SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:40
SVO2 A MARKER WITH EXCELLENT SENSITIVITY AND SPECIFICITY FOR CARDIAC MORTALITY AFTER
SURGERY FOR AORTIC STENOSIS
Svedjeholm Rolf 1 , Holm Jonas 1 , Vanky Farkas 1 , Håkanson Erik 1
1) Linköping University Hospital, Sweden
Objective
Adequate monitoring of hemodynamic state is essential after cardiac surgery and vital for medical decision making
particularly concerning hemodynamic management. Unfortunately commonly used methods to assess hemodynamic
state are poorly documented with regard to outcome. Mixed venous oxygen saturation (SvO2) was therefore
investigated after cardiac surgery.
Methods
Detailed data regarding mortality was available on all patients undergoing aortic valve replacement for isolated
aortic stenosis during 1995 - 2000 in the southeast region of Sweden (n=396). SvO2 was routinely measured on
arrival to intensive care unit (ICU) and registered in a data base. A receiver operating characteristics (ROC) analysis
of SvO2 in relation to mortality related to cardiac failure and all cause mortality within 30 days was performed.
Results
Area under the curve (AUC) was 0.97 (95% CI 0.96-1.00) for mortality related to cardiac failure (p=0.001) and 0.76
(95% CI 0.53-0.99) for all cause mortality (p=0.011). The best cut off for mortality related to cardiac failure was
SvO2 53.7% with a sensitivity of 1.00 and a specificity of 0.94. Negative predictive value was 100%.
The best cut off for all cause mortality was SvO2 58.1% with a sensitivity of 0.75 and a specificity of 0.84. Negative
predictive value was 99.4%
Conclusions
SvO2 on arrival to ICU after surgery for aortic stenosis demonstrated excellent sensitivity and specificity for
postoperative mortality related to cardiac failure and fairly good AUC for all cause mortality with excellent negative
predictive value.
P01:41
RESTORING SUBVALVAR CONTINUITY BY REIMPLENTING STRUT CHORDA IN THE SETTING OF
RHUMATIC MITRAL VALVE REPLACEMENT1
Kargar Faranak 1 , Samiei Niloofar 1 , Mohebi Ahmad 2 , Noohi Freidoun 1 , Aazami Mathias 1
1) Shahed Rajaei Heart Hospital, Iran
Introduction
Preserving mitral subvalvar continuity is technically challenging in the setting of rheumatic heart valve disease. We
report on a new technique to restore mitral subvalvar continuity by re-implanting the strut chorda that are primary
mediators of LV-central fibrous body interplay.
Patients and methods
During 2009, 7 patients (mean age: 48.6 ± 12.6 y.o; female: 57%; mean LVEF: 44.29 %; mean PAP: 51 mmHg;
mean logistic Euroscore: 9.5 ± 8 %) with rheumatic heart valve disease (mitral stenosis: 43%; mitral regurgitation:
14%; mitral stenosis and regurgitation: 43%) underwent mitral valve replacement using the current technique that
consists on preserving mitral subvalvar continuity by reimplanting mitral strut chorda to the mitral annulus and sitting
a mechanical bi-leaflet valve prosthesis in an intra-annular position.
Results
All patients survived on operation; displaying an uneventful postoperative course. 5 patients (71.4%) required one
or more concomitant procedures. The mean pump and ischemic times were 269 and 193 minutes respectively. At
the time of discharge the means LVEF and trans-mitral prosthetic gradient were 42.14 % and 4.2 mmHg (ranged
from 3 to 7) respectively. The re-implanted anterior and posterior strut chorda were identified in all patients on
postoperative echocardiography without inferring with prosthetic valves leaflets.
Conclusions
Restoring the mitral subvalvar continuity by re-implanting the strut chorda is safe and reproducible in patients with
rheumatic heart valve disease. The latter may be more physiologic rather than re-approximating marginal chorda to
the annulus in terms of preservation of LV function that needs to be further investigated.
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