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Effects of an outpatient cardiological rehabilitation programme that is offered to patients following their inpatient treatment in a rehab clinic are measured and compared with the data collected from an untreated group. The study group consists of 155 cardiological patients (after heart attack, bypass operation and heart-valve prosthesis) in the treatment group as well as 136 in the non-treatment group. The outpatient programme takes place twice a week in a cardiological rehab clinic, with patients participating for a maximum period of twelve weeks. Data are collected at the beginning, the end and three months after the end of the programme from the treatment group resp. twice with a six months interval from the non-treatment group. The used outcome measures are a number of medical variables (e.g. stress ECG, BMI, blood pressure), variables concerning vocational reintegration, plus a questionnaire. This questionnaire consists of a Functional Limitation Scale, a Mood Check List, a "Health Locus of Control"-Scale as well as a number of items regarding health-related behaviour and heart complaint symptoms. The project duration was 36 months, starting in June 1993. The funding source is the "Landesversicherungsanstalt Westfalen", a regional division of the German Statutory Old Age Insurance. As data concerning vocational reintegration indicate, the programme can be a meaningful complement to a larger amount of reintegrated patients (66.9%) compared to the non-treatment group (50.2%). To estimate the long-term effects of the programme, a 24-month-follow-up was started in January 1996.

This study shows that additional outpatient/partially inpatient treatment provided in a cardiological rehabilitation hospital effectively complements inpatient rehabilitation treatment but does not replace it. Our flexible system which comprises a shorter stay in hospital and subsequent partially inpatient treatment allows more intensive treatment of the patient in the early phase of rehabilitation. It supports patients when they have returned home and have to test out how they manage with their restricted physical and mental performance in their social environment. It appears possible to develop criteria to select the individually appropriate form of treatment. The introduction of outpatient/partially inpatient therapy in a cardiological rehabilitation hospital does not appear to entail disadvantages for the patients. It contributes to more flexible, and in particular to more individualized, treatment. The ongoing pilot projects will show whether in the final analysis this will also entail a saving of costs. Not only in view of their specialist competence are the cardiological rehabilitation hospitals suitable and able to participate in measures to increase the flexibility of cardiological rehabilitation. They should therefore either completely integrate outpatient/partially inpatient methods in their concept of therapy or after a shortened inpatient treatment. They should then evaluate these methods so as to be able to contribute to an informed discussion on this topic. This also would mean that available resources would be better utilized, which would in addition be of particular importance at present, in a situation dominated by discussions of costs.

A total of 164 patients with a mean age of 78.6 +/- 2.7 years and often critical preoperative conditions [New York Heart Association (NYHA) class III + IV, 78.7%] underwent cardiac operations [coronary artery bypass grafting (CABG) 97; valve replacement, 33; CABG + valve replacement, 18; replacement of ascending aorta and others, 18] with an in-hospital mortality of 8.5% (n = 14). Follow-up was completed for 147 patients (98%) after 16.5 +/- 10.8 months. Most patients were in a good clinical condition (NYHA I + II, 79.6%; late deaths, 8 patients, 5.4%) and more than 95% of patients lived at home or with relatives. Charges for hospital treatment dropped to one third after the hospitalization period for surgery in the first postoperative year compared to the year immediately preceding the cardiac operation.

The present investigation was performed to determine the dependence of the length of stay in community hospitals and rehabilitation clinics from patient characteristics and physical activity at the end of treatment. Comparing age, end-diastolic volume index, left ventricular ejection fraction, number of stenosed coronary arteries, number of bypass grafts, levels of physical exercise, body mass index and the ratio total cholesterol/HDL-cholesterol, no significant differences were found in patients, who reached the rehabilitation clinic in the early postoperative period (7.4 +/- 2.0 days, n = 98), after 15-28 days (n = 74) or later than 28 days (n = 156) after bypass-surgery. Similar results were observed in 103 patients after heart-valve replacement, who arrived at the rehabilitation clinic after a corresponding length of hospital care like the bypass patients. Also, no significant differences in the clinical characteristics and physical activity appeared in patients who were admitted in the early phase (9.2 +/- 4.5 days) after transmural myocardial infarction (n = 37) and those entering the rehabilitation clinic after 26.7 +/- 9.4 days of hospital stay (n = 32). The absence of any relationship between the length of stay in hospitals on the one hand and severity of the heart disease on the other hand points out that the whole duration of stay in community hospitals and rehabilitation clinics after surgical intervention and also after transmural myocardial infarction could be drastically shortened by an optimal cooperation of both, hospitals and rehabilitation clinics, without any impairment of clinical results.

