Biomedical subjects

G Ruvolo

Publications and source records attributed to G Ruvolo.

At least 37 records · Page 2Linked to original sources

PubMed1999

Extracorporeal circulation does not induce intra-alveolar release of Endothelin 1, but only a modest overproduction in pulmonary circulation.

OBJECTIVE: To investigate whether ECC may produce regional liberation of inflammatory mediators capable of inducing vascular effects and organ damage. EXPERIMENTAL DESIGN: Comparative study [corrected]. SETTING: Cardiac surgery department in a University hospital. PATIENTS: Fifteen patients undergoing coronary artery bypass grafting (CABG, group A) and ten patients operated for infrarenal abdominal aortic aneurysm (controls, group B) have been studied. MEASURES: Levels of Interleukin 1beta (IL1), Tumor Necrosis Factor alpha (TNF), Interleukin 6 (IL6), and Endothelin 1 (ET1) were measured in pulmonary capillary, arterial, and venous blood and in bronchoalveolar lavages (BAL) before, during and after extracorporeal circulation (ECC) or surgical intervention. RESULTS: TNF-alpha (never >35 pg/ml) and IL1beta (range 20-300 pg/ml) values did not change over time for both groups. IL6 concentrations in all samples of group A increased between five and twenty fold, during and after ECC (from 3-5 pg/ml up to 240 pg/ml, p<0.001). This trend was similar in controls after surgical stress. Endothelin 1 was always undetectable in the BAL fluid, with a modest, but significant increase in pulmonary capillary blood of group A, after ECC, (from 11+/-4 pg/ml to 18+/-5 pg/ml, p<0.001). This increment correlated well with the PVR increase, but was transient and after 24 hours, ET1 values returned to baseline levels. Mean values of ET1 increased also in controls, but not significantly. CONCLUSIONS: ECC may induce ET1 liberation in pulmonary circulation with transient pulmonary vasoconstriction, but wihout intra-alveolar release, or lung damage. Augmented concentrations of IL6 probably express a response to surgical procedure rather than an effect exclusively related to ECC.

Adult↗

PubMed1999

Flow capacity of inferior epigastric artery in composite arterial grafts.

BACKGROUND: In the effort to expand the use of arterial conduits for myocardial revascularization, 'Y-graft' techniques are utilized with increasing frequency, although the physiology of this type of composite arterial grafts is not yet fully understood. The aim of this study was to measure changes in blood flow through a 'Y-graft' constructed by anastomosing a segment of inferior epigastric artery (IEA) off the side of an in situ internal thoracic artery (ITA). METHODS: Twenty-two patients who underwent CABG were enrolled in this prospective study. Exclusion criteria were age > 70 years, poor left ventricular function (Ejection Fraction < 0.25) and need for associated cardiac procedures. Blood flow in the TrA-IEA 'Y-graft' was measured in the operating room after completion of left ITA to left anterior descending artery (LAD) and IEA to marginal or diagonal branch anastomoses. Follow-up evaluation was performed at 3 and 12 months postoperatively. RESULTS: After completion of surgery, blood flow in ITA and IEA as measured downstream from the Y anastomosis was 45+/-7 and 39+/-6 ml/min respectively. Temporary occlusion of either branch did not significantly affect flow in the other side of the arterial Y. All patients were discharged from the hospital in excellent condition. At follow-up no cases of angina recurrence were recorded. CONCLUSIONS: Composite ITA-IEA arterial grafts provide excellent short-term clinical results. Blood flow on either side is not affected by run off in the other side branch. Information from this study may be used to understand the role that undivided ITA side branches play in reducing flow rate in an ITA graft harvested during minimally invasive CABG procedures.

Aged↗

PubMed1998

Neuropeptide Y-induced potentiation of noradrenergic vasoconstriction in the human saphenous vein: involvement of endothelium generated thromboxane.

