The Monostrut prosthetic valve. Predictors for valve-related events during an eight years' experience.

All postoperative complications, including transient ischaemic attacks (TIA) and cerebrovascular accidents (CVA) of 259 patients, in whom a total of 301 Monostrut tilting-disc valves were implanted between January 1985 and December 1991 were evaluated retrospectively. The follow-up was maximally 8 years, with a mean of 3.5 years, and totaled 914 patient-years. In this study we found no mechanical deterioration of the Monostrut valve and demonstrated the elimination of valve thrombosis in patients receiving adequate anticoagulation. The actuarial probability of being free of thrombo-embolism was 94.7% +/- 1.7% and free of anticoagulant related hemorrhage 95.4% +/- 1.5% at 8-years. In comparison with earlier reports by others, our findings show a lower ratio of thromboembolic and hemorrhagic events. We demonstrated a correlation (p < 0.05) between thrombo-embolic and hemorrhagic complications. In addition, a lower incidence of CVA's (0.22 per 100 patient-years), but a higher incidence of TIA's (0.66 per 100 patient-years) in comparison with the general Dutch population was found. At eight years follow-up, all patients were in Class I or II of the New York Heart Association Classification. Although the overall valve related event-free survival at eight years was only 47.9%, 93.5% of the patient were satisfied with their operative result. Predictive factors for late mortality were the occurrence of paravalvular leakage (p < 0.01), the age of the patient at the time of operation (p < 0.01) and the number of diseases coronary arteries (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Bilateral mammary artery surgery or percutaneous transluminal coronary angioplasty for multivessel coronary artery disease? An analysis of effects and costs.

Seventy-two patients with stable or unstable angina treated since 1983 by multivessel-PTCA(MVP) were retrospectively compared with 44 similar patients that were suitable for MVP, but who had undergone bilateral mammary artery (BIMA) surgery (and additional vein grafts in 60.5% of the patients) since 1986. Both groups were comparable (P = not significant [NS]) for gender, age, most risk factors, objective ischaemia and left ventricular function; however, in the BIMA group there were more previous infarctions (P = 0.02), hypertension (P = 0.03), three-vessel disease (P = 0.0001), and less severe angina (P = 0.007). In the BIMA group, a mean of 3.1 (range 2-5) vessels were treated and in the MVP group 2.0 (range 2-3) vessels (P = 0.0001). Both groups were almost completely revascularized (NS). In 39.5% of the BIMA group, no veins were used and in 20.9% the BIMAs were used as sequential grafts. In-hospital mortality was comparable: 2.3% for BIMA and 1.4% for MVP, so were periprocedural infarctions (13.6% vs 8.3%), rethoracotomies (9.1% vs 0%), emergency procedures (0% vs 5.7%), low cardiac output (2.3% vs 5.6%) and other complications (18.2% vs 9.2%). The mean stay (days) on the ICU/CCU for BIMA was 2.3 and for MVP 1.6 (P = 0.005) and the mean hospital stay for BIMA 12.3 and for MVP 6.6 (P = 0.0001). The maximum and mean follow-up (months) of 43 BIMA and 71 MVP hospital survivors was 35 vs 72 and 9.5 vs 22.3 (P = 0.0001) with a late mortality of 0% and 4.2% (NS). MVP patients, including 12 with re-procedures, had more recurrent angina (17.7% vs 4.7%, P less than 0.05) and more often used anti-anginal medications (62.0% vs 18.6%, P less than 0.0001). Late complications (excluding re-procedures) were comparable for MVP and BIMA (20% vs 9.3%, 4.4% vs 0%, 9.2% vs 14%). MVP patients had more re-hospitalizations (34 vs 5, P less than 0.0001), re-catheterizations (33% vs 2.3%, P less than 0.0001) and cardiac re-procedures (16 vs 0, P = 0.0006) than BIMA patients. Recurrent-angina-free survival at 1 year was 96% after BIMA and 64% after MVP (P less than 0.01). Event-free survival at 1 year was 86% after BIMA and 58% after MVP (P less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Erroneous radial artery pressure reading during dissection of the right internal mammary artery.

Erroneous radial artery blood pressure reading occurred during asymmetrical chest wall retraction required for internal mammary artery dissection, used for coronary artery bypass grafting. The most likely cause was subclavian artery compression. It is advised to insert a catheter in the contralateral radial artery when the internal mammary artery is going to be dissected. When bilateral internal mammary arteries are used, a femoral artery catheter should be inserted.