Off-pump bypass of the left anterior descending coronary artery: 23- to 34-year follow-up.

Objective: We sought to develop a baseline for long-term survival of patients after off-pump bypass of the left anterior descending coronary artery with the heart beating.

Methods: We reviewed results for 241 consecutive patients with significant obstruction of the left anterior descending coronary artery who underwent surgery between November 1969 and the end of 1980. The off-pump operative technique involved elevating and stabilizing a segment of the distal left anterior descending coronary artery with 4 traction sutures.

Off-pump bypass surgery: the early experience, 1969-1985.

This is a review of 733 patients who underwent off-pump bypass surgery of the right coronary artery and left anterior descending coronary artery between 1969 and 1985. Two hundred sixty-four patients underwent single bypass of the left anterior descending coronary artery, and 79 patients underwent single bypass of the right coronary artery. Both the left anterior descending and right coronary arteries were bypassed in 390 patients.

Quality control for cardiac surgery in the Veterans Administration.

The volume of cardiac surgical procedures and the 30-day mortality associated with them were reviewed for the total experience of 72 Veterans Administration medical centers over a 10-year period (1975 to 1984). The total number of cardiopulmonary bypass operations increased from 3,074 in 1975 to 6,455 in 1984, whereas operative mortality declined from 8.3 to 4.

A 20-year review of ostium primum defect repair in children.

Between July, 1963, and July, 1983, a total of 69 patients (35 boys and 34 girls) underwent ostium primum defect repair. There were four perioperative deaths and four patients were subsequently lost to follow-up, leaving 61 children followed for 6 months to 20 years (mean 5 years). Results of surgery were assessed by cardiac catheterization in 17 of 61 patients, while the remaining patients were evaluated noninvasively.

Activated coagulation and activated partial thromboplastin times in assessment and reversal of heparin-induced anticoagulation for cardiopulmonary bypass.

In 22 adult patients, activated coagulation times (ACT) were compared to activated partial thromboplastin times (aPTT) before, during, and after cardiopulmonary (CP) bypass surgery. After intravenous heparin (150 units/kg), mean ACT increased from 131 +/- 14 (mean +/- SD) to 362 +/- 72 s (P less than 0.001).

Surgical therapy for congenital aortic valvular stenosis. A 23 year experience.

This is a review of 70 consecutive patients (2 to 20 years old) who underwent valvotomy for congenital aortic valvular stenosis from 1958 through 1980. A tricuspid valve was created in 36, a bicuspid valve in 33, and a valve prosthesis was inserted in one, with two operative deaths (2.8%).

Assurance.

The Society of Thoracic Surgeons was created for practicing thoracic surgeons, but the response to recertification indicates there has been a breakdown in communication between practicing thoracic surgeons and the leadership of this Society and other decision-making organizations of our specialty. To provide greater input and participation by members, it is suggested that regional representatives be elected to the Council, open discussion of issues important to thoracic surgeons be held at the Annual Meetings, small-group clinical workshops be added to the Scientific Sessions to increase opportunity for participation, and more nonacademic surgeons be included as members of working committees of the Society. Recertification represents the third phase on the part of the medical education and establishment of standards for postgraduate training.

Severe aortic stenosis in a patient with recurrent gastrointestinal bleeding: replacement of the aortic valve with a porcine xenograft.

Patients with aortic stenosis are subject to recurrent episodes of gastrointestinal bleeding of uncertain cause. How such patients should be handled when aortic valve replacement is required is not established. This report deals with such a patient who underwent successful aortic valve replacement with a porcine xenograft without anticoagulation.

Coronary artery bypass grafts: increased flow in the early postoperative period.

The long-term outcome of coronary artery bypass operations is contingent upon the patency of aortocoronary bypass grafts. Flow measurements taken at operation may not truly reflect the capacity of the graft to carry glow because the heart may not have fully recovered from the consequences of ischemic arrest, despite the protective effects of hypothermic cardioplegia. During a three-year period, we observed increases of up to 200% in the flow rate of 8 of 11 saphenous vein grafts in 7 patients who underwent reoperation for bleeding or cardiac tamponade in the early postoperative period.

Surgical repair of inferior sinus venosus atrial septal defect.

A 9-year-old girl presented for cardiac evaluation with symptoms of dyspena, fatigue, and cyanosis with exercise. Cardiac catheterization demonstrated an atrial septal defect; an anomalous right superior pulmonary vein was suspected but not confirmed. Operation disclosed anomalous drainage of the right superior and inferior pulmonary veins into the right atrium, an intact fossa ovalis, and an inferior sinus venosus defect.

Comparison of exercise and catheterization results following total surgical correction of tetralogy of Fallot.

Although surgery may correct the hemodynamic abnormalities of tetralogy of Fallot (TOF), the long-term effects on exercise tolerance are uncertain. Twenty-eight patients, aged 7 to 30 years, had cardiac catheterization and maximal graded exercise testing to evaluate the adequacy of the ehmodynamic repair and its relation to exercise performance. Patients were tested 2 to 9 years after operation, and 13 previously had had palliative shunt procedures.

Resolution of surgically induced right bundle-branch block.

In a retrospective study, the serial electrocardiograms of all patients with surgically induced right bundle-branch block (RBBB) were reviewed. None of these patients had had RBBB prior to operation. Seven patients who had RBBB from 6 to 16 days after operation showed resolution in ECGs done 3 to 8 months later.

Congenitally cleft atrioventricular valves associated with secundum atrial septal defects.

Three patients with the rare association of secundum ASD and congenital clefts of A-V valves are reported. These three patients illustrate the predictive valve of vectoracardiographic analysis in precisely determining the anatomic location of the valvular pathology. The embryologic origins of the lesion are briefly discussed.