Primary percutaneous coronary intervention (PCI) of culprit lesions (CLs) is the standard of care in patients presenting with ST elevation myocardial infarction (STEMI). However, optimal revascularization strategy for significant nonculprit lesions (non-CLs) in the setting of STEMI remains controversial. The importance of defining of such a strategy lies in the fact that approximately 50% of patients with STEMI have multivessel disease (MVD). The aim of this study was to describe characteristics, therapeutic strategies, and 1-year outcomes in a cohort of patients with STEMI and MVD. We retrospectively analyzed a cohort of 63 patients with STEMI and MVD obtained from a 5-year catheterization database. MVD was defined as ≥70% stenosis of ≥2 epicardial coronary arteries. This cohort was followed for a period of 1 year for major adverse cardiac events (MACE was defined as acute coronary syndrome, new onset heart failure, or death) and all-cause mortality. PCI with stent placement was the major therapeutic procedure (87.5%) performed for CLs. Non-CLs did not undergo interventions in a majority of individuals (47.6%), while the remaining patients underwent PCI (29%) and coronary artery bypass graft surgery (22%) for non-CLs. At 1-year follow-up, prevalence of MACE events and death in the entire cohort were 30% and 15%, respectively. A trend for better outcomes (1-year cumulative MACE events but not mortality) was observed in CL-only intervention cohort compared with non-CL intervention. The PCI and Coronary artery bypass graft surgery cohorts did not show any significant difference in clinical outcomes. In this retrospective cohort of patients with MVD who presented with STEMI, no intervention of noncritical lesions was the prevalent approach, reflecting guideline recommendations. CL-only intervention strategy showed a better clinical outcome than non-CL intervention. Intervention of noncritical lesions therefore did not seem to improve MACEs or all-cause mortality at 1-year of follow-up and might in fact have had a detrimental effect on outcomes.

From March 1982 through December 1986, 139 Mitroflow pericardial heart valves were utilized in 129 patients. There were 69 males and 60 females, with an average age of 55.2, range 26 to 74 years. Eighty-nine patients underwent isolated aortic valve replacements, 27 isolated mitral valve replacements, 3 isolated tricuspid valve replacements, 10 mitro-aortic valve replacements. In 27 cases (20.9%) additional cardiac surgery was performed. Maximum follow-up was 5.5 years with a mean of 37.9 months. The cumulative follow-up was 407.25 patient-years. Overall hospital mortality was 1.6% (2 cases). There were 3 late deaths in this series (2.4%). The linearized incidence of late mortality was 0.49% per patient-year. The survival actuarial curve was 96% +/- 1.8. The incidence of thromboembolism was 1.22% per patient-year, and the actuarial thromboembolism-free rates was 93% +/- 2.7. Prosthetic endocarditis occurred in one patient. Three patients developed primary tissue failure of the Mitroflow valve in the mitral position. The linearized incidence of primary tissue failure was 0.73% per patient-year and the actuarial freedom from primary tissue failure was 95% +/- 3.2. A total of 4 patients underwent reoperation (0.49% per patient-year). In conclusion, the clinical performance of the Mitroflow pericardial heart valve at medium-term follow-up is satisfactory, however a significant number of early mitral primary tissue failures have already occurred.

Surgical anterior and superior fixation to the diaphragam of a segment of the greater curvature of the stomach simplifies the technical performance of harvesting the right gastroepiploic artery for coronary bypass grafting. Gastropexy avoids objections to the use of this pedicled arterial graft, such as the prolonged dissection time, the limited length of the conduit and the potential damage when abdominal surgery is later required.

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