Risk scores' performance and their impact on operative decision-making in left-sided endocarditis: a cohort study.

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

Extracellular NK histones promote immune cell anti-tumor activity by inducing cell clusters through binding to CD138 receptor.

BACKGROUND: Natural killer (NK) cells are important anti-tumor cells of our innate immune system. Their anti-cancer activity is mediated through interaction of a wide array of activating and inhibitory receptors with their ligands on tumor cells. After activation, NK cells also secrete a variety of pro-inflammatory molecules that contribute to the final immune response by modulating other innate and adaptive immune cells. In this regard, external proteins from NK cell secretome and the mechanisms by which they mediate these responses are poorly defined. METHODS: TRANS-stable-isotope labeling of amino acids in cell culture (TRANS-SILAC) combined with proteomic was undertaken to identify early materials transferred between cord blood-derived NK cells (CB-NK) and multiple myeloma (MM) cells. Further in vitro and in vivo studies with knock-down of histones and CD138, overexpression of histones and addition of exogenous histones were undertaken to confirm TRANS-SILAC results and to determine functional roles of this material transferred. RESULTS: We describe a novel mechanism by which histones are actively released by NK cells early after contact with MM cells. We show that extracellular histones bind to the heparan sulfate proteoglycan CD138 on the surface of MM cells to promote the creation of immune-tumor cell clusters bringing immune and MM cells into close proximity, and thus facilitating not only NK but also T lymphocyte anti-MM activity. CONCLUSION: This study demonstrates a novel immunoregulatory role of NK cells against MM cells mediated by histones, and an additional role of NK cells modulating T lymphocytes activity that will open up new avenues to design future immunotherapy clinical strategies.

Atrial Fibrillation and Stroke Risk After Coronary Artery Bypass Grafting Surgery.

Background: The present multicentre study was aimed at determining the effect of preoperative atrial fibrillation (preop-AF) as stroke risk factor in coronary artery bypass graft surgery (CABG) during the perioperative period. Methods: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish centers. Baseline variables related with perioperative stroke risk were recorded and analysed. The Northern New England Cardiovascular Disease Study Group (NNECVDSG) stroke risk schema was used to stratify stroke risk and compare predicted vs observed neurologic outcomes in this study. Results: 26347 patients were enrolled in the study. Prevalence of preop-AF was 4.2%, and was associated significantly with major cardiovascular comorbidities. The stroke rate was 1.38% (365 strokes), and it was slightly higher for patients with preop-AF vs non preop-AF, 1.82% vs 1.36%, p = 0.2. NNECVDSG schema showed good predictive ability calculating the area under the receiver operating characteristic curve (c-statistic 0.696; 95% CI 0.668 to 0.723). To investigate the associations of baseline preoperative variables with perioperative CABG-stroke a logistic regression model was performed. Preop-AF impact on perioperative stroke was lower that other variables. Preop-AF did not show an adverse impact in the quartiles groups according to NNECVDSG Stroke Risk Index. Conclusion: Risk of perioperative stroke in isolated CABG surgery patients is not significantly increased by preop-AF.

Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months.

BACKGROUND: Plasma exchange (PE) is used to treat severe episodes of CNS demyelination unresponsive to corticosteroids. Predictors of long-term response are not well known. METHODS: We retrospectively reviewed the medical records of 41 patients consecutively treated by PE between January 1995 and July 2007. The primary outcome was improvement at 6 months after PE defined as decrease of >or=1 point in the Expanded Disability Status Scale (EDSS) score for patients with EDSS or=8.0 or improvement of more than 2 lines in the visual acuity chart for patients with optic neuritis (ON). RESULTS: Twenty-five patients (61%) were women, and the median age was 33 years (range 14-57 years). Twenty-three (56%) had multiple sclerosis, 2 (5%) had clinically isolated syndrome, 2 (5%) had Marburg disease, 7 (17%) had acute disseminated encephalomyelitis, 4 (10%) had neuromyelitis optica, 2 (5%) had idiopathic ON, and 1 (2%) had idiopathic transverse myelitis. The median EDSS score before the attack was 1.0 (range 0-6.5). At PE onset, the median EDSS score was 7.0 (range 3.0-9.5). Sixteen patients (39%) improved at discharge, and 26 (63%) improved at 6 months. In the multivariate analysis, early initiation of PE (odds ratio [OR] 6.29, 95% confidence interval [CI] 1.18-52.96) and improvement at discharge (OR 7.32, 95% CI 1.21-44.38) were significantly associated with response at 6 months. CONCLUSIONS: Plasma exchange (PE) was associated with clinical improvement in 63% of patients at 6 months. Early initiation of PE and improvement at discharge were predictors of this response. Twelve patients (48%) who did not improve early did so during follow-up.

