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Transcatheter aortic valve implantation (TAVI) offers a new treatment option for patients with severe symptomatic aortic valve stenosis, classified as "inoperable". The purpose of the study was to reveal the association between ascertained hospital costs with the actual patient Diagnosis-Related Group (DRG).We examined 50 consecutive patients who underwent either transapical TAVI, (TAVI-TA) or transfemoral TAVI (TAVI-TF) with the Edwards SAPIEN valve and CoreValve(®) between September 2009 and August 2011.Fourty-nine patients had successful valve deployment. Seven patients died within 30 days of the operation. The mean length of hospital stay for TAVI-TA was 199 hours (range 77-362), and the mean costs for TAVI-TA were 55,690 US$. For TAVI-TF the mean length of hospital stay was 170 hours (range 49-276) and the mean costs were 52,087 US$.There was no significant difference between TAVI-TA and TAVI-TF patient characteristics. There was a significant discrepancy between actual hospital costs and the current Norwegian DRG reimbursement for the TAVI procedure. This discrepancy can be partly explained by excessive costs related to the introduction of a new program with new technology. Costly innovations should be considered in price-setting of reimbursement for novel technology.

ALCAPA, anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital disease. We have from 1990 to 2003 operated on seven patients in our clinic. The objective of this study was to describe our experience of treating the condition and to remind other doctors of it as a possible diagnosis.The patients were identified by a retrospective review of our clinical records.Symptoms and signs varied from discomfort and pathologic heart murmur to ventricular fibrillation. All patients were operated on by use of cardiopulmonal bypass. Two died postoperatively within one week, two were reoperated later on because of pulmonary artery stenosis.ALCAPA should be suspected if a young patient with no previous history of heart failure presents with dyspnoe, chest pain or dysrhythmia. ALCAPA must be excluded by coronary angiography in younger patients with mitral insufficiency and no other morphological findings. Patients diagnosed early and operated on have a good prognosis.

“When outcomes are consistently good beyond 2 years the devices will be seen not only as a bridge to transplantation but as a feasible alternative to transplantation … .” Editorial Comment: Journal...

Sixty patients aged 5 days-10.3 years (mean 2.9 years) received monocusp valve implants in the right ventricular outflow tract in corrective surgery for congenital heart disease. The free edge of the monocusp valve was attached to the posterior wall of the new pulmonary tract to cover the entire root of the pulmonary tract when the monocusp valve closed. Follow-up was 3.8 (0-11.5) years. Early mortality was 8.3% (5/60) and late mortality 3.6% (2/55). Monocusp valve regurgitation developed in all patients. Moderate or severe valve failure was found in 30 patients at median 1.4, mean 2.2 (0.2-6.8) years postoperatively. Repeat surgery was performed in seven cases because of monocusp failure. It is emphasized that monocusps potentially give short-term reduction of pulmonary regurgitation when used for right ventricular outflow tract reconstruction. Only long-term follow-up can disclose whether all patients with a monocusp valve will require repeat surgery.

Allograft vascular disease is a significant cause of death of cardiac transplant recipients after the first year of transplantation. With few exceptions, angina pectoris does not develop and objective examinations, including coronary angiography, are necessary to diagnose coronary arteriopathy. Between 1983 and 1994, 214 heart transplantations in 211 patients were performed in our unit. All survivors had coronary angiography performed yearly. Thirty patients had significant localized arterial stenoses. Twelve patients with critical stenosis were accepted for percutaneous transluminal coronary angioplasty. Five patients underwent retransplantation due to progressive graft vascular disease with development of congestive heart failure. Conventional revascularization with transluminal coronary angioplasty can safely be performed with primary good results. In selected patients, retransplantation is an option if patients otherwise fulfil standard criteria for cardiac transplantation.

Isolated aortic (AVR, N = 71), mitral (MVR, N = 103), tricuspid (TVR, N = 3), pulmonary (PVR, N = 8), combined AVR + MVR (N = 4), or combined MVR + TVR (N = 2) valve replacement with a Carpentier-Edwards porcine bioprosthesis was performed in 191 patients between 1979 and 1986. Mean age was 56.9 +/- 17 (range 5-80) years in the total cohort. The operative mortality rates were 5.6% and 8.7%, respectively, for AVR and MVR. Mean observation time was 8 +/- 4.2 (0-16.7) years (total = 1.467 patient-years). Follow-up was 100% complete with respect to mortality. There were 78 late deaths (44%). Actuarial survival rates at 5 and 10 years were 73.2 +/- 5.2 and 52.1 +/- 6.6 for AVR and 76.7 +/- 4.2 and 61.6 +/- 4.8 for MVR. Coronary artery disease, concomitant coronary artery bypass grafting and emergency operation were significant risk factors of early mortality (p0.05). Postoperatively, sepsis and multiorgan failure were associated with early mortality (p0.05). The 10-year actuarial freedom from structural deterioration for AVR was 89 +/- 4.6 and 76.4 +/- 4.3 for MVR. It is concluded that structural valve failure is the most important factor that adversely affects the performance of Carpentier-Edwards bioprosthesis.

In 49 patients aged 2.2-34.8 (mean 11) years, homografts (20 aortic, 29 pulmonary) were implanted in the right ventricular outflow tract as an isolated procedure or part of corrective surgery for congenital heart disease: tetralogy of Fallot with pulmonary stenosis (23 cases), pulmonary atresia with ventricular septal defect (10 cases) truncus arteriosus (8 cases) or transposition of the great arteries with pulmonary stenosis (8 cases). Previous palliative procedures had been performed on 34 patients, and 37 had undergone repair of right ventricular outflow tract, with one to four sternotomies prior to homograft implantation. Homograft valve sizes ranged from 14 to 25 mm internal diameter. Concomitant intra- or extracardiac procedures were performed in 29 cases. Follow-up was complete at a mean of 3 +/- 0.3 (0-8) years. Early and total mortality was 2.0% (1/49), due to sepsis and multi-organ failure unrelated to the homograft. At follow-up all but one of the patients had an improved New York Heart Association function class. Eight patients (16.3%) with a mean age of 9.2 +/- 1.8 (2.8-15.5) years at implantation had homograft malfunction (stenosis in three, regurgitation in two and combined in three) at follow-up, averaging 4.1 +/- 1.0 (0.4-6.9) years, with no significant difference between aorta and pulmonary homograft subsets. Freedom from structural valve deterioration was 46.6 +/- 22% for pulmonary and 32.3 +/- 21.3% for aortic homografts at the 7-year follow-up (difference not significant). In two patients an aortic homograft was uneventfully replaced. In conclusion, homograft implantation in patients with right ventricular outflow tract obstruction improves function class and can entail low mortality and morbidity, even after multiple previous median sternotomies.