• Journal of Chest Surgery
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• v.27 no.12
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• pp.995-1001
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• 1994

The CarboMedics valve prosthesis is a relatively new. low profile bileaflet prosthesis. During a 6 year period from Aug. 1988 to July 1994. 158 patients had CarboMedics prostheses implanted in the mitral [n=94], aortic [n=25], or aortic and mitral [n=39] in National Medical Center. Hospital mortality was 9.4% and the main cause of death was low output syndrome. Follow up was 96% complete, with 365.4 patient-years and a mean follow up of 30 months [ range 1 to 72 months ] . The overall actuarial 6 year survival rate was 91.61 3.47% and actuarial 6year freedom from all valve related complications was 73.9 7.67%. The linearized incidence of vavle related complications was as follows: thromboembolism 1.37%/patient-year ; valve thrombosis 0.82%/ patient-year ; anticoagulant related hemorrhage 0.85%/patient-year ; perivalvular leakage 0.55%/paitent-year: prosthetic valve endocarditis 0.82%/patient-year ; reoperation 1.37%/patient-year. There were no instances of structural failure. We conclude that the Carbomedics valve has a low rate of complications that further improves the quality of life in patients with heart valve prostheses.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.353-361
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• 1998

Hypothermia is widely acknowledged as fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. The ideal way to rotect the heart is to electromechanically arrest it and perfus it with blood that is aerobic arrest. However alternative technique has been developed, based on the principles of electromechanical arrest and normothermic aerobic perfusion using continuous warm blood cardioplegia. To determine if continuous warm blood cardioplegia was beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Group included is 31 patients undergoing valvular surgery who received intermittent cold crystalloid cardioplegia. Group II included 30 patients undergoing valvular surgery who received continuous warm blood cardioplegia. Our results suggest that the heartbeat in 100% of patients treated with continuous warm blood cardioplegia converted to normal sinus rhythm spontaneously after the removal of the aortic cross-clamp, compared to only 31% of the cold cardioplegia group. After operation, pericardial closure rate was 90% area in the warm group, compared to 35% area in the cold group. 12 hours after the operation, the total amount of urine output in the warm group was greater than that in the cold group(2863${\pm}$127 ml versus 2257${\pm}$127 ml; p<0.05). After the operation, left diaphragmatic elevation developed in 55% of the cold group but in 0% of the warm group. CK-MB level in the warm group was significantly lower than cold group(2.28${\pm}$0.62 versus 9.96${\pm}$2.12; p<0.01) 1 hour after operation and CK-MB level in the warm group was significantly lower than cold group(1.80${\pm}$1.01 versus 6.00${\pm}$1.74; p<0.05) 12hours after operation. Continuous warm blood cardioplegia is at least as safe and effective as hypothermic technique in patients undergoing cardiac valvular surgery. Conceptually, this represents a new approach to the problem of maintaining myocardial preservation during cardiac operations.