1. We investigated the potentiating effect of low concentrations of neuropeptide Y (NPY) on the vasoconstriction induced by transmural nerve stimulation (TNS) and noradrenaline (NA) in human saphenous veins. The effects of (i) endothelium removal; (ii) the addition of the NO pathway precursor L-arginine; (iii) the ET(A)/ET(B) endothelin receptor antagonist Ro 47-0203; (iv) the cyclo-oxygenase inhibitor, indomethacin; (v) the selective thromboxane A2 (TxA2) receptor antagonists Bay u3405 and ifetroban, and (vi) the TxA2 synthase inhibitor, UK 38485, were studied in order to gain information about the mechanisms of NPY-induced potentiation. 2. Contractile response curves for TNS (0.5-8 Hz) and for exogenously administered NA (0.1-3 microM) were obtained in superfused saphenous vein rings. The contractions induced by both TNS and NA at all tested frequencies and concentrations, respectively, were significantly potentiated by 50 nM NPY in endothelium intact veins. Conversely, in endothelium-denuded vessel rings the contractile-response curves to TNS and NA overlapped both in the absence and presence of NPY, thus suggesting that a release of vasoactive substances from endothelial cells could account for the noradrenergic NPY-induced potentiation. 3. In vessels with intact endothelium, the potentiating action of NPY on TNS and NA was unaffected by the presence of high concentrations of the NO precursor L-arginine (3-10 mM) or the non-selective ET(A)/ET(B) endothelin receptor antagonist, Ro 47-0203 (10 microM). These data indicate that the NPY-induced effect does not involve either the endothelium-derived vasodilator nitric oxide or the vasoconstrictor endothelin. Conversely, in the presence of the cyclo-oxygenase inhibitor, indomethacin (30 microM), NPY failed to potentiate the vasoconstrictions produced by either nerve stimulation or by exogenous NA, thus providing evidence that arachidonic acid metabolites through the cyclo-oxygenase pathway are mainly responsible for the potentiation evoked by NPY. 4. When the TxA2 receptor antagonists, Bay u 3405 (1 microM) and ifetroban (1 microM) were added to the superfusing medium, NPY did not alter either the frequency- or the concentration-response curves for either TNS or NA. Accordingly, both TNS- and NA-induced contractions were not potentiated by NPY in the presence of the TxA2 synthase inhibitor, UK 38485 (10 microM). This clearly demonstrates the pivotal role of TxA2 in NPY-induced potentiation. 5. In superfused vein rings with endothelium, a subthreshold concentration (0.2 nM) of the TxA2 mimetic U 46619 potentiated both TNS- and NA-induced vasoconstrictions. This potentiation was higher at low stimulation frequencies and low NA concentrations, and resembled that produced by NPY. 6. Our results indicate that in the human saphenous vein NPY potentiates the contractions produced by sympathetic nerve stimulation acting at the postjunctional level, primarily on endothelial cells. In particular, the NPY-induced release of a cyclo-oxygenase metabolite, namely TxA2, may have a synergistic effect on the vasoconstriction induced by the noradrenergic mediator. Thus, such a mechanism may play a key role in the maintenance of the sympathetic tone of large human capacitance vessels.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗

PubMed1998

Myocardial infarction caused by compression of anomalous circumflex coronary artery after mitral valve replacement.

We report a case of myocardial infarction after mitral valve replacement occurring in a patient with the left cyrcumflex coronary artery arising from the right one. The patient underwent mitral valve replacement with a size 27 Carbomedics prosthesis and a tricuspidal annuloplasty was performed according to the De Vega technique. Patient died on the 20th postoperative day.

Aged↗

PubMed1998

Platelet activation and cytokine production during hypothermic cardiopulmonary bypass--a possible correlation?

Cardiopulmonary bypass (CPB) is associated with impaired platelet function and a systemic inflammatory response. The present study was designed to evaluate whether any correlation between platelet activation and inflammatory response during CPB exists. The results obtained from 8 patients undergoing hypothermic CPB for cardiac surgery showed the occurrence of a moderate degree of platelet activation during CPB, demonstrated by an increase of platelet CD62P expression in correlation with an increase of beta-thromboglobulin levels, with a concomitant decrease of in vitro platelet response. Plasma IL-1beta levels significantly increased during CPB, with a peak between 1 and 4 h after CPB. Similarly, IL-6 levels were elevated 30 min from CPB starting, peaked at 4 h, and remained elevated after 24 h. A direct correlation was found between plasma IL-1beta and IL-6 levels. A significant correlation between plasma IL-1beta and beta-thromboglobulin levels was also found. In turn, plasma beta-thromboglobulin levels correlated with CD62P expression on activated platelets. An inverse correlation was found between in vitro platelet aggregation and plasma IL-1beta or IL-6 levels. From the present results it may be speculated that platelet activation during CPB may contribute, through the release of IL-1beta, to activation of endothelial cells and subsequent release of other cytokines with chemotactic and pro-inflammatory properties, thus playing an important role in the inflammatory response associated with CPB.