CarboMedics Mitroflow pericardial aortic bioprosthesis - performance in patients aged 60 years and older after 15 years.

BACKGROUND: The purpose of this study was to carry out a current assessment of the Mitroflow pericardial bioprosthesis (model 11) according to the durability of the prosthesis after 15 years in patients aged 60 years or older. METHODS: This bioprosthesis was implanted in 161 patients (mean age 69.5 +/- 6.3 years; range 60 - 94 years) undergoing aortic valve replacement (AVR) between 1982 and 1992. There were 84 patients aged 60 - 69 years (mean 64.5 +/- 3.1years) and 77 patients aged 70 years or older (mean 74.8 +/- 4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1 %); of these, coronary artery bypass grafting was performed in 39 (24.2 %). RESULTS: Early mortality was 4.8 % (4 patients) in the 60 - 69 year age group and 10.4 % (8) in patients aged 70 years or older ( P = 0.290). Late mortality was 4.5 %/patient-year (35) for those aged 60 - 69 years and 8.1 %/patient-year (49) for those aged 70 years or older ( P = 0.007). Patient survival at 15 years of patients aged 60 - 69 years was 47.6 +/- 6.3 % and of patients aged 70 years or older was 20.9 +/- 5.4 % ( P = 0.003) ( ). Freedom from valve-related mortality for patients in the 60 - 69 year age group was 92.1 +/- 3.5 % at 15 years (0.6 %/patient-year [5]), and in the patient group aged 70 years or older it was 84.4 +/- 5.3 % (1.3 %/patient-year [8]; P = 0.194). Freedom from reoperation for patients in the 60 - 69 year age group was 73.9 +/- 5.0 % (2.6 %/patient-year [20]), and for patients aged 70 years or older it was 91.4 +/- 3.4 % (1.0 %/patient-year [6]; P = 0.029). The structural valve deterioration (SVD) rate for patients in the 60 - 69 year age group was 2.4 %/patient-year (19), and for patients aged 70 years or older it was 1.0 %/patient-year (6) ( P = 0.041). Actuarial freedom from structural valve deterioration at 15 years for patients aged 60 - 69 years was 62.0 +/- 7.3 %, and 80.8 +/- 7.9 % for patients aged 70 years and older ( P = 0.049) (actual freedom 73.9 +/- 5.2 % and 91.4 +/- 3.4 %, respectively). CONCLUSIONS: The Mitroflow pericardial bioprosthesis can still be recommended for aortic valve replacement in patients 70 years and older.

Telomere length modulates human radiation sensitivity in vitro.

The molecular basis of the interindividual differences of normal individuals to ionizing radiation is poorly understood. Several studies in telomerase KO mice with short telomeres have uncovered an inverse relationship between telomere length and radiation sensitivity. The present work aims to determine if chromosome radiosensitivity is correlated with telomere length in healthy individuals. With this purpose, individual radiosensitivity was determined by the micronucleus assay in peripheral blood lymphocytes from two groups of individuals of the same age but with highly heterogeneous telomere length, selected from a population of 181 individuals where we previously measured telomere length. Our study demonstrates that telomere length modulates chromosome in vitro radiosensitivity in healthy individuals as the group with short telomeres presented higher frequencies of ionizing radiation-induced micronuclei when compared to the long telomeres group. This result supports the conclusion that individual telomere length acts as biomarker of individual chromosome instability upon exposure to ionizing radiation.

[National Registry of Home Parenteral Nutrition of the year 2001]. / Registro Nacional de la Nutrición Parenteral Domiciliaria (NPD) del año 2001.

