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Background Reoperative (redo) mitral valve surgery is still a continuing challenge to surgeons. The aim of this study was to detect the factors that affect late mortality or morbidity after redo mitral valve surgery in patients with rheumatic disease. Methods Between May 1983 and February 2003, 92 patients who underwent redo mitral valve surgery for rheumatic disease were enrolled. Risk factors influencing survival or cardiac events were investigated with univariate analysis and a Cox model. Results Operative mortality rate was 4.2%. Kaplan-Meier actuarial analysis demonstrated an 84.7% 5-year, a 69.5% 10-year, and a 65.9% 15-year survival. Multivariate analysis demonstrated that age at surgery and preoperative New York Heart Association (NYHA) class were found to be independent predictors of late deaths, and that higher age, advanced NYHA class, and previous mitral valve replacement were independent predictors of cardiac events. Conclusions Redo mitral valve surgery can be achieved with low early mortality. However, long-term results of redo mitral surgery are not necessarily satisfactory in patients with preoperative advanced NYHA class or with a previous mechanical heart valve, and especially in 60 years or older age.

Although the immediate results of radical operation for tetralogy of Fallot are excellent, long-term follow-up has shown that the number of repeated procedures has increased in many institutions. We describe patients who underwent a second or third procedure after radical operation for tetralogy of Fallot.Between April 1981 and August 1996, we operated on 44 patients for the second time and on 4 for the third time after radical operation for tetralogy of Fallot. Indications for a second and third procedure included right ventricular outflow tract obstruction in 38 patients, infective endocarditis in 4, and isolated residual ventricular septal defect in 3.One patient died after concomitant replacement of the pulmonary and tricuspid valves. Three patients who underwent sternotomy more than twice (before the second or third operation) underwent accidental cardiovascular trauma during this procedure (30%). Moreover, when patients underwent more than two sternotomy procedures before the repeated operation for tetralogy of Fallot, the total bypass time, interval between cessation of the cardiopulmonary pump to completion of the operation, amount of blood transfusion, and length of intensive care unit stay were significantly higher compared with those who underwent less than two sternotomy procedures (p0.05). Right ventricular outflow tract obstruction was the main indication for a second operation. After the second operation for right ventricular outflow tract obstruction in 35 patients, the preoperative right ventricle to left ventricle pressure ratio decreased significantly (from 0.75 +/- 0.13 to 0.51 +/- 0.12; p0.0001). However, the right ventricle to left ventricle pressure ratio did not significantly decrease in patients who underwent a third procedure to treat right ventricular outflow tract obstruction.The surgical results of a second procedure after radical operation for tetralogy of Fallot were acceptable. However, the risk of accidental cardiovascular trauma during dissection was high among patients who underwent sternotomy more than twice before repeat operation.

Background: β-blocker therapy for dilated or ischemic cardiomyopathy is now an accepted and effective treatment. However, little is known about its efficacy in patients with postoperative impaired left ventricular function. This retrospective study was designed to assess the effects of β-blocker therapy in patients after aortic valve replacement (AVR) for aortic regurgitation (AR). Methods: A total of 59 patients who underwent AVR for chronic AR were assigned to four groups. Twelve patients were treated with both ACE inhibitors and β-blockers, 12 patients with only ACE inhibitors, eight patients with only β-blockers, and 27 patients without β-blockers or ACE inhibitors. A postoperative echocardiographic study was performed one year after surgery. Results: The heart rate was significantly reduced in patients with β-blockers despite the use of ACE inhibitors after surgery. Postoperative left ventricular volume was more significantly decreased in β patients than in non-β patients despite the use of ACE inhibitors. There were also significant reductions in left ventricular mass index in ACE+β patients compared to ACE+non-β patients. However, there were no significant differences in NYHA functional class and survival rate between β patients and non-β patients. Conclusions: β-blocker therapy may improve cardiac performance by reducing cardiac volume and mass in patients with impaired LV function after AVR for AR.

In 39 mongrel dogs, regional cerebral blood flow was measured during pulsatile and nonpulsatile deep hypothermic cardiopulmonary bypass with total circulatory arrest. Total circulatory arrest was performed at 20° C cerebral temperature for 40 minutes in 15 dogs, 60 minutes in 12 dogs, and 80 minutes in 12 dogs. Cerebral blood flow in both groups decreased as cerebral temperature fell and there was no significant difference in cerebral blood flow between the two groups during the cooling period. After circulatory arrest for 40 minutes, as cerebral temperature increased to 35° C, cerebral blood flow in both groups recovered to values as high as the respective initial values, which were measured just after the beginning of cardiopulmonary bypass for cooling (102.5% ± 10.2% in the pulsatile group and 97.2% ± 12.6% in the nonpulsatile group). After circulatory arrest for 60 minutes, cerebral blood flow in the pulsatile group increased to 141.8% ± 16.1% of its initial value when the cerebral temperature became 35° C, but it remained significantly lower (64.5% ± 9.2%) in the nonpulsatile group ( p