Aged↗

PubMed1997

"Patch-glue" annular reconstruction for mitral valve replacement in severely calcified mitral annulus.

Mitral valve replacement in severe annular calcification may be complicated by atrioventricular rupture, left circumflex coronary artery injury, and thromboembolic events. Mitral valve replacement was performed in 2 patients with massive annular calcification, by suturing a Tissucol fibrin glue-treated Teflon patch on the posterolateral atrial wall. After 30 and 34 months, respectively, the valve was normally functioning and the patients were asymptomatic and free from hemorrhagic and thromboembolic events.

Aged↗

PubMed1997

Interference of antisperm antibodies with the induction of the acrosome reaction by zona pellucida (ZP) and its relationship with the inhibition of ZP binding.

OBJECTIVE: To determine whether antisperm antibodies can interfere with the induction of the acrosome reaction (AR) by the zona pellucida (ZP) and whether this interference also can occur in the absence of an inhibitory effect on ZP binding. DESIGN: Prospective in vitro study. SETTING: A tertiary care center, the Andrologic Clinic, University of L'Aquila. PATIENT(S): Sera from 12 infertile patients with high titers of circulating antibodies directed against the sperm head were studied. INTERVENTION: None MAIN OUTCOME MEASURE(S): The effect of antisperm antibodies on ZP binding was evaluated by matching antibody-exposed and nonexposed donor sperm suspensions labeled with fluorescein or rhodamine, respectively, and incubated with the same salt-stored human ZPs. The effect of antibodies on ZP-induced AR was determined by challenging antibody-exposed and nonexposed donor sperm suspensions with human ZPs disaggregated with acidic NaH2PO4. Acrosomal status was evaluated using fluorescein-labeled Pisum sativum agglutinin and supravital stain Hoechst 33258. In some selected cases, the effect of antisperm antibodies on the acrosomal status of sperm bound to intact ZP also was evaluated using transmission electron microscopy. RESULT(S): Five of 12 sera exhibited an inhibitory effect on ZP binding. An inhibition of AR induction by disaggregated ZPs (ranging from 64% to 98%) was produced by all 5 sera with an inhibitory effect on ZP binding and by 2 of 7 sera without an inhibitory effect on ZP binding. The different effects of antisperm antibodies on AR induction by disaggregated ZP were confirmed by comparing with ultrastructural evaluations on the acrosomal status of sperm bound to intact ZP. CONCLUSION(S): Antisperm antibodies can interfere with the induction of AR by ZP. This inhibition can occur even in the absence of an inhibitory effect on ZP binding. Neither effect may occur.

Acrosome↗

PubMed1997

Left ventricular aneurysmectomy; comparison between two techniques; early and late results.

OBJECTIVE: The aim of the present study was to evaluate early and late results of two different surgical techniques for left ventricular aneurysms repair. The conventional aneurysmectomy and direct closure of the ventricular wall and the endoventricular patch plasty. METHODS: We retrospectively reviewed 118 patients operated on for postinfarction left ventricular aneurysm from 1981 to 1994. Eighty-seven patients (Group A) were operated upon between 1981 and 1991 with the conventional technique and 31 patients (Group B) between 1992 and 1994 with the endoventricular patch plasty technique. Preoperative clinical, hemodynamic and echocardiographic evaluation with operative procedures and early postoperative results of all patients are reported. We also analyzed results of late clinical and echocardiographic controls of 34 patients of Group A and all patients of Group B after a mean follow-up of 42 and 28 months, respectively. RESULTS: Mean number of by-pass grafts was 1.9 in Group A and 2.6 in Group B (P = 0.01). The left anterior descending coronary artery was revascularized in 27 patients of Group A (34.6%) and 26 of Group B (89.7%) (P < 0.001); the left internal mammary artery was used in seven patients of Group A (8.9%) and 24 of Group B (82.8%) (P < 0.001). Hospital mortality in Group A was 10.3% (9/87), in Group B there was no hospital mortality (P > 0.05). Thirty-two patients of Group A (36.8%) and 3 of Group B (9.7%) suffered of low cardiac output syndrome (P = 0.01). At late control, improvements observed in NYHA and CCS classes, left ventricular ejection fraction (all P < 0.001 in both groups versus preoperative values) and left ventricular end-diastolic diameter (P > 0.05 in Group A and P < 0.001 in Group B) proved to be statistically higher in patients of Group B. CONCLUSIONS: Endoventricular patch plasty associated with a complete myocardial revascularization, in particular of the anterior descending coronary, and a larger use of the internal mammary artery, permits, by means of reconstruction of the left ventricular geometry, a better outcome for patients undergoing left ventricular aneurysmectomy.