AIM: We analyse the registered data of home parenteral nutrition (HPN) in our country during the year 2001. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Seventeen hospitals participated, and 66 patients were enrolled. Middle age was 5.5 +/- 4.9 years for patients < 14 years old, and 49.2 +/- 15.8 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.9%), neoplasm (22.7%), radiation enteritis (12.1%), motility disorders (4.5%) and Crohn's disease (4.5%). The mean time on HPN was 8.4 +/- 4.5 months. Tunnelled catheter was the preferential route (62.1%), followed by the implantated one (33.3%). The intermittent method (nocturnal) was preferential (81.8%). Patients receive the formula, mainly from hospital pharmacy (75.7%). The complications related to nutrition (1.3/patient) included the infections (0.46 sepsis/patient, and 0.19 catheter contamination/patients), mechanic (0.15/patient), metabolic (0.1/patient) and electrolytic disorders (0.07/patient). The readmission rate, for nutritional problems, was 1.34/patient. At the end of the year, 74.2% of the patients remained in the HPN program, and 25.8% abandoned the treatment (due to death: 52.9%, and to progress to oral feeding (25.3%). CONCLUSIONS: This review illustrates that the registration of HPN patients in our country is standing (1.65 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

[Home Enteral Nutrition: National Registry 2001]. / Nutrición Enteral Domiciliaria (NED): registro nacional 2001.

GOAL: The NADYA-SENPE Working Group analyzed the registered data of patients on Home Enteral Nutrition (HEN) in our country, during year 2001. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analyzed by the coordinating team. RESULTS: Twenty two hospitals participated and 3,458 patients, aged 5.6 +/- 4.0 y for those younger than 14 y, and 67.1 +/- 19.5 y for those older than 14 y, were enrolled. Of these patients, 43.4% were diagnosed with neurological diseases and 33.5% with cancer. The mean time on HEN was 6.5 +/- 4.5 months. Oral nutrition was the preferential route (54.5%), followed by nasoenteral tube (32.3%), and in 13.3% ostomy tubes were placed. Polymeric was the formula composition mainly used (85.9%). Patients were followed (71.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included mainly the gastrointestinal (0.16 complications/patient), and the mechanical one (0.15 complications/patient). At the end for the year, 48.3% of the patients were in the HEN program, and in 33.3% HEN was finish due to different reasons. In 22.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients, as previous years, were feed with ostomy tube. Due to the few complications observed, HEN is a safe treatment in our country.

Cryopreservation alters antigenicity of allografts in a porcine model of transplant vasculopathy.

UNLABELLED: The need for arterial grafts in coronary surgery to complement autologous vessels has generated interest in cryopreservation of small diameter allografts. We evaluated functional and histologic changes occurring in cryopreserved allografts 3 months after porcine femoral artery transplants. METHODS: Twenty recipient and 15 donor pigs included a control group of 16 fresh and 12 cryopreserved nonimplant arteries were used. Fresh (n=5) and cryopreserved (n=5) autografts were implanted to assess cryopreservation effects in the absence of rejection. Fresh allografts with or without treatment with cyclosporine (CsA) (n=6 of 8) and cryopreserved allografts with or without treatment with CsA (n=6 of 10) were performed to study the antigenicity of cryopreserved allografts. Arteries were stained with hematoxylin and eosin, Masson's trichrome, and orcein for morphometric analyses and immunostained to identify endothelial cells, smooth muscle cells, T lymphocytes, and macrophages. RESULTS: Among nonimplant arteries, cryopreservation reduced alpha-actin expression and increased the luminal area. All implanted autografts were patent. Cryopreserved autografts showed reduced alpha-actin expression and developed intimal hyperplasia compared to fresh autografts. Treatment with CsA improved the patency of fresh allografts from 0% to 83% (P <.01) and of cryopreserved allografts from 40% to 100% (P <.05). Cryopreserved allografts showed substantial intimal hyperplasia, and fresh allografts had more T lymphocyte infiltration in the intimal layer with aneurysmal dilatation. CONCLUSIONS: Cryopreservation reduces the deposition of inflammatory cells and prevents the thrombosis or aneurysmal lesions observed in fresh allografts. Therefore, cryopreservation modifies the antigenicity of vascular allografts.

[Parenteral nutrition at home: NADYA register for the year 2000]. / Nutrición parenteral domiciliaria (NPD): registro NADYA. Año 2000.

