No abstract

The major cause of early death after heart transplantation is graft failure. In 99 consecutive heart transplantations two protocols of myocardial protection were employed. In group 1 (n = 38) initial cold crystalloid cardioplegia combined with cold saline storage and peroperative surface cooling was used. In group 2 (n = 61) cold crystalloid cardioplegia was injected initially and cold blood cardioplegia (Buckberg) was infused every 30 min as soon as the graft arrived in the operating room. No surface cooling was used. Warm blood cardioplegic reperfusion was administered before removal of the aortic clamp. There were 8 early (within 30 days) deaths in group 1 and 6 in group 2 patients. In group 1 there were 5 cardiac deaths against 3 in group 2. Mean ischemic time was 153 +/- 37 min in group 1 and 158 +/- 51 min (p greater than 0.05) in group 2. The post-transplantation need for catecholamines was ten times higher in group 1 patients than in group 2. The first endomyocardial biopsy (after 1 week) showed cytologic lesions compatible with ischemia in 40% of group 1 and only 9% in group 2 patients. We conclude from this initial experience that intermittent cold blood cardioplegia and warm blood cardioplegic reperfusion are useful in heart transplantation in restoring the damage suffered by the graft during brain death and graft storage.

No abstract

We report a case of total thrombosis of a right ventricular assist device in a patient during biventricular assistance. The thrombosis occurred 18 days following implantation and the right ventricular device was immediately removed without any complications. The patient was successfully transplanted after 3 months of left ventricular assistance.

813 patients underwent aortic (AVR) or mitral valve replacement using the Carpentier-Edwards bioprosthesis from 1976 to 1983. Operative mortality was 5.49% for AVR and 4.59% for MVR. Late mortality and complications were classified using criteria described by the Stanford Group. Actuarial survival at 5 years was 87.9% +/- 2.7% for AVR and 91.1% +/- 1.4% in MVR. Thromboembolism occurred at low rates of 0.48% pt yr for AVR and 0.90% pt yr for MVR. 98.2% +/- 0.90% of AVR and 96.9% +/- 1.3% of MVR pts were free from thromboembolism at 5 years. The low incidence of thromboembolism during the early postoperative period played a role in the low rates observed in the complete study. There was no valve thrombosis. Anticoagulation with warfarin was used in 35% AVR and 75% MVR with rates of bleeding complications of 1.20% pt yr and 1.10% pt yr. Overall valve failure rate was 2.04% pt yr at 5 years for AVR and 1.55% pt yr for MVR. Rates of reoperation for tissue failure remained low (0.24% pt yr for AVR and 0.32% pt yr for MVR). The advantage of a low rate of thromboembolism was not outweighed by the specific problems of bioprosthesis at 5 years.