Predictors of outcome in a multicenter port-access valve registry.

BACKGROUND: The aim of this study was to examine the predictors of outcome in patients undergoing isolated valve operation using port-access techniques. METHODS: Logistic regression analysis was performed in a prospective, multi-institutional registry of patients undergoing isolated aortic valve replacement (AVR, n = 252), mitral repair (MVP, n = 491), or mitral replacement (MVR, n = 568) using port-access techniques from 1997 to 1999. RESULTS: Endoaortic balloon occlusion was used in 2% (AVR), 93% (MVP), and 90% (MVR) of cases. Conversion to full sternotomy occurred in 3.8% of all cases. For all patients, early mortality was 50 of 1,311 (3.8%) and onset of new atrial fibrillation occurred in 140 of 1,311 (11%) patients. The determinants of 30-day mortality were redo, age, and MVR or AVR. The determinants of reoperation for bleeding were age, reoperation, and MVR. Age was a predictor for stroke, and age and low or medium volume center were predictors of new atrial fibrillation. CONCLUSIONS: Excellent short-term results can be obtained using port-access techniques in isolated mitral or aortic valve operations. Patient outcome is not related to institutional case volume, and the primary determinants of outcome after port-access valve procedures are generally patient-related factors.

Evaluation of quantitative acid-base balance and determination of unidentified anions in swine.

Arterial blood samples were collected from 19 anesthetized pigs before and after hemorrhage was induced. Blood gas tensions and concentrations of sodium, potassium, chloride, lactate, and total protein were measured. Results indicated that hydrogen ion (H+) concentration calculated from a specific formula was a biased and imprecise estimate of measured H+ concentration. The bias was 5.45 nEq/L, with limits of agreement from -7.92 to 18.83 nEq/L. Because albumin is the fraction of plasma protein most important in acid-base balance, the agreement between predicted and measured H+ concentration was reevaluated, using an albumin charge estimate and a reference swine albumin-to-globulin ratio. This improved the ability of the formula to predict H+ concentration; the bias decreased to 1.33 nEq/L with limits of agreement from -12.16 to 9.49 nEq/L. The formula and a simplified approach for clinical application were biased and unacceptably imprecise estimators of lactate (L-) concentration. The formula approach underestimated L- concentration by 2.8 (-12.4, 6.7) mEq/L, whereas the simplified method overestimated L- concentration by 5.0 (-3.8, 13.9) mEq/L.

Parenteral anticholinergics in dogs with normal and elevated intraocular pressure.

Dogs given parenteral anticholinergic drugs have been thought to be at risk for development or exacerbation of elevated intraocular pressure (IOP). In a randomized, blinded, placebo-controlled study, we evaluated the effect of intramuscular glycopyrrolate (0.01 mg/kg) on pupil diameter and IOP in unanesthetized normal dogs. Treatment with glycopyrrolate did not change pupil diameter or IOP from baseline, nor were there differences between glycopyrrolate and saline-treated (control) dogs. In addition, the authors retrospectively reviewed the medical records of 2,828 dogs undergoing general anesthesia between April 1987 and September 1990 to determine if there was an association between parenteral anticholinergic medication and postanesthetic elevation in IOP. The authors also determined the frequency of bradycardia requiring anticholinergic therapy during anesthesia in dogs with glaucoma. Of the 2,828 cases reviewed, the records of 46 dogs coded for glaucoma were examined in detail. The 46 dogs underwent 62 episodes of anesthesia, with 23 episodes including exposure to an anticholinergic drug. An increase in IOP from preanesthetic to postanesthetic measurement occurred in three dogs. One of these dogs received anticholinergic medication for bradycardia during anesthesia. The postanesthetic elevation in IOP in this dog was probably not drug related. Preanesthetic anticholinergic administration did not affect the incidence of anticholinergic administration for bradycardia during the anesthetic episode. Anticholinergic therapy during anesthesia was more frequent when the preanesthetic medication included an opiate drug. These studies do not indicate an association between parenteral anticholinergic administration and elevations in IOP.