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ARTIGO ORIGINAL

Implante de bioprótese aórtica "stentless" em pacientes com alterações do anel aórtico

Bayard Gontijo FilhoI; Mário O VrandecicI; Fernando Antônio FantiniI; Juscelino Teixeira BarbosaI; João Alfredo de Paula e SilvaI; Sandra S AvelarI; Leonardo F DrumondI; Cristiana GutierrezI

DOI: 10.1590/S0102-76381993000200006

RESUMO

Dezessete pacientes portadores de doença da valva aórtica associada a alterações estruturais do anel aórtico foram submetidos a implante de bioprótese aórtica "stentless" (Biocór): 8 pacientes eram portadores de endocardite bacteriana, sendo 3 em valva aórtica e 5 em próteses. Os demais pacientes eram portadores de próteses aórticas disfuncionantes. A técnica de implante foi basicamente a mesma, utilizandose dois níveis de sutura, sendo o primeiro ao nível do anel aórtico e o outro na parede aórtica. Em 11 pacientes a aorta ascendente foi ampliada com remendo de pericárdio bovino e 3 pacientes foram submetidos, também, a substituição valvar mitral. Houve 1 óbito hospitalar no 23º dia de pós-operatório por falência de múltiplos órgãos em 1 paciente portador de endocardite bacteriana e quadro de AVC pré-operatório. Dois pacientes necessitaram implante de marcapasso definitivo. Na evolução tardia houve apenas 1 óbito no 6º mês, de forma súbita, em uma criança portadora de marcapasso. Um paciente desenvolveu deiscência parcial da bioprótese na sutura inferior, o que gerou um gradiente na via de saída do ventrículo esquerdo, sendo reoperado com sucesso de 18º mês de pós-operatório. Todos os pacientes encontram-se em controle ambulatorial, com estudos ecocardiográficos seriados, que demonstram excelente desempenho da bioprótese "stentless" sem gradientes transvalvares importantes e ausência de regurgitação aórtica significativa.

ABSTRACT

An aortic stentless bioprosthesis (Biocor Ind.) was implanted in 17 patients with difficult aortic annulus due either to endocarditis orto a previous aortic valve replacement. Native valve endocarditis was present in 3 patients and prosthetic valve endocarditis in 5; 9 patients had one or more previous aortic valve replacements showing a wheakened aortic rim. The stentless bioprosthesis was implanted with a two layers suture technique similar to a homograft implant. The ascending aorta was enlarged with a patch of bovine pericardium in 11 ocasions; mitral valve replacement was concomitantly performed in 3 patients. There was one hospital death secondary to multiple organ failure in a patient with acute endocarditis and a preoperative cerebro-vascular accident. One patient who was pacemaker dependant had a sudden death in the 6 th postoperative month. All other 15 patients are in regular follow-up with periodic ecocardiographic analysis. One patient had partial deiscense of the lower suture line which generated a gradient in the left ventricular outflow tract; he was reoperated upon and the valve was refixed with flow normalization. In all patients the valve has shown an excellent performance with very small gradients (mean = 10.6 mmHg) and abscence of significant aortic regurgitation. No case of reinfection was observed in the patients with endocarditis. The stentless aortic bioprosthesis proved to be an excellent heart valve substitute in this difficult group of patients.
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REFERÊNCIAS

1. BATISTA, R. J. V.; DOBRIANSKIJ, A.; COMAZZI Jr., M.; LESSA NETO, L. T.; ROCHA, G.; SARTORI, F.; WESTPHAL, R.; TIMI, J. R.; MOREIRA, R.; OLIVEIRA, P. F. - Clinical experience with stentless pericardial aortic monopatch for aortic valve replacement. J. Thorac. Cardiovasc. Surg., 93: 19-26, 1987. [MedLine]

2. DANIELSON, G. K.; TITUS, J. L.; DUSHANE, J. W. - Successful treatment of aortic valve endocarditis and aortic root abscesses by insertion of prosthetic valve in ascending aorta and placement of bypass grafts to coronary arteries. J. Thorac. Cardiovasc. Surg., 67: 443-449, 1974. [MedLine]

3. DAVID, T. E.; POLLICK, C.; BOS, J. - Aortic valve replacement with stentless porcine aortic bioprosthesis. J. Thorac. Cardiovasc. Surg., 99: 113-118, 1990. [MedLine]

4. ERGIN, M. A.; RAISSI, S.; FOLLIS, F.; LANSWAN, S. L.; GRIEPP, R. B. - Annular destruction in acute bacterial endocarditis: surgical techniques to meet the challenge. J. Thorac. Cardiovasc. Surg., 97: 755-763, 1989. [MedLine]

5. GONTIJO FILHO, B.; VRANDECIC, M.; MOREA, M.; RADEGRAN, K.; PAULA E SILVA, J. A.; FANTINI, F. A.; BARBOSA, J. B. - Nova bioprótese aórtica em suporte: resultados clínicos. Rev. Bras. Cir. Cardiovasc., 7: 208-214, 1982.

6. HAYDOCK, D.; BARRATT-BOYES, B. G.; MACEDO, T.; KIRKLIN, J. W.; BLACKS, E. - Aortic valve replacement for active infectious endocarditis in 108 patients: a comparison of freehand allograft valves with mechanical prostheses and bioprostheses. J. Thorac. Cardiovasc. Surg., 103: 130-139, 1992. [MedLine]

7. KIRKLIN, J. W. & BARRAT-BOYES, B. G. - Aortic valve disease. In: KIRKLIN, J. W. & BARRAT-BOYES, B. G. (eds.) Cardiac surgery. New York, Wiley, 1986. p. 373-429.

8. KIRKLIN, J. W. & PACIFICO, A. D. - Aortic valve endocarditis with aortic root abscess cavity: surgical treatment with aortic valve homograft. Ann. Thorac. Surg., 45: 674-679, 1988.

9. MATSUKI, O.; ROBLES, A.; GIBBS, S.; BODNAR, E.; ROSS, D. N. - Long term performance of 555 aortic homografts in aortic position. Ann. Thorac. Surg., 46: 187-191, 1988. [MedLine]

10. RANDOLPH, J. D.; TOAL, K.; STELZER, P.; ELKINS, R. C. - Aortic valve and left ventricular outflow tract replacement using allograft and autograft valves: a preliminary report. Ann. Thorac. Surg., 48: 345-349, 1989. [MedLine]

11. TIENA, I. C.; ORSZULAK, J. A.; SCHAFF, H. V.; DANIELSON, G. K. - Results of homograft aortic valve replacement for active endocarditis. Ann. Thorac Surg., 49: 619-624, 1990. [MedLine]

12. VRANDECIC, M.; MOREA, M.; RADEGRAN, K.; GONTIJO FILHO, B.; PAULA E SILVA, J. A.; FANTINI, F. A.; BARBOSA, J. T. - Clinical use of a new stentless porcine aortic bioprosthesis: a multicenter study. In: Cardiology and cardiac surgery: current topics. New York. Futura Publishing Co. Inc, 1992. p. 23-234.

13. ZWISCHENBERG, J. B.; SHALABY, T. Z.; CONTI, V. R. - Viable cryopreserved aortic homograft for aortic valve endocarditis and annular abscesses. Ann. Thoracic. Surg., 48: 365-370, 1989.

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