Contemporary Ross procedure outcomes: medium- to long-term results in 214 patients.

OBJECTIVE: Our goal was to present 2 decades of our experience with the Ross procedure and its sequential modifications, adopted since 2010, to improve the reoperation rate. METHODS: We performed a single-centre, retrospective review of database information and medical notes about the implantation technique: the freestanding root. We compared era 1 (1997-2009) and era 2 (2010-2019). RESULTS: Between 1997 and 2019, a total of 214 Ross procedures were performed (71% men, median age 24 years) [interquartile range (IQR) 15-38]. Of these, 87% had various forms of congenital-dysplastic aortic valves. The median cross-clamping and bypass times were 173 (IQR 148-202) and 202 (IQR 182-244) min. The median postoperative stay was 6 days (2-77). Thirty-day mortality was 0.5%. The median follow-up time was 8.2 years (IQR 3.9-13.2). Survival at 10 and 20 years was 97% and 95%; freedom from greater than moderate aortic regurgitation or aortic valve intervention was 91% and 80%; and 93% of the patients were in New York Heart Association functional class I. Twenty (21%) patients operated on during era 1 and 6 (9%) during era 2 underwent autograft reoperations. The median follow-up time was 14.3 (IQR 11.5-17.4) and 4.8 (IQR 2.5-7) years. Freedom from autograft reoperation was 87% and 69% at 10 and 20 years, with no significant difference between eras. Freedom from homograft reoperation was 96% and 76% at 10 and 20 years. The presence of aortic regurgitation, infective endocarditis and era 1 were predictors of autograft reoperation. Male gender and era 1 were predictors of neoaortic root dilatation. CONCLUSIONS: The contemporary modified Ross procedure continues to deliver excellent results and should remain part of the strategy to treat children and young adults requiring aortic valve replacement.

Immediate clinical and haemodynamic benefits of restoration of pulmonary valvar competence in patients with pulmonary hypertension.

OBJECTIVE: To analyse the potential benefit of restoration of pulmonary valvar competence in patients with severe pulmonary regurgitation (PR) and pulmonary hypertension (PH) associated with congenital heart disease. DESIGN: Retrospective study. SETTING: Tertiary paediatric and adult congenital heart cardiac centre. INTERVENTIONS: Percutaneous pulmonary valve implantation (PPVI). PATIENTS: All patients who underwent PPVI for treatment of PR in the presence of PH (mean PAP >25 mm Hg). RESULTS: Seven patients with severe PH as a result of congenital heart disease and severe PR underwent PPVI. The valve implantation procedure was feasible and uncomplicated in all seven cases, successfully abolishing PR. There was a significant increase in diastolic (15.4 (7.3) to 34.0 (8.5) mm Hg; p = 0.007) and mean (29.7 (8.1) to 41.3 (12.9) mm Hg; p = 0.034) pulmonary artery pressures, and an improvement in NYHA functional class (from median IV to median III; p<0.008). Peripheral oxygen saturations rose from 85.9% (11.0%) to 91.7% (8.3%) (p = 0.036). Right ventricular (RV) volumes decreased (from 157.0 (44.7) to 140.3 (53.3) ml/m(2)), while effective RV stroke volume increased (from 23.4 (9.3) to 41.0 (11.6) ml/m(2)). During a median follow-up of 20.3 months (range 1.3-47.5), valvar competence was well maintained despite near systemic pulmonary pressures. None of the valved stents were explanted during follow-up. CONCLUSION: Trans-catheter treatment of PR in patients with PH is well tolerated and leads to clinical and haemodynamic improvement, most probably caused by a combination of increased pulmonary perfusion pressures and RV efficiency.

The SolCos model: facilitating reminiscence therapy.

1. Reminiscing is an effective strategy for processing information, feelings, and thoughts into a broader life perspective. 2. The SolCos Reminiscence Model has been developed to facilitate reminiscence therapy. It may be used singularly or in a group, and with elders and persons who are terminally ill. 3. The model, which consists of processes, items, and outcome categories, is a fluid construction and may be approached nonlinearly. The model is both beneficial and longitudinally cost-effective for the individual and yields a lasting benefit to the practitioner, both personally and professionally.

Task analysis of Air Force pharmacy practice.

The frequency with which United States Air Force pharmacists perform specific professional tasks and the pharmacists' views as to the importance of those tasks were studied. A questionnaire was prepared that asked recipients to rate each of 36 tasks selected as representing the spectrum of practice activities. There were four categories of tasks: managerial tasks, dispensing tasks, drug information tasks, and patient care tasks. Recipients rated the tasks with respect to frequency of performance and importance on separate 6-point scales. The questionnaire was mailed in May 1991 to the 225 pharmacists then serving in the Air Force worldwide. Of the 225 questionnaires, 150 usable questionnaires were returned (response rate, 67%). All the tasks in the survey were performed by at least one Air Force pharmacy officer, although the frequency of task performance varied. In particular, the frequency of many patient care tasks was low. All the tasks were perceived to have some importance, but drug information tasks were rated as being significantly more important than tasks in the other categories; patient care tasks were rated lowest in importance. The results varied with the respondents' demographic characteristics. Pharmacy officers with more years of service, more senior positions, higher rank, or an advanced degree in a field other than pharmacy tended to give responses that diverged from those of the population. A 1991 survey showed an awareness among Air Force pharmacists of the need to orient practice around patient care; however, they were not spending substantial time on patient care and tended to view it as less important than more traditional pharmacy tasks.

The SolCos model: facilitating reminiscence therapy.

1. Reminiscing is an effective strategy for processing information, feelings, and thoughts into a broader life perspective. 2. The SolCos Reminiscence Model has been developed to facilitate reminiscence therapy. It may be used singularly or in a group, and with elders and persons who are terminally ill. 3. The model, which consists of processes, items and outcome categories, is a fluid construction and may be approached nonlinearly. The model is both beneficial and longitudinally cost-effective for the individual and yields a lasting benefit to the practitioner, both personally and professionally.

Prenatal literature testing: a pilot project.

A pilot study was conducted in 1987-1988 to evaluate current health literature utilized for prenatal health education of the high risk population in County Health Departments in Arizona. Towards that end, sixty-five distinct pamphlets were obtained from Arizona's County Health Departments and assessed for reading level using the SMOG Readability Formula. The majority of the prenatal literature were found to be 10th to 12th grade reading level, higher than the typical reading level of the high risk prenatal population. A modified literature testing instrument was further utilized to test eight general prenatal pamphlets to assess the printed literature for accuracy, usability, believability, appeal, and cultural relevance. Four pamphlets of those tested, two English and two Spanish, were identified as being the most appropriate for the high risk prenatal population.

In vitro effects of fatty acids on the actions of serum on rat and pig cartilage.

It has been reported that fatty acids preferentially inhibit serum-stimulated incorporation of sulfate by embryonic chick cartilage, suggesting that they may interfere with the effects of a proposed mediator (serum somatomedin) of the actions of growth hormone (GH). This was studied further in mammalian cartilage. Butyrate and octanoate at concentrations of 0.5 to 5 mM produced a concentration-dependent inhibition of both basal and serum-stimulated sulfate and thymidine incorporation by costal cartilage from hypophysectomized rats. Butyrate also inhibited basal and serum-stimulated sulfate incorporation in cartilage from normal pigs and normal sucklings rats. In all 3 test systems, oleate (0.2--5 mM) bound to serum albumin (4 g/dl) was ineffective. There was no evidence that fatty acids preferentially inhibited the stimulation of sulfate incorporation produced by serum.