall incidence of these in the two groups combined was noted compared with other studies.Results: On comparing these 2 groups incidence of long term complications was found more in group 1; however on statistical analysis difference was not significant. As also incidence of individual long term complications in all patients together were identical or lower than in other published series. Mortality in our study was 8 of 49 neonates which was 17% of all patients presenting with CDH or born at our centre.Conclusions: Despite the growing population of CDH survivors the morbidity is not very significant and most patients lead a normal average active life.

Abstract 15733: Long-Term Follow-Up of Patients With Paroxysmal Atrial Fibrillation and Severe Left Atrial Scarring: Comparison Between Pulmonary Vein Antrum Isolation Only or PVAI Combined With Either Scar Homogenization or Trigger Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
Prasant Mohanty ◽  
Luigi Di Biase ◽  
Chintan Trivedi ◽  
Rong Bai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group 3 ◽  
Group 2

Background: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF and severe LA scarring/fibrosis identified by 3D mapping undergoing ablation of the pulmonary veins (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI plus ablation of the non-PV triggers. Methods: One-hundred seventy seven consecutive patients with paroxysmal atrial fibrillation and severe left atrial scarring were included in this study. LA scarring was diagnosed by 3D voltage mapping. The degree of scar was described as severe when >60% of the LA area was involved. Non-PV triggers were defined as ectopic triggers originating from sites other than pulmonary veins such as interatrial septum, superior vena cava, left atrial appendage, ligament of Marshall, crista terminalis and coronary sinus. Patients underwent ablation of the pulmonary vein antrum (PVAI) only (n=45, group 1), PVAI extended to the entire scar areas (scar homogenization [n=66, group 2]) or PVAI plus ablation of non-PV triggers (n=66, group 3). Choice of ablation strategy was determined by the operator. Patients were followed up for arrhythmia recurrence with event recorders, ECG and Holter monitoring. Results: Baseline characteristics were not different between the groups (age 63±9 vs 58±10 vs. 60±11 years, p=0.23; male 71%, vs. 72% vs. 73% p= 0.91). After a single procedure, all patients were followed-up for a minimum of two years. The long-term success rate at the end of the follow up was 19% (12 pts) in group 1, 21% (14 pts) in group 2, and 61% (40 pts) in group 3. Kaplan-Meier log-rank test indicated that the cumulative probability of AF-free survival was significantly higher in group 3 (overall log-rank p <0.001, pairwise comparison 1 vs. 3 and 2 vs. 3 was significant at p<0.01). Conclusions: In patients with paroxysmal atrial fibrillation and severe left atrial scarring, PVAI plus ablation of non-PV triggers is associated with significantly better long-term outcome than PVAI alone or when PVAI is combined with scar homogenization.

Long term outcome of single ventricle physiology with pulmonary restriction not undergoing Fontan repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Buendia ◽  
B Ramirez ◽  
P Gallego ◽  
J.M Oliver ◽  
S Montserrat ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Single Ventricle Physiology ◽  
Pulmonary Flow ◽  
Adult Congenital ◽  
Group 3 ◽  
Group 2

Abstract Background Patients with univentricular physiology who do not complete the palliation to Fontan are a heterogeneous group with unknown long term outcome. Aims This study aimed at describing the clinical course and long-term survival of patients with SV physiology with restricted pulmonary flow that had not undergone a Fontan type of repair. Methods From the prospectively maintained databases of the adult congenital cardiac units of five tertiary referral centers, data from all SV physiology patients were obtained. Patients completing a Fontan type palliation or developing Eisenmenger physiology and segmental pulmonary hypertension were excluded. Baseline data were recorded on the first visit at adult congenital heart disease (ACHD) unit. The primary end point was death. Results 101 patients (50.5% females) were identified. Mean age at end of follow up was 39.3±11.3 years. Of these, 45 (44.6%) were unoperated (group 1, restricted forward pulmonary flow with or without pulmonary banding), 38 (37.6%) had undergone a cavopulmonary shunt as a definitive palliation (group 2) and 18 (17.8%) had aortopulmonary shunts (group 3). The main diagnosis was double inlet left ventricle (DILV) (N: 52, 51.5%) and most of the ventricle was left (82.2%). The principal reason for not performing a Fontan repair was mean pulmonary artery pressure &gt;18 mmHg. At initial visit at the ACHD unit patients were 32.2±11.1 years of age. 35% of the patients were in NYHA class III-IV, with no differences between groups. However, patients in group 2 had worse oxygen saturation (p=002) and higher haemoglobin (p=0.037). After a mean follow-up of 7.3±4.1 years, mortality was 20.8% (21 patients), being sudden death (7p, 6.9%) the most frequent cause. Patients in group 3 showed worse ventricular function (p=0.0001) and a trend to higher mortality that did not reach statistical significance (HR 2.7, CI 95% 0.91–8.14, P=0.07). Conclusions Patients with single ventricle physiology not undergoing Fontan repair are a population of high risk, with sudden death as main driver of mortality. Patients palliated with aortopulmonary shunts are prone to worse ventricular function and a trend to higher mortality. Funding Acknowledgement Type of funding source: Public hospital(s)

