Hemodynamic stability during 17 years of the Carpentier-Edwards aortic pericardial bioprosthesis.

Background: Long-term stability of the hemodynamic performance of commercially available Carpentier-Edwards stented bovine pericardial aortic bioprostheses (Perimount RSR) is unknown. To anticipate the fate of this bioprosthesis, we examined its hemodynamic performance up to 17 years using echocardiographic studies in a Premarket Approval cohort.

Methods: Of 267 patients at four institutions in the Premarket Approval cohort, 85 had a total of 168 echocardiographic studies during a 17-year period of yearly follow-up examinations.

Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis.

Background: Bioprosthesis durability decreases with time and younger age. However, the time-scale and determinants of durability of the aortic Carpentier-Edwards stented bovine pericardial prosthesis are incompletely characterized.

Methods: Between September 1981 and January 1984, 267 patients underwent implantation of the pericardial aortic prosthesis at four centers.

Emergency coronary artery bypass graft surgery in abciximab-treated patients.

Background: Although the platelet antiaggregant abciximab is frequently used with percutaneous coronary interventions, results of emergency coronary artery bypass graft operations in patients recently treated with abciximab are poorly characterized.

Methods: During a 29-month period, 12 patients required emergency coronary artery bypass grafting within 12 hours (mean, 1.9 hours) of abciximab therapy.

Long-term durability and patient functional status of the Carpentier-Edwards Perimount pericardial bioprosthesis in the aortic position.

Background And Aims Of The Study: The study aim was to examine the long-term durability of the aortic Carpentier-Edwards Perimount pericardial bioprosthesis using actuarial and actual analyses.

Methods: A total of 267 patients were implanted at four centers between September 1981 and December 1983. Of these patients, 171 (64%) were males and 96 (36%) females; mean age at implant was 64.

Biocompatible circuits: an adjunct to non-cardiac extracorporeal cardiopulmonary support.

The utilization of cardiopulmonary bypass systems, for circulatory and/or pulmonary support of patients undergoing non-cardiac procedures, has been previously reported. There is, however, a sub-group of patients for whom total systemic anticoagulation for cardiopulmonary support is extremely undesirable or contraindicated altogether, due to the presenting pathology or procedure to be performed. Clinical and experimental reports have suggested that with the use of heparin-bonded bypass circuits, the amount of heparin required for anticoagulation of the patient may be substantially reduced, or eliminated, safely.

Serial follow-up of an experimental bovine pericardial aortic bioprosthesis. Usefulness of pulsed Doppler echocardiography.

Echocardiography was used in the serial evaluation of 50 patients at 1, 3, and 7 years after aortic valve replacement with a new bovine pericardial aortic bioprosthesis. For valve sizes of 19-27 mm, at 7 years of follow-up mean transvalvular gradients (xGrad) ranged from 15.2 to 8.

Early experience with mitral valve reconstruction for mitral insufficiency.

Mitral valve repair for mitral regurgitation has been reported to have more favorable early and late results than mitral valve replacement. From July 1985 through July 1990, 63 patients have undergone valve repair at Good Samaritan Hospital. Twenty-two men and 41 women whose ages ranged from 34 to 81 years (mean 67.

Coronary artery bypass grafting in elderly patients. Comparative results in a consecutive series of 469 patients older than 75 years.

A consecutive series of 7104 patients undergoing isolated coronary artery bypass grafting during an 18-year period (1971 to 1988) included 469 patients older than 75 years. Results were analyzed to determine comparative risk factors for morbidity, early and late survival, and functional outcome. Patients younger than 75 years (group I) and patients older than 75 years (group II) were identical for ejection fraction and standard hemodynamic indices.

Reoperative coronary surgery. Comparative analysis of 6591 patients undergoing primary bypass and 508 patients undergoing reoperative coronary artery bypass.

During an 18-year period a consecutive series of 6591 patients underwent primary coronary bypass grafting and 508 patients underwent reoperative bypass. The mean patient age for the reoperative group was identical to that of the primary group, 59.8 years, but the mean age at initial operation for the reoperative group was 55.

Percutaneous transluminal coronary angioplasty. A growing surgical problem.

The incidence of prior percutaneous transluminal coronary angioplasty in surgical cases is nearly doubling yearly. In 1985, 11.4% of our bypass patients had one or more prior angioplasties.

The impact of electroencephalography, pressure, and pO2 monitoring on the risk of stroke during cardiopulmonary bypass.

Currently it is possible to account for an incidence of perfusion-related perioperative stroke of about 1%. The sources of stroke over which cardiac surgeons have some control relate to the perfusion circuit, the conducting of coronary pulmonary bypass, the operative approach to the patient with intracardiac clot, maneuvers that eliminate air during left heart procedures, control of biochemical factors such as hyperglycemia, and to the choice of anesthetic agents and drugs given during the procedure. The availability of equipment that allows in-line continuous monitoring of arterial and venous O2 saturations, control of physiologic parameters within certain limits, selective use of encephalographic monitoring for high-risk patients, along with careful attention to the details of the procedure, may allow the surgeon to alter favorably the numbers of patients suffering neurologic complications as a consequence of cardiac surgery.

