Aortic valve replacement with the Lillehei-Kaster prosthesis in 262 patients: an assessment after 9 to 17 years.

A 9 to 17-year follow-up after aortic valve replacement with the Lillehei-Kaster prosthesis was carried out in 262 patients with a mean age of 53 years. All patients were traced. The operative mortality was 7.3%. The observed survival of the total series after 5, 10 and 15 years amounted to 75%, 61%, and 49% respectively. The majority of survivors showed improvement of functional capacity and decrease of heart volume. Freedom from valve-related death, thromboembolism and valve-related morbidity and mortality after 15 years amounted to 94%, 85% and 75% respectively. Only two instances of valve thrombosis were seen, and fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards and the Björk-Shiley prostheses. Analysis of the relative survival rates, i.e. the observed survival rates as ratios of those of the general population, indicates that the 10-year survival of patients with aortic stenosis is close to normal, whereas the survival rates of patients with aortic incompetence and with combined aortic stenosis and incompetence are significantly lower. It is suggested that earlier operation should be considered in patients with aortic incompetence and with combined stenosis and incompetence in order to lower the late mortality rate.

Long-term follow-up in 54 patients after combined mitral and aortic valve replacement with the Lillehei-Kaster prosthesis. Overall results and prosthesis-related complications.

A follow-up study was carried out in 54 patients after combined mitral and aortic valve replacement with the Lillehei-Kaster prosthesis. Twenty-two males and thirty-two females with a mean age of 54 years provided a total of 272 years of observation. The operative mortality was 16.7%. The long-term survival rates were 67% after 5 years and 55% after 8 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. In spite of long-term anticoagulant treatment thromboembolic incidents were the most frequent valve-related complications. The percentage of patients free from valve-related morbidity and mortality was 75% after 8 years. Valve-related death accounted for 4% of all deaths. Fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr-Edwards' or the Björk-Shiley prostheses.

Long-term follow-up in 185 patients after mitral valve replacement with the Lillehei-Kaster prosthesis. Overall results and prosthesis-related complications.

A follow-up was carried out in 185 patients after mitral valve replacement with the Lillehei-Kaster prosthesis. Fifty-eight males and one hundred and twenty-seven females provided a total of 876 years of observation. The operative mortality amounted to 13% for the total series and to 9.3% after elective surgery. The long-term survival for the total series was 67% after five years and 56% after 10 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. In spite of long-term anticoagulant treatment thromboembolic events were the most frequent valve-related complications. Thrombosis of the valve occurred in eight patients and appeared to decrease with a change in the orientation of the valve. The percentage of patients free from thromboembolic events amounted to 76 +/- 5% after ten years. The percentage of patients free from valve-related morbidity and mortality was 66 +/- 5% after ten years. Valve related death accounted for 18% of all deaths and 26% of all late deaths. Fracture of the prosthesis was never encountered. These results compare favourably with those obtained with the Starr Edwards' or the Björk-Shiley prostheses.

Long-term follow-up in 262 patients after aortic valve replacement with the Lillehei-Kaster prosthesis. Overall results and prosthesis-related complications.

A follow-up was carried out in 262 patients after aortic valve replacement with the Lillehei-Kaster prosthesis. One hundred and ninety-one males and seventy-one females with a mean age of 53 years provided a total of 1385 observation years. The operative mortality was 7.3%. The long-term survival rates for the total series amounted to 74% after 5 years and 61% after 9 years. The great majority of survivors showed a marked improvement in functional capacity and a significant decrease in heart volume. Angina pectoris disappeared in 76 out of 79 patients, and exertional syncope vanished in 61 out of 62 patients. All patients received long-term anticoagulant treatment. The percentage of patients free from thromboembolic events amounted to 90 +/- 2% after 9 years, and the percentage free from valve related morbidity and mortality was 82 +/- 3% after 9 years. Only one instance of valve thrombosis was seen, and fracture of the prosthesis was never encountered. These results compare very favourably with those obtained with the Starr-Edwards or the Björk-Shiley prostheses.

Cerebral blood flow during early cardiopulmonary bypass in man. Effect of procaine in cardioplegic solutions.