Adult↗

PubMed1997

Occurrence of the interference of sperm-associated antibodies on sperm fertilizing ability as evaluated by the sperm-zona pellucida binding test and by the TEST-yolk buffer enhanced sperm penetration assay.

PROBLEM: This study was performed to evaluate the occurrence as well as the level of the interference of sperm-associated antibodies on fertilization process. METHOD: Motile sperm suspensions from 28 infertile patients with high degree of autoimmunization against the sperm head were tested with the zona pellucida (ZP) binding test and with the sperm penetration assay (SPA) enhanced with TEST-yolk buffer. Both tests were also performed using donor sperm exposed and non-exposed to the patients' circulating sperm antibodies. RESULTS: A low ZP-binding was exhibited by sperm from 50% of patients with normal semen profile. All normozoospermic patients with low ZP-binding showed circulating sperm-antibodies with inhibitory effect on ZP-binding, while no patient with normal ZP-binding showed circulating sperm-antibodies with inhibitory effect. No normozoospermic patient exhibited a negative SPA result, and only in 16% of cases the penetration index was slightly less than 2 (the lowest value exhibited by fertile controls). Circulating antisperm-antibodies did not significantly affect the hamster egg penetration. CONCLUSION: Even in the presence of high degree of autoimmunization against the sperm head, sperm fusion with oolemma is not impaired after sperm preincubation with TEST-yolk buffer, while an impairment of the ZP-binding is demonstrable in half cases, when non-immunologic factors are excluded. A substantial role in this interference is likely exerted by IgG antibodies transuded from the blood into the genital tract.

Autoantibodies↗

PubMed1996

Ruptured aortic cusp aneurysm in infective endocarditis.

We describe a patient affected by infective endocarditis with aortic aneurysm, waiting for valve replacement, in which aortic cusp rupture determined sudden heart failure. Diagnosis was performed by serial transthoracic echocardiograms and successful surgical valve replacement was performed in emergency.

Aneurysm, Ruptured↗

PubMed1996

Return to work and quality of life measurement in coronary artery bypass grafting.

OBJECTIVE: Coronary bypass surgery (CABG) is effective in relieving angina and restoring expectation of life in patients with coronary artery disease. The aim of this work was to evaluate the effects of CABG on the quality of life (QL) and return to work (RW). Medical and non-medical variables influencing QL and RW were investigated. The results were compared with those of medically treated patients. METHODS: Five hundred fifty patients with chronic stable angina undergoing coronary angiography, were consecutively and prospectively enrolled in the study. Coronary lesions narrowing the lumen by more than 70% were considered significant. Questionnaire interviews were performed in hospital on admission and after at least 6 months follow-up. The QL interviews were based on quantitative evaluation of five conceptual dimensions: General Well-Being Schedule, Physical Symptoms Distress Index B, Sexual Satisfaction Unified Test, Social Participation and Work Performance and Satisfaction. Whether the patient had returned to work was recorded at each interview. Patients with significant coronary lesions were electively assigned to surgical (group A) or medical therapy (group B). The indications for surgical therapy were: triple-vessel disease, left main, ejection fraction (EF) less than 50%, angina resistant to medical therapy. Patients with non-significant coronary lesions, poor left ventricular function (EF < 25%) and combined valvular and coronary disease were excluded from the study. Patients scheduled for PTCA were also excluded. RESULTS: Two hundred forty-six patients were assigned to group A, 200 to group B, 26 had non-significant coronary lesions, 16 combined valve and coronary disease, 15 poor left ventricular function and 78 were scheduled for PTCA. The mean follow-up for the two groups was 38 +/- 6 months. At in-hospital admission group A patients had overall worse QL perception, while at follow-up control the improvement in QL test was statistically significant. The group A mean RW rate was statistically significant, subgroup analysis showed a higher RW rate in patients without angina, working before surgery, under 50 years old, literate and with a professional or executive employment before surgery. At follow-up group B QL perception showed a positive trend, but not statistically significant. The group B RW rate was higher than that of group A, subgroup analysis did not show statistically significant data. CONCLUSIONS: Our findings demonstrate that patients undergoing elective CABG surgery show early physical and psychological improvement. Specific rehabilitation programs can be useful in selected subgroups of patients.

