ABSTRACT
We studied 287 consecutive patients who underwent valve replacement procedures under retrograde warm-blood cardioplegia between 1 March 1992 and 30 June 1997 (64 months). Some of the procedures were performed in combination with other operations (70), but most (217) were isolated. Thirty patients had undergone previous "open" procedures and another 25 patients had undergone prior "closed" procedures. The 30-day postoperative mortality rate was 3.8% (11 deaths). In 7 patients, the cause of death was not cardiogenic. We did not observe any instance of right ventricular failure, perforation of the coronary sinus, phrenic nerve palsy, or wound infection. These results indicate that retrograde warm-blood cardioplegia provides excellent myocardial protection of both ventricles during valve replacement.
Subject(s)
Heart Arrest, Induced/methods , Heart Valve Prosthesis Implantation , Myocardial Reperfusion Injury/prevention & control , Adult , Aged , Aged, 80 and over , Aortic Valve , Cardioplegic Solutions , Coronary Artery Bypass/methods , Coronary Artery Bypass/mortality , Female , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation/mortality , Humans , Male , Middle Aged , Mitral Valve , Morbidity , Postoperative Complications/epidemiology , Reoperation/methods , Survival RateABSTRACT
From 1 March 1992 too 31 July 1993 (17 months), 480 consecutive patients underwent various open-heart procedures under anterograde (83 patients) or retrograde (397 patients) or retrograde (397 patients) continuous warm blood cardioplegia. Some 352 patients (73.3%) had isolated coronary artery bypass grafts (CABG) and 117 (24.3%) had valve replacement either isolated (96) or in combination with other operations (21). Two patients had CABG and ventricular aneurysmectomy, eight had correction of congenital defects, and one had resection of left atrial myxoma. The 30-day postoperative mortality rate was 2.9% (14 deaths). In four patients the cause of death was not cardiogenic. An intra-aortic balloon was used in 11 patients following CABG (3.1%) with six survivors. Perforation of the coronary sinus occurred in one patient. Perioperative myocardial infarction was observed in 5.6% of patients after CABG. No myocardial infarction occurred after valve replacement. Phrenic nerve injury and wound infection were not observed. These results indicate that warm blood cardioplegia, especially when delivered retrogradely, provides excellent myocardial protection of both ventricles during various open-heart procedures.
Subject(s)
Heart Arrest, Induced/methods , Adult , Aged , Aged, 80 and over , Cardiac Surgical Procedures/mortality , Cardioplegic Solutions , Catheterization , Coronary Artery Bypass , Female , Heart Aneurysm/surgery , Heart Defects, Congenital/surgery , Heart Neoplasms/surgery , Heart Valve Prosthesis , Humans , Male , Middle Aged , Postoperative Complications/mortality , TemperatureABSTRACT
The following case report describes an early complication of a Carpentier-Edwards porcine heterograft in the mitral position that required emergency replacement of the malfunctioning biological prosthesis with a mechanical one. The leaflets of the valve were in a fixed-open position and would not unfold with left ventricular contractions, resulting in severe mitral regurgitation. After failure to mobilize the valve leaflets, the porcine heterograft valve was excised intact and replaced with a 27 mm Björk-Shiley monostrut prosthesis. The patient was discharged 18 days after operation on Digoxin 0.25 mg daily, Lasix 40 mg twice a week, and Sintrom 2 mg daily. He remains in excellent condition 20 months postoperatively.
ABSTRACT
A case of acquired mitral stenosis in a 29-year-old male with cardiac dextroversion and bone abnormalities of the chest is described. Open mitral valvotomy through a median sternotomy was planned but could not be executed and a closed valvotomy was easily performed.
