[A case of critical postoperative myocardial infarction successfully resuscitated by combination of IABP and r-heart bypass assist].
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Biomedical subjects
Publications and source records attributed to S Sugimura.
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From 1965 to 1976, 721 isolated aortic valve replacements were performed at the University of Oregon hospitals, utilizing Starr-Edwards caged-ball prostheses. Three models of aortic prostheses were introduced during this period: a non-cloth-covered model has been in continuous use since 1965; a cloth-covered model was begun in 1968 and has been supplanted by the modified composite-strut or "track" model since 1972. The 5-year actuarial survival rate for operative survivors is about 80% for both non-cloth-covered and cloth-covered valves, while the 10-year survival is 61%, based on the older model only. The actuarially-determined percentages of patients experiencing significant thromboembolic episodes (i.e., all except transient ischemic episodes) at 5 years are 7% for the cloth-covered and 9% for the non-cloth-covered model. If transient ischemic attacks are included, the cloth-covered model has only an 8% incidence at 5 years compared to a 22% incidence for the older model. However, the cloth-covered valves are subject to a higher risk of reoperation because of the possibility of cloth injury. The "track" valve, therefore, was designed with exposed metal on the inner surface of each strut to prevent ball-cloth contact. In 107 patients (mean follow-up period 1 year) receiving anticoagulation, this prosthesis has maintained the same low incidence of thromboembolism as the previous cloth-covered model, with no reoperations for valve failure.
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Acute dissection of the ascending aorta secondary to cross-clamp injury can be successfully managed if the problem is recognized immediately. Bypass must be instituted after recannulation at a point distal to the innominate artery so that proper exposure of the site of injury can be obtained. Systemic as well as local hypothermia for myocardial preservation are both necessary. Direct suture closure of all layers at the site of dissection over Teflon felt can terminate this process.
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