Clinical experience with heart valve homografts in Brazil.

The purpose of this paper is to describe the development and progress of the first heart valve homograft bank in Brazil as well as to report the 5-year clinical results. The bank was started in 1995 and employs modern techniques of cryopreservation. Organ procurement increased from 11 hearts in 1995 to 138 hearts in 2000. In the beginning of the experience, only 2 hospitals were using these valves, but this increased to 18 centers in 2000. Clinical experience at the major center includes 117 cases of the Ross procedure, 62 aortic homograft implantations, and 18 cases of mitral homografts. Five-year survival after the Ross procedure was 99.1%, and survival free from any kind of complication was 88.8%. No patients are on anticoagulants, and the incidence of thromboembolism was null. We conclude that auto- and homografts are probably the best alternative to aortic valve replacement for young patients in developing countries.

Myocardial revascularization with the radial artery: a clinical and angiographic study.

BACKGROUND: It has been well documented that the use of the internal thoracic artery yields better long-term patency rates than saphenous vein grafts for coronary artery bypass grafting. This knowledge has prompted surgeons to use other arterial conduits such as the radial artery. METHODS: Between April 1994 and January 1996, radial artery grafts were used in 83 patients (mean age, 54.6 years) undergoing myocardial revascularization. All patients received diltiazem, 80 mg orally three times daily. Angiographic studies were performed in the early post-operative period in 61 patients, and 6 to 19 months later in 12 patients. RESULTS: There were four hospital deaths (4.8%), none of them due to cardiac causes. Perioperative myocardial infarction was observed in 3 patients, 1 related to a radial artery graft occlusion. Of 61 grafts studied early, 59 were patent (96.7%), but two grafts showed diffuse spasm. Twelve patients had a second angiogram after a mean interval of 8.7 months, and all grafts were patent. One patient who had a diffuse spasm at the early study had recurrent symptoms, and repeat angiogram showed further narrowing of the graft (string sign). CONCLUSIONS: Our results suggest that with proper care, the radial artery may be used for coronary artery bypass grafting with good early results. Long-term follow-up and angiography studies will be needed to establish the merit of the radial artery as a graft for coronary artery operations.

[Aortic valve replacement with pulmonary autograft (Ross procedure). Initial experience]. / Substituição da valva aórtica com auto-enxerto pulmonar (cirurgia de Ross). Experiência inicial.

PURPOSE: Report the initial surgical experience with four cases utilizing a pulmonary autograft for aortic valve replacement. METHODS: Four patients, all males, white, age between 23 and 46 years having aortic valve disease were submitted to aortic valve replacement with a pulmonary autograft using the root replacement technique. Right ventricular outflow tracts were reconstructed with antibiotic sterilized pulmonary or aortic homografts. All patients had control bidimensional eco-doppler (ECO) and hemodynamic study to evaluate the function of the implanted auto and homografts. RESULTS: All patients had an excellent post-operative recovery, without the necessity of inotropic drugs. All presented in normal sinus rhythm. Post-operative ECO and hemodynamic studies revealed excellent function of the implanted autografts, without gradients in three and with a 15mmHg mean residual gradient in one case. There was no regurgitation in three cases and only trace aortic insufficiency in one. The right sided homografts also showed good function, with no gradient in two cases and mean systolic gradient of 6 and 8mmHg in the other two. CONCLUSION: The pulmonary autograft procedure should be implemented definitely in our country.

Substituição da valva aórtica com auto-enxerto pulmonar (cirurgia de Ross). Experiência inicial / Aortic valve replacement with pulmonary autograft (Ross procedure). Initial experience

Objetivo - Relatar a experiência cirúrgica inicial de 4 casos com a utilizaçäo do auto-enxerto pulmonar para substituiçäo da valva aórtica. Métodos - Quatro pacientes masculinos, brancos, com idades entre 23 e 46 anos, portadoras de valvopatia aórtica, forma submetidos a substituiçäo da valva aórtica pelo auto-enxerto pulmonar pela técnica de substituiçäo total da raiz aórtica. Para a reconstituiçäo da via de saída do ventrículo direito foram utilizados homo-enxertos pulmonares e aórtico conservad em soluçäo de antibióticos. Todos tiveram controle pós-operatório com eco-doppler (ECO) e estudo hemodinâmica para a avaliaçäo da funçäo dos auto e homo-enxertos implantados. Resultados - Todos apresentaram excelentes evoluçäo pós-operatória, sem necessidade de drogas inotrópicas e em ritmo sinusal. Os resultados obtidos através do ECO e estudo hemodinâmico revelaram excelente fuçäo dos auto-enxertos implantados sem gradiente em 3 casos e gradiente médio residual de 15 mmHg em um. Näo se observou reguriaçäo aórtica em 3 casos e insuficiência leve no 4o. ano. Os homo-enxertos implantados no lado direito do coraçäo apresentaram excelentes funcäo, sem gradiente em 2 anos e gradiente médio de 6 e 8 mmHg nos outros dois. Conclusäo - A cirurgia do auto-enxerto pulmonar deve ser implantada de forma definitiva em nosso meio

Purpose - Report the initial surgical experience with four cases utilizing a pulmonary autograft for aortic valve replacement Methods - Four patients, all males, white, age between 23 and 46 years having aortic valve disease were submitted to aortic valve replacement with a pulmonary autograft using the root replacement technique. Right ventricular out flow tracts were reconstructed with antibiotic sterilized pulmonary or aortic homografts. All patients had control bidimensional eco-doppler (ECO) and hemodynamic study to evaluate the function of the implanted auto and homografts. Results - All patients had an excelent postoperative recovery, without the necessity of inotropic drugs. All presented in normal sinus rhythm. Postoperative ECO and hemodynamic studies revealed excelent function of the implanted autografts, without gradients in three and with a 15mmHg mean residual gradient in one case. There was no regurgitation in three cases and only trace aortic insufficiency in one. The right sided homografts also showed good function, with no gradient in two cases and mean systolic gradient of 6 and 8mmHg in the other two. Conclusion - The pulmonary autograft procedure should be implemented definitelly in our country