ABSTRACT
To establish a benchmark for the clinical efficacy of PTCA and the IMA graft in our institution, the data from 79 patients who underwent isolated SVBG to the LAD between July, 1971, and December, 1984, were analyzed. Follow-up averaged 96.16 months/patient. Actuarial freedom from reoperation was 100% at 12 months, 95% at 60 months, and 89.4% at 120 months. Actuarial freedom from cardiac death was 100% at 12 months, 94% at 60 months, and 87% at 120 months. Actuarial freedom from an LAD graft failure myocardial event was 100% at 12 month, 94% at 60 months, and 77% at 120 months. Our SVBG failure rate did increase from 1.2%/year during the first 5 years to 3.4%/year during the second 5 years. We are presently selectively employing IMA grafts to the LAD. Our results with the SVBG and the palliative nature of all coronary artery bypass graft procedures remove the imperative to always use the IMA. Individual patient considerations such as age, clinical stability, IMA flow, and the residual anatomy for the potential reoperation are important considerations.
Subject(s)
Coronary Artery Bypass , Actuarial Analysis , Age Factors , Aged , Angioplasty, Balloon , Coronary Disease/mortality , Coronary Disease/surgery , Evaluation Studies as Topic , Female , Follow-Up Studies , Graft Rejection , Humans , Male , Mammary Arteries/transplantation , Middle Aged , Reoperation , Saphenous Vein/transplantation , Time FactorsABSTRACT
MVR was examined in 181 patients undergoing 188 consecutive operations during a 12 1/2-year observation time. Hospital mortality for MVR without aortic valve disease was 7 of 156 or 4.5% and was independent of the valve type employed and the presence of coronary artery pathology. Late cardiac mortality in isolated MVR was significantly greater in those patients receiving a Starr-Edward 6120 prosthesis when compared to those receiving an MPX. The presence of coronary artery pathology, however, defines the patient subgroup with the poorest late survival. Tissue durability has not significantly altered late survival after MPX. However, the actuarial analysis of tissue failure reveals important increases in tissue failure incidence 5 years after placement. Although MPX is our prosthesis of choice for MVR, limited tissue durability creates an important subgroup for judicious use of a mechanical prosthesis. We conclude that no valve type should be championed as "the valve" for all patients undergoing MVR. The selection of a valve for MVR remains a difficult judgment which must be tempered by the patients age, history of previous operations, severity of his present illness, and the feasibility of a second MVR.
Subject(s)
Heart Valve Diseases/surgery , Heart Valve Prosthesis , Adult , Aged , Anticoagulants/adverse effects , Coronary Vessels/pathology , Female , Heart Valve Diseases/pathology , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis/mortality , Hemorrhage/etiology , Humans , Male , Middle Aged , Mitral Valve , Postoperative Complications/etiology , Thromboembolism/etiology , Time FactorsABSTRACT
The clinical diagnosis of traumatic descending thoracic aortic aneurysm is not obvious but is usually suggested on a roentgenogram of the chest. The diagnosis, therefore, is based upon a high index of suspicion and confirmed by an angiogram. Femoral-femoral bypass is a safe approach, assuring adequate distal perfusion and, thereby, avoiding problems of ischemia. By assuring adequate distal perfusion and preserving all possible intercostal arteries, spinal cord injury was avoided in this series.