Adult↗

PubMed1996

Inhaled nitric oxide in patients with severe heart failure: changes in lung perfusion and ventilation detected using scintigraphy.

Inhaled nitric oxide (NO) is a selective pulmonary vasodilator in patients with end-stage cardiac failure. Preoperative high pulmonary vascular resistance could modify early and late results after heart transplantation generally due to right-ventricular failure. Aim of this study was to assess pulmonary vascular resistance variability following inhalation of NO by using a scintigraphic method. Our preliminary results suggest that inhaled NO in patients with end-stage heart failure redistributes blood away from apical regions and towards more basal and posterior segments, probably dilating blood vessels in ventilated but nonperfused zones. NO may represent a simple and reliable method to evaluate dynamic response of pulmonary vasculature.

Administration, Inhalation↗

PubMed1996

Quality of life following coronary bypass surgery.

Quality of Life (QL) following coronary bypass surgery (CABG) can be modified by medical and non-medical factors (i.e., functional class, medical therapy, psychological changes, economic status, educational level, return to work, country origin). The aim of this study was to evaluate QL in 203 patients that underwent CABG (Group A). QL perception was assessed by 5 questionnaires self-rated by the patient. Data obtained by surgical series were compared with 107 patients with coronary artery disease and treated medically (Group B), and a population of 102 normal subjects (Group C). Our findings demonstrated that general well-being, functional status and social participation improved in Group A. Sexual activity decreased in Group A. CABG did not modify job satisfaction. Chest pain was the main variable influencing negatively return to work; age, work before CABG, low educational level and country area were negatively related non medical variables. Work resumption rate decreased significantly in patients over 50 years, in those coming from the south of Italy and also with low educational level.

Age Factors↗

PubMed1996

A role for nitric oxide in the vasoplegic syndrome.

INTRODUCTION: Cardiopulmonary bypass (CPB) is frequently associated with hemodynamic disorders caused by a whole blood inflammatory response. In particular vasoplegic syndrome occurs in the immediate postoperative time of patients who underwent normothermic CPB. Nitric oxide (NO) was described as an endothelium derived relaxing factor (EDRF). We report changes in NO concentration occurred in patients who experienced vasoplegic syndrome following CPB. MATERIALS AND METHODS: We analyzed changes in NO concentration in 95 consecutive patients who underwent coronary artery bypass grafting under normothermic CPB. NO was measured as nitrite plasma level (NPL) by the Griess reaction. RESULTS: In all cases a significant NPL increase 30 minutes after starting CPB and 10 minutes after CPB interruption was observed (p<0.005). No significant differences were measured 60, 120 and 240 min after CPB interruption when compared with before CPB. Three patients experienced vasoplegic syndrome and NPL values measured at 60, 120 and 240 min after CPB interruption were still significantly increased when compared with before CPB (p<0.005). CONCLUSION: NO plays a role in the CPB-related hemodynamic disorders. Use of NO synthase inhibitors could provide a better management of vasoplegic phenomenon following CPB.

Cardiopulmonary Bypass↗

PubMed1996

Changes in coagulation patterns, blood loss and blood use after cardiopulmonary bypass: aprotinin vs tranexamic acid vs epsilon aminocaproic acid.

Cardiopulmonary bypass (CPB) increases risk of postoperative bleeding and need for transfusion. The aim of this study was to evaluate the effects of aprotinin, epsilon aminocaproic acid and tranexamic acid on coagulation patterns and need for banked blood transfusion. Ninety-six consecutive patients who underwent coronary artery bypass surgery were randomly assigned to 4 groups (24 patients each). The following parameters were monitored before, during and after CPB: activated lotting time, hemoglobin, prothrombin time, activated prothromboplastin time, fibrinogen, antithrombin III, xDP, Factor VIII, Thrombin-Antithrombin Complex and plasminogen. Analysis of postoperative bleeding and need for transfusion showed that the aprotinin group had significantly lower mediastinal bleeding. Transfused patients were 2, 4, 12 and 18 respectively in the aprotinin, epsilon aminocaproic acid, tranexamic acid and placebo treated group. In conclusion the use of protease inhibitors significantly reduces postoperative bleeding and transfusion. The aprotinin-treated group had the lower need for transfusion.

