The role of surgery on ambulatory patients in one teaching hospital.

The development of a program of one-day surgery for ambulatory patients in one hospital was stimulated by overloaded operating room facilities and a long waiting list of patients for hospital admission. This concept has received enthusiastic reception by the surgical staff and the number of operations has increased to over 7,500 per year. All of the surgical specialty services use the surgical day care unit, although the number of cases suitable for ambulatory surgical treatment varies greatly on the various services.

Protection by plasma proteins of the isolated lamb heart perfused with stroma-free hemoglobin at 38 degrees.

Isolated lamb hearts were perfused for eight hours at 38 degrees with stroma-free hemoglobin solution (SFHS). The preservation of cardiac structure and function was studied. Control hearts perfused with blood (N = 6) developed no ventricular failure or significant weight gain (13% +/- 5), showed no alteration of cellular ultrastructure, and little interstitial edema.

Selective arterialization of the coronary venous system. Encouraging long-term flow evaluation utilizing radioactive microspheres.

The long-term effectiveness of a retrograde coronary venous bypass graft (CVBG) to an ischemic left ventricle was evaluated in 18 dogs. A saphenous vein was interposed between the aorta and left anterior descending (LAD) vein. The LAD vein was ligated cephalad to the CVBG to prevent an arteriovenous fistula.

Effect of cross-clamp time, temperature, and cardioplegic agents on myocardial function after induced arrest.

To evaluate the importance of time, temperature, and cardioplegia on the ability of the canine myocardium to maintain functional and ultrastructural integrity following induced arrest, we studied 220 dogs by varying myocardial temperature (34 degrees, 24 degrees, and 11 degrees C.), arrest time (0 to 120 minutes), and cardioplegic agents. Change in left ventricular function (LVF) was defined as the arithmetic difference in the center of mass between prearrest and postarrest LVF curves and was expressed as percent recovery of left ventricular stroke work.

Clinical experience with intraaortic balloon pump support in 728 patients.

From November, 1968, through December, 1976, intraaortic balloon pump (IABP) circulatory support was used 747 times in 728 patients. Overall in-hospital survival was 413/747 (56.9%).

Management of acute myocardial ischemia with intraaortic balloon pumping and coronary bypass surgery.

Ninety-three patients with unstable angina pectoris resistant to maximum medical therapy were treated with intraaortic balloon pumping (IABP), early angiography, and myocardial revascularization. Sixty patients had no recent infarction: 42 with typical angina (ST depression > 0.1 mV) and 18 with variant angina (ST elevation > 0.

Hemodynamic evaluation of the Hancock-modified orifice bioprosthesis in the aortic position.

Porcine xenografts have had marginal hemodynamic function in the aortic position, particularly in the smaller sized valves. A new modified orifice heterograft prosthesis (MO) has been designed with the muscular leaflet of the porcine valve excised and replaced with the nonmuscular leaflet of a second valve, thus allowing 25 to 35% improvement in effective internal orifice area. In vitro studies on MO show clear hydraulic improvement over standard porcine prostheses and function comparable to that of low-profile metal prostheses.

Early intraaortic balloon pumping for anterior myocardial infarction without shock.

Eleven patients with anterior myocardial infarction less than six hours old underwent intraaortic balloon pumping (IABP) in an attempt to control injury. Direct hemodynamic measurements excluded shock. Response to therapy was judged individually by comparison to a one-hour pretreatment period.

Late prosthetic valve endocarditis: clinical features influencing therapy.

To assess the clinical features which might influence therapy, we studied 43 patients with late prosthetic valve endocarditis (LPVE). Twenty patients (47 per cent) survived. Of patients with streptococcal LPVE 61 per cent (11 of 18) survived compared to 36 per cent (nine of 25) of the patients with nonstreptococcal LPVE (p less than 0.

Assessment of the heart by histochemical and birefringence techniques as compared with ventricular function tests.

We have compared results of isovolumic ventricular function studies and results of histochemical and birefringence examinations of biopsy specimens from 80 isolated canine hearts both before and after three hours of preservation utilizing several variables. The direct and derived mechanical tests and histochemical and birefringence assessments of the myocardium were correlated by multiple regression analysis. Our results suggest that initial ventricular health may be indicated by acid hematein staining of free phospholipids and by the response of myocardial birefringence to adenosine triphosphate and calcium, while succinic dehydrogenase staining and birefringence without adenosine-triphosphate treatment are more useful in showing ventricular deterioration during operation.

Life-threatening hemorrhage from inadvertent cervical arteriotomy.

Catastrophic hemorrhage followed accidental puncture of the carotid artery or its branches during attempted preoperative insertion of flow-directed balloon-tipped pulmonary artery catheters in 2 patients who underwent open cardiac procedures. Direct repair of two carotid artery lacerations was necessary in 1 patient; the second patient slowly resorbed a large extrapleural hematoma without surgical intervention. This experience suggests that patients experiencing such seemingly innocuous but potentially disastrous arterial injuries should not be heparinized, and that any procedure involving cardiopulmonary bypass should be postponed for several days to allow safe healing of the laceration.

Surgery for post-myocardial infarct ventricular septal defect.

Forty-three patients (mean age 62 +/- 1 years) were treated for ventricular septal defect (VSD) secondary to myocardial infarction. Whenever possible, operation was postponed until six weeks post-onset chest pain. However, hemodynamic instability, evidenced by cardiogenic shock, refractory pulmonary edema, or a rising blood urea nitrogen (BUN) forced operation in 21 patients within 21 days post-infarct (Group I).

The management of infected arterial aneurysms.

Infected aneurysms involve the aorta, visceral and peripheral arteries and are associated with a high morbidity and mortality. Prompt confirmation of the suspicion of infection, resection of all infected tissue, and prolonged antibiotic therapy based on appropriate sensitivity studies are crucial to successful management. Patients whose aortic aneurysms grew Gram negative organisms were more likely to suffer early rupture of an aortic aneurysm, and had a higher mortality.