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.

Long-term survival after single aortic or mitral valve replacement with the present model of Smeloff-Cutter valves.

Two hundred fourteen survivors of single aortic (AVR) or mitral valve replacement (MVR) were evaluated. The present model of the Smeloff-Cutter prosthesis was used in these patients, and the series was started in September, 1966, following the last structural change in the valve. Clinical follow-up ended in September, 1976.

Development of a cardiac valve substitute: the Smeloff-Cutter prosthesis.

Several criteria were used for the development of the Smeloff-Cutter prosthesis: (a) the valve must permit adequate pulsatile forward flow with minimal gradients and regurgitation; (b) materials used must be inert or compatible with tissue and blood; (c) the prosthesis must be durable; (d) attachment must be easy and secure; (e) the valve must be nonhemolytic and nonthrombogenic; (f) its geometry must not impinge on surrounding structures; (g) testing must be in vitro as well as in vivo; and (h) its use must result in an acceptable long-term clinical response. Application of these criteria to the design of the Smeloff-Cutter valve is described.

Complications of heart valve replacement. Embolism bleeding and hemolysis.

Fifty-two patients surviving single heart valve replacement since September 1962 were reviewed in order to detail the incidence of post-operative embolism, bleeding and hemolysis. A substantial decrease in the occurrence of embolism has been seen with newer prosthetic devices paralleling the improvement in cardiac catheterization dynamics. The frequency of embolism appears also to be affected by the degree and adequacy of anticoagulant control although a higher morbidity from bleeding must be accepted.