Early experience with the intraluminal graft prosthesis.

Surgical therapy for dissection of the thoracic aorta has been associated with a high mortality rate due in part to intraoperative bleeding at the suture lines and through the prosthesis. A technique has been devised to obviate some of these problems which utilizes a sutureless prosthesis that can be placed within the aorta. This device is now commercially available.

Diabetes mellitus and coronary artery bypass. Short-term risk and long-term prognosis.

A consecutive series of 3,707 patients over a 12 year period undergoing isolated coronary artery bypass grafting (CABG) included 250 diet/oral medication-controlled and 162 insulin-dependent patients with diabetes mellitus. Analysis of 20 pre- and 18 intra-operative variables revealed a higher incidence of hypertension, left ventricular hypertrophy, and tobacco consumption for both diabetic groups. The extent of diffuse coronary disease as judged angiographically and at operation was significantly greater in both diabetic groups than in nondiabetic CABG patients.

Reoperation in symptomatic patients after direct coronary artery revascularization.

Seventy-nine patients underwent 85 reoperations to revascularize the myocardium at intervals from 2 days to 5 years (mean 13 months) after primary direct revascularization procedures. A total of 122 bypass grafts including 43 individual veins, 43 double or triple sequential veins, and 17 internal mammary arteries (IMA) were utilized. Failure of previous bypass grafting was the most common reason for recurrent symptoms, partially due to the high failure rate of radial artery segments used as bypass conduits.

Early and late results of resection of ventricular aneurysm.

Fifty-seven patients have undergone ventricular aneurysm resection with a mortality rate of 10 percent. Recent surgical trends have been toward complete revascularization and treatment of concomitant disorders when present. Although the early mortality rate may be favorable influenced by these maneuvers, analysis of survivors reveals no significant difference in survival between the group that had concomitant coronary artery bypass and the group that had aneurysm resection alone (84 percent versus 78 percent).

Effects of infusion of cardiotomy suction blood during extracorporeal circulation for coronary artery bypass surgery.

The effects of infusion of cardiotomy suction blood during extracorporeal circulation were evaluated in 15 patients undergoing coronary artery bypass surgery without the use of a left ventricular vent. In Group I all cardiotomy suction blood was discarded. In Groups II and III cardiotomy suction blood was reinfused without and with Dacron wool filtration, respectively.

Myocardial revascularization and carotid endarterectomy: a combined approach.

The approach to the patient with combined carotid and coronary artery occlusive disease has been evolving since corornary bypass procedures became feasible. When neurological and cardiac symptoms are remote, sequential procedures are adequate. Neurological symptoms or severe carotid stenoses (or both) appearing simultaneously with symptoms of myocardial ischemia present a more difficult problem.

Medical vs. urgent surgical therapy for acute coronary insufficiency: a randomized study.

Forty-two patients with acute coronary insufficiency (high risk subgroup) were randomly assigned to urgent coronary bypass surgery or to initial medical therapy followed by elective coronary bypass at four months if indicated at that time for relief of incapacitation angina pectoris. Coronary bypass performed on an urgent basis offered no advantage in preventing early myocardial infarction or death. The acute illness was resolved without permanent complications in most patients by either urgent bypass surgery or intensive medical therapy.

A newly designed arterial monitoring/perfusion cannula for cardiac operations.

A newly designed arterial monitoring and perfusion cannula for cardiopulmonary bypass eliminates the need for cannulation of a peripheral artery for pressure monitoring. The double-lumen cannula is designed as follows: the large central lumen (12 to 26f) acts as the arterial inflow conduit from the pump oxygenator, while a second, smaller lumen (18 gauge)constructed in the wall of the first cannula acts as the pressure-monitoring port and the source for blood sampling and drug infusion. This monitoring/perfusion cannula has been used succesfully in more than 250 clinical patients in a variety of settings--total cardiopulmonary bypass, left heart bypass, and when multiple arterial inflow lines were necessary (as in aortic arch replacement).

Mitral valve replacement: a 10-year follow-up of non-cloth-covered vs. cloth-covered caged-ball prostheses.

The timing of operation and the selection of prosthesis depend upon the evaluation of long-term results at 5 years and beyond. From 1965 to 1975, 290 patients had isolated mitral valve replacement with currently used prostheses, resulting in a 6.6% operative mortality and 64% relative survival at 10 years.

Mediastinal wound infection and aortocoronary graft patency.

In our experience, eight of ten aortocoronary grafts in five patients remained patent in the face of mediastinal infection. Combining reports of seventeen other grafts from the literature, we conclude that patency can be anticipated in approximately 70 per cent of such grafts and that mediastinal infection does not necessarily adversely affect aortocoronary saphenous vein bypass graft patency. We recommend aggressive therapy of mediastinal infection in this setting due to the high survival rate which can be anticipated with modern methods of therapy, as well as the high probability of graft patency.

Acute aortic dissection from cross-clamp injury.

Acute dissection of the ascending aorta secondary to cross-clamp injury can be successfully managed if the problem is recognized immediately. Bypass must be instituted after recannulation at a point distal to the innominate artery so that proper exposure of the site of injury can be obtained. Systemic as well as local hypothermia for myocardial preservation are both necessary.