AIM: We analyze the registered data of home parenteral nutrition (HPN) in our country during the year 2000. METHOD: The data were collected through a previously designed questionnaire. Apart from epidemiological information, the form includes the disease to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Fourteen hospitals participated, and 67 patients were enrolled. Middle age was 5 +/- 4 years for patients < 14 years old, and 48 +/- 15 years for those > or = 14 years old. The more prevalent diagnosis were: ischemic bowel (28.4%), neoplasm (16.4%), radiation enteritis (13.4%), motility disorders (7.5%), Crohn's disease (2.9%), and other. The mean time on HPN was 7.5 +/- 4.4 months. Tunelized catheter was the preferential route (77.6%), followed by the implantated one (20.9%). The intermittent method (nocturnal) was preferential (91.0%). Patients receive the formula from hospital pharmacy more frequently than from Nutriservice (71.5% versus 19.4%). The complications related to nutrition (0.32/100 days of HPN) included the infections (0.12 catheter sepsis/100 d of HPN), metabolic (0.06/100 d of HPN), mechanic (0.03/100 d of HPN) and electrolitic disorders (0.03/100 d of HPN). The readmission rate, for nutritional problems, was 0.3 hospitalizations/100 d of HPN. At the end of the year, 61.2% of the patients remained in the HPN program, 37.3% abandoned the treatment (due to death (40%), to progress to oral feeding (48%), and to progress to enteral nutrition (4%); and 1.5% of the patients were not follow up. CONCLUSIONS: This review illustrates that there is an increment in the registration of HPN patients in our country (1997: 0.7 patients/10(6) habitants, 2000: 1.9 patients/10(6) habitants), that vascular pathology is the more frequent diagnoses in HPN patients, and the rate of readmission and complications and the behaviour is similar to other series making this as a safe treatment in our place.

[Enteral nutrition at home: National register for the year 2000]. / Nutrición enteral domiciliaria (NED): Registro Nacional del año 2000.

GOAL: Once again, the NADYA-SENPE Working Group analysed the registered data of Home Enteral Nutrition (HEN) in our country, during the year 2000. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication to prescribe this treatment, the specific nutritional treatment used and its duration, access path, complications and readmission rate in hospital, follow-up of the treatment, patient's quality of life and progress. All data were processed and analysed by the co-ordinating team. RESULTS: Twenty two hospital participated and 2,986 patients, aged 65.1 +/- 19.7 years, were enrolled. Of these patients, 41.2% were diagnosed with neurological diseases and 33.3% with cancer. The mean time on HEN was 6.3 +/- 4.4 months. Oral nutrition was the preferential route (50.8%), followed by nasoenteral tube (30.5%), and in 17.4% ostomy tubes were placed. Polymeric was the formula composition mainly used (83.2%). Patients were followed (70.1%) by the hospital reference Nutritional Support Unit. The complications related to nutrition included the gastrointestinal (0.25 complications/patient), the mechanical one (0.19 complications/patient), and the metabolic (0.007 complications/patient). Feeding tube need to be replaced 0.3 times/patient/year. The readmission rate, for nutritional problems, was observed in 0.03 patients. At the end of the year, 54.9% of the patients were in the HEN program, and in 30.3% HEN was finish due to different reasons. In 21.9% of the patients no, o light, discapacity degree was found. CONCLUSIONS: Related to previous years, there is an increment in the number of enrolled patients. Neurological diseases and cancer were the more frequent diagnoses in HEN patients. Oral access was the higher feeding route due, probably, to the high prevalence of cancer patients. In spite of the elevated prevalence of neurological diseases, a few number of patients were feed with ostomy tube. Finally, due to the few readmission rate and complications, HEN is a safe treatment in our country.

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Outcome of heart transplantation in patients previously infected with hepatitis C virus.

The lack of knowledge about the course of hepatitis C virus infection (HCV) before heart transplantation (HTx) prompted us to describe our experience with 4 such patients who presented with positive HCV serology before surgery. Two experienced non-liver related deaths at 3.5 and 5 years after HTx, and none of the patients developed signs of hepatic insufficiency during the follow-up (mean 3.8 years). Tests for HCV antibodies were frequently negative, whereas viral RNA was detected in 81% of the measurements, showing that virus detection techniques seem to be more sensitive than serology techniques in detecting HCV infection in this group of patients. Although immunosuppression promotes active HCV replication, it does not seem to change the chronic features of HCV infection during the first years in patients with good liver function.

The structure and function of the helical heart and its buttress wrapping. IV. Concepts of dynamic function from the normal macroscopic helical structure.

