Gumersindo Blanco

Results of aortocoronary artery saphenous vein bypass surgery for ischemic heart disease

Abstract The results of direct myocardial revascularization using aortocoronary artery saphenous vein bypass grafting in 100 consecutive patients with ischemic heart disease are evaluated. Twelve patients died at operation or early thereafter. Of 88 patients surviving, 72 had severe angina pectoris before operation, 15 had moderate angina and 1 mild angina. After operation, only 10 patients had severe angina, 6 had moderate angina and 72 were free of angina. Thirty-seven patients underwent an exercise stress test in the upright position using a bicycle ergometer 3 to 5 days before operation. Angina pectoris developed in 33 patients during exercise and was accompanied by significant S-T segment depression. The exercise study was terminated in four patients who experienced shortness of breath. Three to four months postoperatively, 20 of these 37 patients underwent exercise at similar and higher work load levels. No pain or S-T segment depression was noted in 18 of the 20 patients. Two of the 20 patients had positive exercise responses similar to their preoperative responses. Seventeen of the 37 patients did not undergo exercise testing after operation: Four died; eight showed clinical improvement but were not available for repeat exercise studies; the remaining five showed no clinical improvement and did not undergo repeat exercise studies. Left ventricular function was determined by measuring ejection fraction and mean velocity of circumferential fiber shortening per circumference in 51 patients. The preoperative ejection fraction of patients who manifested clinical improvement after operation was greater than that of patients whose condition did not improve; how-ever, there was considerable overlap of data. The success or failure to achieve a good clinical result correlated with flow through the bypass, measured at the time of operation. Flow through the saphenous bypass was directly related to the state of the distal coronary arterial system.

Autogenous lung oxygenation during cardiac bypass; experimental studies and clinical application in aortic valve surgery.

Abstract A study was undertaken to assess the applicability of autogenous lung oxygenation during cardiac bypass. The results of the experimental employment of varying amounts of pulmonary parenchyma for this purpose have been presented. Clinically, the method has been applied successfully to the surgical treatment of aortic valve disease. Five such cases are reported.

A controlled surgical approach to annulo-aortic ectasia.

Annulo-aortic ectasia has attracted much surgical attention in the last 20 years. Replacement of the aortic valve and ascending aorta from the valve ring to just proximal to the innominate artery eliminates most, if not all, the pathologically involved tissue. Composite valve-Dacron tube grafting, plus elective saphenous vein grafts from the coronary orifices to the Dacron tube or distal aortic wall, provide a safe systematic approach to this entity. A review of surgical techniques and a description of a successful case employing this method are presented.

Criteria for open heart surgery for acquired aortic valvular disease

Abstract A historical review of surgical procedures for the relief of acquired aortic valvular deformities is presented. The present status of “open” operation on the aortic valve is reviewed. Our personal experience with 302 “open” heart procedures for the correction of these lesions is summarized. The proper selection of patients for surgical intervention prior to the development of intractable heart failure is outlined. The physician should entertain enthusiasm and optimism in view of the impressive array of advances in this surgical field. More objective postoperative evaluation including more frequent use of left heart catheterization and aortography is necessary for a definitive and just appraisal of the surgical results.