Triple valve procedures: an analysis of early and late results

This study summarizes the results in 107 patients with triple valve procedures (TVP) performed between 1972 and 1983. Forty-five patients underwent double valve replacement with tricuspid annuloplasty, and 62 simultaneous triple valve replacement. The hospital mortality was 19.6% (21 patients) and was influenced by: the preoperative functional class: 4.7% (1 of 22 patients) in class II, 13.7% (7 of 51) in class III and 37.2% (13 of 35) in class IV (p less than 0.05). the urgency of operation: 13.2% in elective operations (11 of 83 patients) and 41.6% for emergencies (10 of 24) (p less than 0.02) the type of tricuspid procedure: 15.5% for annuloplasty (7 of 45 patients), 21.1% for bioprosthetic replacement (11 of 52) and 30% for mechanical valve replacement (3 of 10) (p less than 0.05). Other factors such as patient age, right ventricular systolic pressure (RVSP) and type of myocardial protection had no significant influence. The late mortality was 9% per patient-year (18 patients, 9 of whom died in the first year), the majority related to cardiac causes. The 5-year survival rate was 53%. It appears that the survival rate is higher if the patient is in preoperative functional class II (55%), the right ventricular pressure is below 60 mmHg (67%), and if the operation is performed electively (57%). The findings suggest that surgery should continue to be offered to such patients.     

Clinical history and anatomic findings following the longest survival after cardiac transplantation

The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.     

Haemocompatibility and biological course of carbonaceous composites for cardiovascular devices

A new class of carbonaceous composites has been developed for cardiovascular devices. The aim of the present study, performed in dogs, was to test the immediate blood compatibility of these materials when inserted within the vascular bed. Biocompatibility studies were performed on vascular cylinders (6 mm i.d.) and intra-atrial implants. The specimens were examined sequentially by SEM at 10, 20, 30, 180 s and 10 min after re-establishment of the blood flow. Patency of the vascular cylinders was tested during the second and third postoperative month by Doppler ultrasound investigations; specimens were examined by light and electron microscopy (scanning and transmission) at 15, 60 and 110 d following implantation. As early as 10 s after re-establishment of the blood flow platelet adhesion and a limited fibrin mesh with few erythrocytes developed on the material. Platelet aggregates were only observed on intravenous implants. Except in the case of the intravenous insert, no thrombosis developed at the contact of intra-arterial or intracardiac implants. After 15 d it was completely covered by a fibrocellular layer (3-5 cells thick) consisting of large myofibroblasts with microfilaments, newly synthesized collagen and elastin. Endothelial-like cells developed and were completed 2 mnth after implantation. However, deposits present inside and outside the fibrocytic cells of the newly developed tissue were observed corresponding to carbon peaks as indicated by wavelength dispersive X-ray microanalysis.