Torrent-Guasp's model of the helical heart is presented, which includes the cardiac muscular structures that produce 2 simple loops and that start at the pulmonary artery and end in the aorta. These components include a horizontal basal loop that surrounds the right and left ventricles, changes direction through a spiral fold in the ventricular band to cause a ventricular helix produced by now obliquely oriented fibers, forming a descending and ascending segment of the apical loop with an apical vortex. These anatomic concepts are successively activated to produce a sequence of narrowing by the basal loop, shortening by the descending segment, lengthening by the ascending segment, and widening in the cardiac cycle that causes ventricular ejection to empty and suction to fill. The factors responsible for internal torsional movements for cardiac output and suction are defined, together with mechanisms responsible for electromechanical activity produced during sequential changes in contraction and relaxation properties. These interactions of mechanical structure and function are defined in relation to pressure-related cardiac events observed from aortic, left ventricular, and left atrial recordings.

Mitroflow pericardial bioprosthesis experience in aortic valve replacement > or =60 years of age.

BACKGROUND: The Mitroflow pericardial bioprosthesis (model 11), a second-generation pericardial prosthesis, has clinical performance assessment to 10 years. The authors previously recommended the prosthesis for aortic valve replacement in patients 70 years or older. The purpose of the current assessment is to report on performance in patients 60 years or older undergoing aortic valve replacement. METHODS: This bioprosthesis was implanted in 161 patients (mean age, 69.5+/-6.3 years; range, 60 to 94 years) with aortic valve replacement from 1982 to 1992. There were 84 patients 60 to 69 years (mean, 64.5+/-3.1 years) and 77 patients 70 years or older (mean, 74.8+/-4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1%); of these, coronary artery bypass grafting was performed in 39 (24.2%). RESULTS: The early mortality was 4.8% (4 patients) for the 60 to 69-year age group and 10.4% (8) for those 70 years or older (not significant). The late mortality was 4.4%/patient-year (27) for those 60 to 69 years and 6.9%/ patient-year (35) for those 70 years or older (not significant). The patient survival for those 60 to 69 years was 58.0%+/-6.3% and for those 70 years or older, 45.3%+/-5.9% at 10 years (p < 0.05). The valve-related mortality for those 60 to 69 years was 0.82%/patient-year (5) and for those 70 years or older, 1.58%/patient-year (8) (not significant). The reoperation rate for those 60 to 69 years was 3.29%/patient-year (20) and for those 70 years or older, 1.0%/patient-year (5) (p < 0.05). The structural valve deterioration rate for those 60 to 69 years was 3.13%/ patient-year (19) and for those 70 years or older, 1.2%/ patient-year (6) (p < 0.05). CONCLUSIONS: The Mitroflow pericardial bioprosthesis remains recommended for aortic valve replacement in patients 70 years and older.

Mitroflow pericardial bioprosthesis: clinical performance to ten years.

The Mitroflow pericardial bioprothesis, a second generation pericardial prosthesis, has clinical performance assessment to 10 years. This bioprosthesis was used in 445 operations in 445 patients between 1982 and 1992 inclusive (mean age, 59.1 years; age range, 19 to 94 years). There were 253 aortic valve replacements (AVR), 155 mitral valve replacements (MVR), 31 multiple valve replacements (MR), and 6 tricuspid valve replacements. Concomitant procedures were performed in 40 patients (14.2%). The age group distributions (years) were less than or equal to 35 years, 28 patients; 36 to 50 years, 79; 51 to 64 years, 167; 65 to 69 years, 70; and 70 years or more, 101 patients. The total follow-up was 1,524 patient-years (mean, 5.4 years), 96% complete. The early mortality was 6.3%/patient-year (28 patients) and the late mortality was 4.1%/patient-year (96 patients). Concomitant procedures did not influence either early or late mortality (p = not significant [NS]). The overall patient survival at 10 years was 58% +/- 5% (p = NS by valve position). The overall freedom from structural valve deterioration (SVD) at 8 years was 69% +/- 3% and at 10 years, 45% +/- 7%; and at 8 years AVR 80% +/- 4%, MVR 58% +/- 6%, and MR 38% +/- 11% (p < 0.05, AVR > MVR > MR). The freedom from thromboembolism (TE) was 87% +/- 2%, overall at 10 years, and was not different by valve position (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute thrombotic occlusion of the suprarenal aorta: importance of early diagnosis and treatment.

Five patients with suprarenal aortic thrombosis were diagnosed and treated over the past 6 years. Attempts were made to establish aggressive medical and surgical treatment promptly. Three patients died in spite of immediate therapeutic measures. Two patients survived operation but one died 9 months later from myocardial infarction. The syndrome of high acute aortic occlusion is considered; attention is focused towards immediate diagnosis and treatment.