Cerebral blood flow (CBF), plasma procaine concentrations, and somatosensory evoked potentials (SSEP) were recorded in 2 groups of patients in whom either a high-procaine cardioplegic solution (Bretschneider's n = 29), or a low-procaine cardioplegic solution (St. Thomas', n = 13) was used. In the Bretschneider's group, marked changes in CBF occurred (p less than 0.001). Mean CBF was 27 (range 18 to 51) ml/(100 g X min) between sternotomy and the onset of extracorporeal circulation (ECC). A mean of 6 minutes after the onset of ECC, and before the administration of Bretschneider's cardioplegic solution, CBF increased to 39 ml/(100 g X min). After administration of the cardioplegic solution, CBF decreased significantly within the first 15 minutes, and then gradually increased to a mean of 68 (range 43 to 108) ml/(100 g X min). Cerebral blood flow was 45 ml/(100 g X min) just after ECC was stopped. Marked plasma procaine concentrations, up to 100 mg/l, were reached just after the infusion of Bretschneider's solution. The flow was significantly reduced (p less than 0.015) in patients with plasma procaine greater than or equal to 10 mg/l, when compared to patients with plasma procaine values less than 10 mg/l. In the St. Thomas' cardioplegic solution group the same reduction in CBF did not occur (p less than 0.02). Despite the depressant effect of procaine on CBF in the Bretschneider group, a consistent brain hyperperfusion was observed in all patients during hypothermic ECC if their blood pressure was sufficient to produce hyperemia. In rats (n = 6), during normothermia without extracorporeal circulation, the effect of procaine was much more pronounced. The CBF fell from a mean resting level of 108 ml/(100 g X min) to 68 and 54 ml/(100 g X min) after 15 and 35 minutes, respectively, of continuous infusion of Bretschneider's solution. The flow returned to the resting level about 40 minutes after termination of the infusion.

Continuous suture technique in prosthetic aortic valve replacement.

Among 80 patients having aortic valve replacement using a continuous suture technique the occurrence of periprosthetic leak was 8.8%. There is a statistically significant difference in the occurrence of the periprosthetic leak in patients having pure stenosis (o) of combined stenosis and insufficiency, and patients having pure insufficiency (26%). Continuous suture technique reduces cross clamp time and by-pass time significantly but should be used routinely only in stenotic lesions. In pure insufficiency the method of suture should be considered separately in each case. Interrupted suture technique should be used if one or more of the known factors predisposing to perivalvular leak are present.

The cardiovascular and respiratory effects of fenoterol in patients after open-heart surgery.

Fenoterol (a selective beta-2-adrenergic drug) was given intravenously (2 mcg/kg body weight/15 min) to 7 normotensive patients after open-heart surgery in order to study the cardiovascular and respiratory effects. A marked cardiovascular effect was seen without changes in venous or arterial pressure. The increased heart rate (46%) was of sinus or atrial origin; no ventricular arrhythmias were seen. The cardiac index rose by 91%; left and right ventricular stroke work increased by 26% and 54% respectively; systemic and pulmonary vascular resistance decreased by 31% and 23% respectively; arterial oxygen tension decreased from 264 to 205 mm Hg; oxygen consumption rose 31%. No changes occurred in respiratory dynamics, in the total respiratory system of patient and tubes. The cardiovascular effect of fenoterol, without a corresponding increase in end-diastolic filling pressure and resistance against systolic ejection of the left ventricle, as well as the absence of ventricular arrhythmias, indicate that the drug may be useful as a supplement to other sympathomimetic compounds in normal use.

Debanding and repair of ventricular septal defect: a new technique for older patients.

Between October 1972 and April 1977 15 patients underwent definitive repair of a ventricular septal defect (VSD) and reconstruction of the pulmonary artery at the banding site. This report presents pre- and post-operative haemodynamic data in 12 patients, seven to 22 years after banding (mean 13.4). Banding of the pulmonary artery was performed before the age of 6 months (mean 4). The indications were increased pulmonary blood flow and intractable heart failure. As we had previously become dissatisfied with patch angioplasty of the main pulmonary artery, we introduced a new technique in this group of excising the site of the band and anastomosing the pulmonary artery end-to-end. The gradient between the right ventricle and pulmonary artery was abolished completely in nine cases and reduced to below 30 mmHg in the remaining three patients. This technique is used only in older patients in whom the banding has persisted for a long time. In children under 2 years of age we usually remove the band and dilate the pulmonary artery.

Acute aortic regurgitation and abscess of sinus of Valsalva due to fulminating ulcerative endocarditis. Report of three fatal cases in children.

Acute aortic regurgitation due to ulcerative endocarditis developed in 3 children aged 10, 6, and 7 years, respectively. All had congenital aortic valve lesions. Intractable congestive heart failure ensued about 2 weeks, 1 week, and a few days, respectively, after onset of infection. Two patients were operated on in the acute stage, and in both, perivalvular spread of the infection was found with abscess formation of the right sinus of Valsalva perforating through the interventricular septum to the right ventricle; valve replacement and repair were performed, but both patients died. The correct diagnosis was missed in the third patient, who was thought to have myocarditis and who died one week after onset of infection: at autopsy a perforation of a bicuspid aortic valve and an aneurysm of the sinus of Valsalva were found.