HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bernal, J. M. Articles by Revuelta, J. M. Search for Related Content PubMed PubMed Citation Articles by Bernal, J. M. Articles by Revuelta, J. M. Related Collections Valve disease

Eur J Cardiothorac Surg 2006;29:144-149
© 2006 Elsevier Science NL

Performance at 10 years of the CarboMedics ‘Top-Hat’ valve. Postclamping time is a predictor of mortality

^a Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, E-39008 Santander, Spain
^b Division of Preventive Medicine and Public Health, Universidad de Cantabria, Santander, Spain

Received 15 August 2005; received in revised form 11 October 2005; accepted 17 October 2005.

^_* Corresponding author. Tel. +34 942 202536; fax: +34 942 203535. (Email: bernal{at}humv.es).

Objective: The CarboMedics ‘Top-Hat’ supraannular prosthesis was designed to permit the implantation of a larger prosthesis. We evaluated the outcome at 10 years in patients with this prosthesis. Methods: Between June 1993 and May 2001, 269 patients (average age, 63.9 years) received a CarboMedics ‘Top-Hat’ supraannular aortic prosthesis. Primary valve replacement was performed on 203 patients (75.5%) and repeat valve replacement on 66 (24.5%). The duration of myocardial ischemia was 70.2 ± 31.4 min, cardiopulmonary bypass 96.1 ± 48.3 min, and postclamping time (time between release of aortic clamp and the end of extracorporeal circulation) 22.1 ± 41.3 min. The mean follow-up was 82.3 ± 17.8 months. Follow-up was 97.6% complete. Results: The hospital mortality was 5.9%. It was 1% when the duration of postclamping time was <15 min, 2.8% between 15 and 29 min, 13.2% between 30 and 44 min, and 26.9% >44 min. In the multivariate analysis, postclamping time, urgent surgery, and body mass index were statistically significant risk factors for hospital mortality. The late mortality was 17.1%. Cardiac-related mortality showed a linearized rate of 18.1% per 1000 patients-year. The Kaplan–Meier estimates for cardiac-related mortality was 75.0% at 10 years. Postclamping time, aortic valve gradient, age over 70 years, and BMI were statistically significant risk factors for cardiac-related late mortality. The incidence of paravalvular leak in the ‘Top-Hat’ aortic prosthesis was 1.7% per 1000 patients-year. Conclusions: Using the CarboMedics supraannular prosthesis allows implantation of a larger prosthesis without increasing valve-related complications. Postclamping time appears as a strong predictor of both hospital mortality and late cardiac-related death.

Key Words: Aortic valve surgery • Cardiopulmonary bypass • Prosthesis • Survival

This article has been cited by other articles:

				J. M. Bernal, A. Ponton, B. Diaz, J. Llorca, I. Garcia, A. Sarralde, C. Diago, and J. M. Revuelta Surgery for rheumatic tricuspid valve disease: a 30-year experience. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 476 - 481. [Abstract] [Full Text] [PDF]