Clinical results of the Pop De Popa xenobioprosthesis in patients with advanced heart failure: long-term follow-up of 562 patients.

From January of 1984 through December of 1990, we implanted 739 Pop De Popa wild boar aortic valves in 626 patients, in all cardiac valvular positions. Of these patients, 562 received only the Pop De Popa xenobioprostheses, which numbered 620 valves. Only patients with contraindications for bioprosthetic valves (such as children under the age of 15) were excluded. At surgery, the 562 patients ranged in age from 17 to 66 years (mean, 41.7 yrs). Five hundred thirty-one (94.48%) were in NYHA functional class III or IV before valve replacement. Of the 620 valves implanted, 20 were replacements for Pop de Popa prostheses and the other 600 were replacements for native valves. Survivors were followed-up for a mean period of 31.6(+/-22) months (range, 3 months to 7 years), and for a cumulative period of 2,432 patient-years. Over the 7-year period of study, there were 78 late deaths, and 32 other patients were lost to follow-up. The analysis demonstrated good cardiac and general improvement. At the conclusion of the 7-year study, 94.83% of the survivors subject to follow-up were in NYHA functional class I or II. The early mortality rate was 12% (68 patients), and the following incidence of early valve-related complications was noted: thromboembolism, 3% to 4%; endocarditis, 1% to 2%; paravalvular leak, 1% to 2%; primary tissue failure, 1%; and anticoagulant-related hemorrhaging, 1%. At 7 years, 90% of survivors subject to follow-up were still free of valve failure. The probability of complications was as follows: thromboembolism, 16.1%; endocarditis, 8.8%; paravalvular leak, 4.4%; anticoagulant-related hemorrhaging, 1.2%; and valvular degeneration and reoperation, 12.5%. The probability of survival at 7 years was 86.12%. While this study does not yet demonstrate the superiority of the wild boar valve over other bioprosthetic valves, it does reaffirm the worth of implanting biologic valves in adult patients when not contraindicated. Perhaps as we continue follow-up beyond 7 years, the apparent durability of the wild boar cusps will manifest itself in a statistically significant manner.

[The reperfusion syndrome]. / Sindromul de reperfuzie.

The syndrome of reperfusion is a succession of pathologic phenomena, developing at the level of a tissue that had suffered from an episode of acute ischemia and is then reperfused normally. The clinical phenomena present, characterized mainly by the appearance of an important local edema and of clear signs of tissular suffering, with sensory and motor nervous disturbances, lack of muscular contracture and, finally, phenomena of necrosis, are due to development at cellular level of some processes leading, during reperfusion and resuming of the oxygen contribution towards cells, to some chemical processes which generate an important activation of several systems with major tissular aggressiveness. The phenomena initiated locally produce here a secondary lesion that impairs the recovery of the ischemized territory, on the one hand, and the products generated in this territory activate similar phenomena in the distance, on the other hand. The primary wounded area becomes an important inflammatory focus which emits a series of mediators leading to the generalized activation of the nonspecific immune system. Both phenomena generate, in fact, a syndrome of multiple organic insufficiency that puts in danger the patient's life. Casuistics of 1506 interventions on patients with peripheral acute ischemic syndromes showed that the maximum mortality is given by tardy interventions of reperfusion (more than 12 hours) in which the syndrome of organic insufficiency appeared almost permanently.

[Influence of extracorporeal circulation on renal function]. / Influenta circulatiei extracorporale asupra functiei renale.

The renal function was investigated comparatively in two lots of patients with cardiovascular diseases that had been operated with and without extra-corporeal circulation. It was shown that extra-corporeal perfusion alters the renal function in an increased number of cases (28% against 17.75%). Other parenchymatous tissues have also been involved, such as the liver and the pancreas. The humoral parameters and the clinical data are discussed, which demonstrate the organic involvement following such interventions. The good results obtained stress the necessity of an energetic treatment, which should include early dialysis.

[Fatal postoperative pulmonary embolism]. / Emboliile pulmonare postoperatorii fatale.

A total of 76 cases were investigated in which fatal postoperative pulmonary embolisms were identified at the necroptic study. The following aspects are considered: the high incidence of fatal postoperative pulmonary embolisms in patients without favouring factors in antecedents (38%), and of patients operated for benign affections (50.6%); the rare occurrence of clinical signs of venous thrombosis in patients with fatal postoperative pulmonary embolisms (11.8%); the high incidence of early fatal postoperative pulmonary embolisms (46%)--in the first three days after surgery, of which 26.3% in the first 24 hours and the importance of their identification so as to exclude an erroneous interpretation of the cause of death, and finally the indications and the limitations of the prophylactic treatment with low amounts of heparin.

[Use of naloxone (Narcar) in anesthesiological practice]. / Folosirea naloxonului (Narcan(R)) în practica anestezica.

The antagonising effect induced on respiratory depression by fentanyl and morphine was studied in two lots of patients. Recovery from respiratory depression was general and evident. A correlation was found between the amount of naloxone and the amount of the major analgesic used. Beside respiratory depression naloxone has also partially antagonised in some cases the analgesic effects of fentanyl and morphine.

[Personal experience with 2,500 closed heart mitral commissurotomies]. / Experienta noastra în peste 2 500 de comisurotomii mitrale pe cord închis.

Between 1953 and 1976 a total of 2527 mitral commissurotomies have been performed in the Clinic for Cardio-Vascular Surgery of the "Fundeni" Hospital. This group included cases with pure mitral stenosis (predominantly following rheumatic disease), but also cases of mitral stenosis associated with other cardiac lesions in which the major hemodynamic element was the mitral obstruction. Criteria are discussed for surgery, the preoperative preparation of the patient, incidents, accidents and complications, as well as technical difficulties of the digital and/or instrumental mitral commissurotomies on closed heart, either carried out for the first time in the respective patient, or as iterative intervention. Comparing the results in relation with the functional stage of the disease (62.5% of the patients were classified in the III-IV evolutive degree, according to the NIHA classification), pulmonary hypertension (61.6% of the patients had medium or severe pulmonary hypertension), associated lesions (present in 17% of the cases--mitral failure predominated, together with tricuspid or aortic failures), it is appreciated that the technique of mitral commissurotomy on closed heart is an useful therapeutic method (88.6% very good and good results, a global death rate of 3.9%) that can be applied in a large category of patients, although there is a trend toward open-heart surgery, with all medico-economical major implications.