Clinical experience with the Bicarbon heart valve prosthesis

BACGROUND: We have previously reported mid-term results of a study, which ended in January 2000, on the Bicarbon valve. The study concluded that the valve showed excellent clinical results, associated with a low incidence of valve-related complications. In the present study, the same patients were prospectively followed for an additional 5 years. METHODS: Forty-four patients had aortic valve replacement (AVR), 48 had mitral valve replacement (MVR), and 13 had both aortic and mitral valve replacement (DVR). The mean age of the 105 patients was 61.2 ± 11.3 years. The mean follow-up was 6.1 ± 1.9 years with a cumulative follow-up of 616 patient-years. RESULTS: There were 5 early deaths (4.7%: 4 in the AVR group and 1 in the MVR group) and 21 late deaths (3.4%/patient-year: 5 valve related deaths and 16 valve unrelated deaths). Survival at 8 years was 75.2 ± 7.0% in the AVR group, 76.6 ± 6.2% in the MVR group, and 55.4 ± 16.1% in the DVR group. The linearized incidence of thrombo-embolic complications, hemorrhagic complications, and paravalvular leaks in all patients was 0.65 ± 1.48%, 0.81 ± 1.69%, and 0.16 ± 0.54%/patient-year respectively. No other complications were observed. CONCLUSION: The Bicarbon prosthetic heart valve has shown excellent long-term clinical results, associated with a low incidence of valve-related complications

Periodic Macrostructure in Unidirectionally Solidified Ni-C Ingot

Carbon-saturated nickel melt containing sulphur up to 300ppm was unidirectionally solidified at a rate of 0.3 to 0.5mm/sec. When sulphur content was 100～200ppm, the ingots had a periodic macrostructure consisted of alternate layers with spheroidal graphite and with flaky graphite, which are parallel to solidification front. The thicknesses of layers with spheroidal graphite and those with flaky graphite were 2 to 10mm, and 1 to 3mm respectively. There were some features of the boundaries between two kinds of layers. Possibilities of the formation of the periodic structure were discussed

Laboratory Studies of Perioperative Abdominal Aortic Aneurysm Repair

Purpose: This study aimed to determine the procedure-related major morbidity of infrarenal abdominal aortic aneurysm (AAA) repair, to investigate the changes in perioperative laboratory values, and to clarify the degree of physical strain of surgery and specific independent predictive factors for major morbidity. In addition, in the case of endovascular aneurysm repair (EVAR), we weighed how occlusion of the internal iliac artery related to physical strain of surgery in terms of laboratory values. We retrospectively evaluated patients who were treated at Jichi Medical University Hospital. Methods: Consecutive patients with an AAA (excluding ruptured AAA) between April 2007 and August 2010 were studied. The effects of various patient- and operation-related variables on outcomes (major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage) were assessed by univariate and multivariate analyses. Results: Overall in-hospital mortality was 0.4%. Statistically significant differences, mostly in favor of EVAR, were observed in the intraoperative and postoperative data. The presence of an internal iliac artery occlusion did not affect the perioperative laboratory data. Of various patient- and operation-related variables for each outcome, the relative factors were duration of operation, blood loss, white blood cells, C-reactive protein, lactate dehydrogenase, creatine phosphokinase, and potassium. In multivariate logistic analysis, blood loss, C-reactive protein, creatine phosphokinase, and potassium were significantly related to each outcome. Conclusions: Both elective open repair and EVAR can be safely performed in patients with an infrarenal AAA. EVAR has perioperative advantages of reduced blood loss and blood transfusions as well as a decreased duration of stay in hospital. In particular, we identified specific independent relative factors of laboratory values for major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage. and #8195; [Arch Clin Exp Surg 2013; 2(2.000): 71-79

Analysis of Perioperative Factors for Neurological Dysfunction in Patients with Thoracic Aortic Surgery

Objectives: Surgical procedures for various aortic arch pathologies still result in high mortality and morbidity. Success in these aortic procedures is directly related to cerebral protection techniques during circulatory arrest. Herein, we analyzed risk factors for postoperative neurological dysfunction. Methods: Between June 2008 and April 2010, 104 patients underwent surgery for aneurysms or dissections using hypothermic circulatory arrest, with or without retrograde cerebral perfusion or antegrade cerebral perfusion. The mean age of patients was 68.5 +/- 12 years, and 63.5% were male. Sixty patients were treated for acute aortic dissection, eight patients for chronic dissection, and 36 patients for a degenerative and atherosclerotic aneurysm. Results: Hospital mortality was 2.9%, and the overall post-operative neurological dysfunction rate was 16.3%. In addition, the incidence of permanent and temporary neurological dysfunction was 12.5% and 3.8%, respectively. Univariate analysis of risk factors for permanent neurological dysfunction revealed that acute aortic dissection, emergency case pre-operative neurological dysfunction, partial arch replacement, cannulation from cardiac apex, and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were associated with post-operative permanent neurological dysfunction. Multivariate analysis revealed that pre-neurological dysfunction and deep hypothermic circulatory arrest plus retrograde cerebral perfusion duration were significant independent risk factors for permanent neurological dysfunction. Conclusions: Prolonged duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion and pre-operative neurological dysfunctions were risk factors for permanent neurological dysfunction. The moderate hypothermic circulatory arrest plus an antegrade cerebral perfusion method used at our institution can reduce the incidence of postoperative neurological dysfunction. [Arch Clin Exp Surg 2013; 2(3.000): 141-148