Distal Aortic Arch Hypoplasia and Coarctation Repair: A Tailored Enlargement Technique

2018 ◽  
Vol 9 (5) ◽  
pp. 496-503
Author(s):  
Alain J. Poncelet ◽  
Arnaud Henkens ◽  
Thierry Sluysmans ◽  
Stephane Moniotte ◽  
Geoffroy de Beco ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Antihypertensive Drugs ◽  
Interrupted Aortic Arch ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cardiac Lesions ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Several techniques have been described to correct coarctation associated with distal arch hypoplasia. However, in neonates, residual gradients are frequently encountered and influence long-term outcome. We reviewed our experience with an alternative technique of repair combining carotid–subclavian angioplasty and extended end-to-end anastomosis. Methods: From 1998 through 2014, 109 neonates (median age, 9 days) with coarctation and distal arch hypoplasia (n = 106) or type A interrupted aortic arch (n = 3) underwent repair using this technique. Thirty patients had isolated lesions (group 1), 44 associated ventricular septal defect (group 2), and 35 associated complex cardiac lesions (group 3). Median follow-up was 98 months. Results: Repair was performed via left thoracotomy in 97%. There was one procedural-related death (0.9%) and overall five patients died during index admission (4.6%). Ten deaths were recorded at follow-up. Actuarial five-year survival was 86% (100% in group 1, 91% group 2, and 66% in group 3). Recurrent coarctation (clinical or invasive gradient >20 mm Hg) developed in 15 patients, all but 2 successfully treated by balloon dilatation. Freedom from any reintervention (dilatation or surgery) at five years was 86%. Only two patients were on antihypertensive drugs at last follow-up. Conclusions: This combined technique to correct distal arch hypoplasia and isthmic coarctation results in low mortality and acceptable recurrence rate. It preserves the left subclavian artery and allows enlargement of the distal arch diameter. Late outcome is excellent with very low prevalence of late arterial hypertension.

Does Conversion of Intended Remote Iliac Artery Endarterectomy Alter the Early and Long-Term Outcome?

Vascular ◽  
2005 ◽  
Vol 13 (6) ◽  
pp. 336-342 ◽  
Author(s):  
Luuk Smeets ◽  
Garmt van der Horn ◽  
Suzanne S. Gisbertz ◽  
Gwan Ho ◽  
Frans Moll
Keyword(s):  
Iliac Artery ◽  
Patency Rate ◽  
Long Term Results ◽  
Secondary Patency ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Secondary Patency Rate ◽  
Group 2 ◽  
Group 1

The purpose of this study was to compare the perioperative and long-term results of initial successful remote iliac artery endarterectomies (RIAEs) with converted procedures. From April 1994 to September 2003, 63 remote endarterectomies of the external and/or common iliac artery were planned in 62 patients (41 males, 42 procedures). The median age was 65 years (range 39–83 years), and the indication for operation was severe claudication in 37 (59%), rest pain in 16 (25%), and gangrene in 10 (16%) procedures. Initial technical success was achieved in 56 (89%) procedures (group 1); seven conversions (group 2) were necessary. In group 1, the 5-year primary patency rate improved from 64 ± 15% to a primary assisted patency of 88 ± 9.3% after percutaneous transluminal angioplasty in 11 patients, with 7 requiring stent placement. The 5-year secondary patency rate was 94 ± 7.4%. The primary and secondary patency rates in group 2 were 86 ± 19% and 100%, respectively. RIAE can be offered to patients with long occlusions of the iliac arteries as a first treatment option. The inherent risk of a possible conversion of an intended RIAE to a more invasive surgical procedure has no significant adverse clinical effect on the early and 5-year clinical outcomes.

Effects of Pregnancy on Long-Term Follow-Up of Mitral Valve Bioprostheses

1998 ◽  
Vol 6 (3) ◽  
pp. 174-178
Author(s):  
Mustafa Emir ◽  
Gürkan Uzunonat ◽  
Birol Yamak ◽  
A Tulga Ulus ◽  
M Kamil Göl ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Structural Valve Deterioration ◽  
Group 2 ◽  
Group 1

Between 1986 and 1990, 304 females between 11 and 45 (mean, 33.9 ± 6.9) years of age underwent isolated mitral valve replacement with a bioprosthesis. Thirty-nine of the 285 survivors experienced 48 pregnancies during the late follow-up period (group 1). Structural valve deterioration occurred in 25 (64.1%) of these patients and in 70 (28.4%) of the 246 patients (group 2) who did not become pregnant (p < 0.01). The mean time at which structural valve deterioration occurred was 7.01 ± 1.19 years postoperatively (range, 4.74 to 8.36 years) for group 1 patients and 6.76 ± 1.34 years (range, 2.33 to 10.17 years) for group 2 patients (p > 0.05). Freedom from structural valve deterioration at 10 years was 22.9% ± 8.11% for group 1 and 29.24% ± 6.09% for group 2 (p > 0.05). We concluded that pregnancy did not influence the long-term outcome after mitral valve replacement with a bioprosthesis.

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