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