Thirty-year results after implantation of the Björk-Shiley Convexo-Concave Heart valve prosthesis.

BACKGROUND: Modifications of the Björk-Shiley valve prosthesis have shown good long-term results. The convexo-concave model, however, was recalled 27 years ago because of a propensity for breakage due to outlet strut fracture. The objective of this study is to describe the 30-year outcome after implantation of the Björk-Shiley convexo-concave mechanical heart valve prosthesis (Pfizer, Rye Brook, NY). METHODS: The study included 279 patients who were operated between 1979 and 1983 at Turku University Hospital. A total of 305 valves were implanted; 205 in the aortic position and 100 in the mitral position. Patient records were reviewed for baseline characteristics and late events, data on mortality were acquired from registries. RESULTS: Mean actuarial survival was 19.8 years and mean follow-up was 19.2 years (maximum 34 years). Freedom from reoperation was 91.3% at 30 years. There were 3 outlet strut fractures (2 fatal) during follow-up. Statistically significant predictors of mortality were age and concomitant coronary artery bypass grafting. CONCLUSIONS: Despite the possibility of structural valve failure the Björk-Shiley convexo-concave valve confers excellent 30-year survival.

Comparison of results of coronary artery bypass grafting versus percutaneous coronary intervention in octogenarians.

The aim of the present study was to compare the outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients aged ≥80 years. The present analysis included 274 patients who underwent isolated CABG and 393 patients who underwent PCI. The patients undergoing PCI had a greater prevalence of a history of cardiac surgery and recent myocardial infarction and had more frequently undergone emergency revascularization. Patients undergoing CABG had a significantly greater prevalence of 3-vessel coronary artery disease. The unadjusted 30-day mortality rate was 8.8% after CABG and 7.4% after PCI (p = 0.514). However, on multivariate analysis, CABG was associated with a significantly increased risk of 30-day mortality (odds ratio 2.246, 95% confidence interval 1.141 to 4.422). The unadjusted overall intermediate survival was significantly poorer after PCI (at 5 years, CABG 72.2% vs PCI 59.5%, p = 0.004), but this was not confirmed on multivariate analysis. PCI and CABG had similar intermediate survival rates when adjusted for propensity score (p = 0.698), a finding confirmed by the analysis of 130 propensity score-matched pairs (at 5 years, CABG 66.4% vs PCI 58.9%, p = 0.730). In conclusion, the survival of patients aged ≥80 years undergoing CABG is excellent, and the suboptimal survival after PCI seems to be related to the disproportionately greater risk of these patients compared to those undergoing CABG. When adjusted for important clinical variables, PCI and CABG achieved similar intermediate results.

Initial healing of sternotomy wounds: correlation between preoperative data and wound inflammatory cell response.

Local inflammation after a surgical incision is an essential prerequisite for wound healing and later scar formation both in children and adults. However, the underlying regulatory mechanisms are still poorly known and need further investigations. In this study, one hundred sternotomy patients, operated on routinely for cardiac disease, were studied with the Cellstick device to harvest wound inflammatory cells for differential count and subsequent computerized analysis using an artificial neural network. As a result a nonparametric line of ranked nodes was obtained reflecting wound inflammatory cell response in individual patients at hour 24 post surgery. A number of preoperative and operative parameters were recorded to see their possible correlation with the node values of wound inflammatory cell response. It was found that the age of the patient had a remarkable role in this respect while a majority of laboratory values, if within reference values of healthy persons, had a minor correlation or no correlation at all. Therefore, individual and genetic factors seemed to play a dominant role providing that the patient had a good or moderate general condition and surgical site infection was avoided.