Aminocaproic Acid↗

PubMed1996

[Analysis of risk factors in patients undergoing closed heart mitral commissurotomy].

The aim of this study was to analyse the risk factors in patients undergoing closed heart commissurotomy (CHC). From 1956 to 1978 a total of 630 patients with severe mitral stenosis underwent CHC at this Institute. The study was performed on a sample of 100 patients. Follow-up was performed using data taken from the Institute archives, questionnaires sent to the doctors in charge, telephone interviews or visits to outpatient clinics by the Institute's medical staff. The mortality rate 30 days after surgery was 2.9%. Re-CHC was necessary in 11 patients after a mean interval of 7.2 years. The overall probability of survival was 83%, 71%, 48% an 33% respectively at 10, 20, 30 and 40 years. Survival free from mitral re-operation at 10, 20, 30 and 40 years was 76%, 39%, 29% and 11% respectively. The probability of incidence for central and peripheral thromboembolism was 38%, 26%, 11% and 4% at 10, 20, 30 and 40 years. Mitral valve replacement surgery (MVR) was performed in a total of 64 patients. Operative mortality was 0.6% (1 patient). The mean duration of follow-up in patients undergoing post-CHC MVR was 10 years. The probability os survival in overall terms and free of cardiac decompensation was 79 and 53% respectively. From this study it is clear the CHC is a surgical procedure that offers excellent long-term results with a low incidence od thromboembolic events, very low costs and a good quality of life. CHC currently represents a valid alternative o mitral valve replacement in selected patients.

Follow-Up Studies↗

PubMed1995

Nitric oxide release during hypothermic versus normothermic cardiopulmonary bypass.

Cardiopulmonary bypass (CPB) produces hemodynamic and inflammatory disorders involving changes in vascular permeability and regional blood flow and alterations of coagulation and complement systems. It has been reported that an abnormal release of vasoactive substances during CPB, like bradykinin or nitric oxide, could play a role. The aim of this study was to investigate the changes in nitric oxide (NO) release occurring in patients undergoing CPB, under both hypothermic and normothermic conditions. Forty patients (mean age 61.4 +/- 8.4 years) undergoing coronary bypass surgery were studied. In 20 patients (group A) systemic hypothermic CPB and antegrade cold intermittent crystalloid cardioplegia were used. The remaining 20 cases (group B) underwent surgery under systemic normothermic CPB and with antegrade warm blood intermittent cardioplegia. Nitric oxide was measured as the nitrite plasma level (NPL) by the Gries reaction. The time course of changes in NPL were obtained by collecting five whole blood samples: before CPB, 10 and 30 min after the start of CPB, and 10 and 60 min after the end of CPB. Although there were no significant variations of NPL shortly after the start of CPB (10 min after), values measured 30 min after CPB commencement and 10 min after the end of CPB showed a significant increase (P < 0.0001) in both groups. Considering the two groups separately, NPL changes seemed to be similar, so independent of temperature; however, in group B higher values of NPL were measured during (30 min) and after (60 min) CPB (P < 0.0001). In conclusion, during CPB there is a progressive increase, independent of temperature in NO release.

Blood Pressure↗

PubMed1995

Combined coronary bypass grafting and mitral valve surgery: Early and late results.

It is reported that the mortality rate for combined coronary bypass grafting and mitral valve replacement is greater than for either isolated operation. To evaluate the effects of various predicting factors we analyzed the results of 67 consecutive patients undergoing combined mvr and CABG. The mean age was 61.3 +/- 7 years. There were 55 males and 12 females and the mean follow-up was 59.4 +/- 7 months. The hospital mortality rate was 13.4% (9/67). Preoperative NYHA functional class (p<0.05), left-ventricular motion score (increased scores indicating impaired function, (p<0.05), and aortic cross-clamp time (p<0.05) were associated with hospital mortality. There was no significant relationship of age (>60), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, or previous myocardial infarction with hospital mortality. There were 7 late deaths, and survival at five years was 76.1%. Although there was a trend for preoperative NYHA class and aortic cross-clamp time to be associated with late survival, the only factor significantly related to late survival was global wall-motion score (p<0.05). Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival, but we have found no such relationship. Our results indicate that both hospital and late mortality are strongly correlated with preoperative left ventricular function.

Adult↗