From March 1995 to April 1998, 24 men and 5 women (mean age, 62.2 ± 10 years) underwent the Batista procedure for end-stage cardiac dysfunction due to ischemic dilated cardiomyopathy. Preoperatively, mean cardiac index was 1.9 ± 0.3 L·min -1 ·m -2 , stroke index was 25 ± 5 mL·beat -1 ·m -2 , ejection fraction was 20% ± 6%, and 22 (79%) patients were in New York Heart Association functional class IV. Associated procedures were coronary bypass (25), mitral valvuloplasty (15), aortic or mitral valve replacement (5), dynamic cardiomyoplasty (2), and aneurysmectomy (1). One patient (3.4%) died early and 3 (10.3%) died later. The 1-and 2-year actuarial survival was 87%. A left ventricular assist device was required in 2 patients during the follow-up period. Postoperatively, cardiac index was 2.9 ± 0.3 L·min -1 ·m -2 , stroke index was 36 ± 5 mL·beat -1 ·m -2 , and ejection fraction was 38% ± 10%. Left ventricular end-diastolic diameter decreased from 71 ± 8 mm to 55 ± 8 mm. Currently, 88% of survivors are in functional class I or II. It was concluded that the Batista procedure significantly improved objective and subjective parameters of cardiac performance during early and intermediate follow-up.

A method based on the principle of thermodilution was developed for a quasi non-invasive permeability control of aortocoronary bypass. An epivascularly-attached thermistor records the cooling of the bypass wall when, following the intravenous injection of 5 to 10 ml of a NaCl solution at 4 degrees C, a bolus of cooled blood passes through the bypass. During cardiosurgical intervention, the thermistor is attached to the venous bridge by one or 2 sutures. The efferent cable goes through the thorax wall and is coupled to a subcutaneously implanted telemetric amplifier unit. The influence of the vessel wall on the perivascular temperature signal, as compared to the intravascular one, was studied in acute and chronic animal experiments. In acute experiments the perivascular peak of temperature was found to be lower than the intravascular one. Continuous measurements over 9 days showed variations in the perivascular signals which must have been due to changes in the thermal capacity of the tissue coupled to the thermistor as well as to changes in resistance caused by a variable extent of scarred area and by the varying water content of the wound bed. These variables will continue to keep rheothermia within the limitations of a method with primarily binary results (= bypass: open or closed). Given stable coupling conditions after full development of the scar around the thermistor, the signal falsification by the then constantly coupled tissue capacity becomes calculable such as to obtain semiquantitative results which, theoretically should vary predominantly with cardiac output.

Bei chronisch progredientem Verschlufl der Arteria mesenterica superior kann sich ein so ausgepragter Umgehungskreislauf uber die Art. mes. inf. entwickeln, dai3 der endgiiltige Verschlui3 des Hauptgefafles dann sogar symptomenfrei uberstanden wird. Beim akuten Verschlui3 wird die Symptomatik der Ernahrungsstorung in Abhangigkeit von den vorbestehenden Verhaltnissen des Gefai3systemes so variabel (1 I), dai3 das folglich uncharakteristische Krankheitsbild zu 40-50 O/o erst 48 Stunden nach Eintritt des akuten Ereignisses zur Krankenhausaufnahme kommt. Im Mittel vergehen 4,3 Tage vom Symptomenbeginn bis zur Klinikaufnahme und 16,5 Stunden von der Klinikaufnahme bis zur Operation (28). Das Krankheitsbild ist im gesamtchirurgischen Krankengut selten, 0,4 O / o aller akuten Abdomina und 2 O / o aller Ileusfalle (12, 21, 26) sind durch einen Mesenterialgefai3verschlui3 verursacht. Nach VOLLMAR handelt es sich in 60 bis 80 O/o aller Verschlusse der Arteria mesenterica superior um Embolien, in 20-30 O/o um Thrombosen. In etwa 5 O / o der Falle ist der Entstehungsmechanismus thromboembolischer Natur (28). Die Letalitat liegt nach VOLL-MAR zwischen 70 und 90 O / o (28).

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