The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 1984
Randomized Controlled Trial Comparative Study Clinical TrialA clinical trial of blood and crystalloid cardioplegia.
Although experimental studies suggest that blood cardioplegia provides better protection than crystalloid cardioplegia, clinical studies have been inconclusive. Ninety patients undergoing coronary bypass grafting were randomized to receive either blood (n = 43) or crystalloid cardioplegia (n = 47). The incidence of perioperative myocardial infarction was lower with blood cardioplegia (blood, n = 0; crystalloid, n = 5; p = 0.06), and the maximum MB isoenzyme of creatine kinase was significantly less with blood cardioplegia (blood, 26.3 +/- 12.6 U/L; crystalloid, 35.6 +/- 17.0 U/L, mean +/- standard deviation; p less than 0.02.) Sixty patients (blood cardioplegia, n = 28; crystalloid cardioplegia, n = 32) had more sensitive measurements to assess the metabolic response to aortic occlusion and to compare the metabolic and functional recovery from the operation. ⋯ Myocardial performance (the left ventricular stroke work index-left ventricular end-diastolic volume index relation) and systolic elastance (the systolic blood pressure-left ventricular end-systolic volume index relation) were significantly better with blood cardioplegia (p less than 0.01 by multivariate analysis); diastolic compliance (the left atrial pressure-left ventricular end-diastolic volume index relation) was similar. Blood cardioplegia reduced ischemic injury, decreased anaerobic metabolism during arrest, and permitted better functional recovery. Blood cardioplegia provides superior protection for elective coronary bypass grafting and may improve the clinical results in patients with unstable angina and in other high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Nov 1984
Late surgical results for ischemic mitral regurgitation. Role of wall motion score and severity of regurgitation.
The indication for concomitant valve operations for ischemic mitral regurgitation is examined in 120 consecutive patients with regurgitation who had coronary bypass. Ischemic mitral regurgitation was mild in 56%, moderate in 18%, and severe in 27%. Compared with patients without mitral regurgitation who underwent coronary bypass, significantly more patients with regurgitation had cardiomegaly (31% versus 5%), left heart failure (42% versus 6%), and abnormal wall motion scores (71% versus 42%). ⋯ Mild regurgitation is best managed by coronary bypass alone. If regurgitation is moderate, it may still be possible to avoid a valve operation and have acceptable results. Severe ischemic mitral regurgitation usually necessitates coronary bypass and a mitral valve operation.
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J. Thorac. Cardiovasc. Surg. · Nov 1984
Biography Historical ArticleEvarts Graham and surgical residency education.
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The modified Blalock-Taussig shunt, interposing an expanded polytetrafluoroethylene graft between the subclavian and pulmonary arteries, was performed in 30 neonates with a mean age of 8.8 days and a mean weight of 3.14 kg. Underlying lesions included severe tetralogy of Fallot or its variant (N = 10), transposition complex (with pulmonary stenosis or atresia) (N = 6), single ventricle equivalents (with pulmonary atresia or stenosis) (N = 9), and pulmonary atresia with intact ventricular septum (N = 5). The mean preoperative arterial oxygen tension prior to prostaglandin E1 therapy was 29.5 torr. ⋯ The ratios of the diameter of the right pulmonary artery and pulmonary valve anulus to that of the descending aorta increased after the operation by 50% (p less than 0.001) and 52% (p less than 0.05), respectively. Our experience indicates that the modified Blalock-Taussig shunt has an excellent function, offers several technical advantages, and lacks most of the drawbacks of other systemic-pulmonary artery shunts. It may be the shunt of choice in patients less than 1 month of age.
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J. Thorac. Cardiovasc. Surg. · Nov 1984
Comparative StudyEarly and late risk of aortic valve replacement. A 12 year concomitant comparison of the porcine bioprosthetic and tilting disc prosthetic aortic valves.
Aortic valve replacement was performed in 912 consecutive patients from January, 1972, to January, 1983. The 616 male and 296 female patients, whose ages ranged from 16 to 95 years (mean 60.6 years and median 63 years), received 663 bioprosthetic valves and 249 tilting disc valves. A higher incidence of Functional Class IV heart disease and ascending aortic aneurysms was noted in the group receiving the tilting disc valve. ⋯ At 108 months, the probability of freedom from thromboembolism was 85% +/- 3% after bioprosthetic valve replacement and 83% +/- 3% after replacement with a tilting disc valve (p = NS). The probability of freedom from hemorrhage at 108 months was 98.6% +/- 7% for the bioprosthetic valve group and 89% +/- 2% for the tilting disc valve group (p less than 0.001). The valve thrombosis rate was 0.34% per patient-year for the tilting disc valves and 0.07% per patient-year for the bioprostheses.(ABSTRACT TRUNCATED AT 400 WORDS)