Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results.

In the present climate of quality-assurance policies, rigorous requirements for informed consent, and a constantly changing patient population, a system of preoperative risk assignment and postoperative correlation was developed to monitor and evaluate surgical performance. Patients were categorized by operation, priority (emergent, urgent, elective), New York Heart Association Functional Class, and risk. Risk was assigned before operation using data from the Coronary Artery Surgery Study (CASS) and the recent literature.

Performance of the Smeloff aortic valve beyond ten years.

The Smeloff aortic valve has remained unchanged in design and material since 1966. To assess the long-term performance of this prosthesis, we reviewed 394 consecutive patients undergoing elective aortic valve replacement. Concomitant coronary artery bypass grafting was performed in 26.

Modification of the Smeloff mitral prosthesis.

The simplicity of the ball valve with its random seating capabilities coupled with its durability, reliability, and predictability has made it the attractive choice of many surgeons. A low incidence of embolic phenomena with the Smeloff full-orifice, double-caged, bare-strutted ball valve has made us reluctant to alter the design over 17 years. Recent evaluation of the reasons for reoperation on the Smeloff mitral valve implantation in 376 cases revealed 16 cases in which development of fibrous subvalvular pannus with signs and symptoms of mitral stenosis occurred.