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Ann Thorac Surg 1980;29:434-439
© 1980 The Society of Thoracic Surgeons

Articles

Acute Hemodynamic Alterations after Mitral Valve Replacement with the Glutaraldehyde-Treated Porcine Heterograft Prosthesis

Paul F. Hoar, Ph.D. M.D.*, Avijit Mookerjee, M.D., J. Gilbert Stone, M.D., Anthony E. Wicks, M.D., James R. Malm, M.D., Michael B. Mirsky, M.S.

Departments of Anesthesiology and Surgery, Columbia University College of Physicians and Surgeons, New York, NY

Accepted for publication December 13, 1979.

* Address reprint requests to Dr. Hoar, Department of Anesthesiology (129), Room 3C-14—Building 203, Veterans Administration Medical Center, 4150 Clement St, San Francisco, CA 94121

Perioperative hemodynamic changes following mitral valve replacement using the porcine heterograft prosthesis were measured in 21 patients with acquired mitral valve disease. Preoperatively, a state of compensatory cardiac failure was suggested by the following: an increased heart rate (HR) (96 beats per minute); low cardiac and stroke volume (SVI) indices (2.3 ± 0.10 L/min/m2 and 25 ± 2 ml/beat/m2); and increased systemic vascular resistance (SVR) (1,626 ± 116 dyne sec cm–5). Both the mean pulmonary artery (PAP) and pulmonary capillary wedge pressures (PCWP) were elevated as well (32 ± 3 and 22 ± 2 torr). Immediate hemodynamic improvement followed valve replacement. HR, SVR, PAP, and PCWP all decreased significantly. Twenty-four hours after valve replacement, PAP (23 ± 1 torr) and PCWP (13 ± 1 torr) demonstrated marked declines, SVR was reduced by one-third (1,173 ± 87 dyne sec cm–5), HR had decreased by 10 beats per minute, and SVI had increased to 30 ± 2 ml/beat/m2. The prompt circulatory improvement of patients soon after mitral valve replacement using the porcine heterograft compares favorably with studies in which other valve types were employed and in which postoperative cardiovascular depression was encountered frequently.






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