Long-term clinical outcomes of the Toronto stentless porcine valve: 15-year results from dual centers.

Background And Aim Of The Study: The purpose of this study is to examine the long-term durability of the Toronto stentless porcine valve (SPV) in the aortic position (St Jude Medical, Minneapolis, MN).

Methods: We assessed the long-term clinical outcomes of 515 patients with aortic valve replacement (AVR) with the Toronto SPV from 1987 to 2001 at two centers, excluding early (<30 days) death. Median follow-up was 11.

Mending Hearts and Building Bridges: The Save a Child's Heart Foundation.

Context: Save a Child's Heart addresses the challenges of heart care for children in underdeveloped countries.

Objective: Save a Child's Heart has created a center of excellence for pediatric cardiac care at the Wolfson Medical Center in Israel, helped develop partner sites for evaluation and referral, and trained medical teams to return and build their own capacity for local cardiac care.

Results: Save a Child's Heart has treated more than 3600 children from 48 countries, with 50% from Iraq, Jordan, the Palestinian Authority, and Syria.

Are stentless valves hemodynamically superior to stented valves? Long-term follow-up of a randomized trial comparing Carpentier-Edwards pericardial valve with the Toronto Stentless Porcine Valve.

Objective: The benefit of stentless valves remains in question. In 1999, a randomized trial comparing stentless and stented valves was unable to demonstrate any hemodynamic or clinical benefits at 1 year after implantation. This study reviews long-term outcomes of patients randomized in the aforementioned trial.

Impact of clopidogrel use on mortality and major bleeding in patients undergoing coronary artery bypass surgery.

Patients who received clopidogrel prior to coronary bypass surgery are at increased risk for bleeding that must be balanced with risk of ongoing ischemia if coronary artery bypass grafting is delayed. This study aimed to evaluate the impact of clopidogrel on mortality and major bleeding in patients undergoing urgent coronary bypass surgery. We reviewed 451 consecutive patients who underwent urgent isolated coronary bypass surgery; 262 had not received clopidogrel, whereas 189 received clopidogrel < or = 5 days preoperative.

Troponin after cardiac surgery: a predictor or a phenomenon?

Background: Increased cardiac troponin is observed after virtually every cardiac operation, indicating perioperative myocardial injury. The clinical significance of this elevation is controversial. This study aimed to correlate postoperative troponin levels with major adverse cardiac events (MACE).

Determinants of pacemaker dependency after coronary and/or mitral or aortic valve surgery with long-term follow-up.

The aim of the present study was to investigate potential preoperative, operative, and postoperative predictors of pacemaker (PM) dependency after coronary, mitral valve, and aortic valve surgery. One hundred two patients (mean age 68 +/- 11 years; 62% men) who had received a permanent PM after cardiac surgery were included. The presence of any pacing activity in VVI mode with a lower rate of 30 beats/min was defined as PM dependency.

History of surgical treatment of ischemic heart disease--pre-'coronary bypass grafting' era.

Background And Aim: To review the various concepts, surgical experiments, and actual procedures performed for the treatment of ischemic heart disease, which eventually led to the evolution of direct coronary artery bypass surgery.

Methods: References were collected from original articles and through pubmed search.

Results: Various concepts and procedures were introduced, all with the aim of increasing myocardial blood flow and relief of angina.

The life and hard times of a coronary surgeon.

Coronary artery bypass is arguably the most extensively studied operation in surgical history. The technical advances and beneficial effects on symptoms and prognosis have been well documented over four decades. Percutaneous coronary interventions (PCIs) have also evolved through numerous modifications, and symptom relief has been substantiated; both modalities have been challenged by many randomized controlled trials.

A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts.

Background: Early coronary bypass graft failures may be preventable if identified intraoperatively. The purpose of this investigation was to compare the diagnostic accuracy of two intraoperative graft assessment techniques, transit-time ultrasound flow measurement and indocyanine green fluorescent-dye graft angiography.

Methods: Patents undergoing isolated coronary artery bypass grafting with no contraindications for postoperative angiography were enrolled in the study.

Improving the quality of coronary bypass surgery with intraoperative angiography: validation of a new technique.

Objectives: We report a comprehensive assessment and validation of a new intraoperative angiography technique.

Background: Technical problems at the site of the distal anastomosis compromise an underappreciated proportion of coronary bypass grafts. The absence of a systematic, validated technique to verify graft patency in the operating room represents a significant breach in quality assurance.

Determinants of incomplete left ventricular mass regression following aortic valve replacement for aortic stenosis.

Objective: Incomplete regression of left ventricular hypertrophy (Abn-LVMI) following AVR for aortic stenosis (AS) may decrease long-term survival. In this prospective study, we identified the predictors of Abn-LVMI.

Methods: Between 1990 and 2000, 529 patients undergoing AVR for AS had clinical and hemodynamic data collected prospectively.

Long-term results of aortic valve replacement with the St. Jude Toronto stentless porcine valve.

Background: Long-term survival and freedom from valve-related events of the St. Jude Toronto stentless porcine valve (SPV) are unknown. The aim of this study was to investigate late clinical outcomes after aortic valve replacement with the Toronto SPV.

Contemporary trends in aortic valve surgery: a single centre 10-year clinical experience.

The purpose of this study is to present a comprehensive profile of the trends in aortic valve replacement at a single institution over the past decade. Prospectively collected data concerning 873 patients undergoing aortic valve replacement (AVR), with and without coronary artery bypass grafting (CABG), were analysed. The patients were divided into three time periods: period I, (1990 to 1993); period II, (1994 to 1996); and period III, (1997 to 2000).

Why is off-pump coronary surgery uncommon in Canada? Results of a population-based survey of Canadian heart surgeons.

Background: Off-pump coronary artery bypass (OPCAB) is proposed to improve clinical outcomes and decrease resource use. However, off-pump surgery is not widely used in Canada. The purpose of this study was to determine the current use of OPCAB in Canada and determine why surgeons have not adopted this technique.

Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting.

Objectives: Patients undergoing coronary artery bypass grafting often have untreated mild to moderate mitral regurgitation. The long-term outcome of these patients follows an uncertain course. The purpose of this study was to examine the late outcomes in patients with mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting.

Durability and prevalence of aortic regurgitation nine years after aortic valve replacement with the Toronto SPV stentless bioprosthesis.

Background And Aim Of The Study: Stentless aortic bioprostheses have excellent hemodynamics. Previous investigations of the Toronto SPV valve described a correlation between the occurrence of significant aortic regurgitation (AR) and dilation of the sinotubular junction. The study aim was to determine the long-term durability and determinants of AR at nine years in a large, multicenter study of the Toronto SPV valve.

Radial artery use is safe in patients with moderate to severe left ventricular dysfunction.

Background: Using radial artery grafts in patients with moderate to severe left ventricular dysfunction (LVD; ejection fraction < 35%) has been discouraged for the fear that postoperative vasopressor support may cause graft spasm and lead to ischemic complications. We, therefore, examined the safety of radial grafts in aortocoronary bypass (ACB) patients with LVD.

Methods: Data were collected from 5,455 patients who underwent isolated ACB between January 1995 and September 2001.