Heart valve surgery in the modern era: Towards zero operative mortality in the developing area

Objective: Despite modern technology, heart valve replacement still carries significant operative mortality, ranging from 2 to 10% in most cardiac centres. Methodology: From December 1999 to January 2003, more than 150 heart valve operations on mitral valve (MV)/aortic valve (AV) or double valve replacement (DVR) were performed at the cooperative heart institutes with no operative mortality (defined as either in‐hospital or postoperative 30‐day death). The present study analyses the data of the 109 patients among this group who were operated on by a single surgeon (the author). Results: There were 49 male and 60 female patients with an average age of 41.6 ± 1.2 years old (range: 7–69 years). All patients had a certain degree of heart failure and most had cardiothoracic ratio increased, with the largest being 99%. The operations performed were: MV replacement (41); AV replacement (21; five patients had concomitant repair of rupture of the aneurysm of sinus of Valsalva); double valve replacement/intervention (46); MV repair ± annuloplasty ring (3); concomitant coronary artery bypass grafting (5) and tricuspid valve annuloplasty (2). There were no operative deaths. The prostheses used were: St. Jude (86); Sorin (10); Monostrut (24) and China Langzhou (29). One patient died of bleeding and infectious complications 5 months after the operation. Conclusions: We conclude that in the modern era, valve replacement can have superior results even in a developing area. The commonly used prostheses have similar results. Particular attention should be paid to proper preoperative preparation, operative details, and postoperative care.