Purpose: Exercise-based rehabilitation programs improve effort tolerance in patients with cardiovascular disease. Little is known regarding the time course of recovery of objective and subjective indices of exercise tolerance., Methods: Twenty-six patients were studied at 0, 4, 8, and 12 weeks following early entry into rehabilitation following acute myocardial infarction (AMI), coronary artery bypass graft surgery (CABGS), or valve surgery. Exercise tolerance was assessed objectively by percent predicted cycle power output (%PO), and subjectively by a self-efficacy questionnaire for ambulatory (ASE) and muscular (MSE) items and by a disease-specific, health-related, quality-of-life questionnaire (HRQL)., Results: With the exception of percent predicted cycle power output, all exercise tolerance measures improved throughout the rehabilitation program. Extrapolation of recovery curves suggest that recovery to 85% predicted can be achieved in 10, 11, 18, and 21 weeks for a disease-specific, health-related, quality-of-life questionnaire, self-efficacy questionnaire for ambulatory items, muscular items, and power output, respectively., Conclusions: The data demonstrate that evaluation of both objective and subjective indices of exercise tolerance may be important in documenting outcomes of participation in structured rehabilitation programs. The time course of recovery of objective and subjective indices of exercise tolerance may not be highly correlated.

The validity of the biopsychosocial approach to the study of health and illness is reaffirmed by the prospective findings of the Recovery Study. This is a multidisciplinary examination, conducted in four teaching hospitals, of the predictors of symptoms of cardiac illness in 463 patients 6 months after coronary artery bypass or cardiac valve surgery. We found that the following preoperative measures predict freedom from cardiac symptoms 6 months after surgery: low levels of all of the following: angina pain, shortness of breath, fatigue and sleep problems, lifetime cigarette usage, and preoperative hospitalization for cardiac treatment; low levels of anxiety, depression, and hostility, and few life change events; high levels of all of the following: self-esteem, well-being, vigor; prevalence of activities and hobbies, social participation, and social support. The six variables in bold print contributed independently in a multiple regression equation that accounted for 21% of the variance of the symptoms score and was associated with an estimated 45% difference in success of recovery. The statistical strength and general nature of many of the predictors indicate that the predictors may also be important in recovery from other health crises. Psychosocial and biomedical factors correlate across time (predictively), as well as cross-sectionally, indicating that psychological, social, and biological mechanisms may be parts of a single general multifaceted process influencing recovery of health. A clinical trial could determine if psychological, social, or behavioral interventions will hasten and improve recovery from physical illness or trauma.

Altogether 103 patients with rheumatic heart disease were examined within different times after prosthetics of heart valves (mitral or aortal). The purpose was to elaborate the principles of applying the data of instrumental methods of cardiological examination to the improvement of disability criteria. The examination included echocardiography, tetrapolar chest rheography and ECG exercise test. The data allowed one to estimate myocardial reserves and to specify the intensity of functional disorders of the cardiovascular system. The expert medical conclusions on the working ability were revised in 47 patients, bearing in mind the data obtained. Before the examination 70 patients (68%) were considered to completely lose the working ability. However, after the examination their number dropped to 34 (33%), whereas the number of persons able to work rose from 5 to 12%.

In a consecutive series of 1109 patients undergoing aortic valve replacement (AVR) between January 1988 and December 1990, there were 48 patients (33 female, 15 male) over 80 years of age (mean age 83.5 years, median 82.9 years). Of those, 33 had aortic stenosis and 15 combined aortic valve disease, with additional coronary artery disease being present in 36. Isolated AVR was performed in 25 patients, and it was combined with coronary venous bypass grafting, with 1-4 (mean 1.8) peripheral anastomoses in 23. Two patients died within 30 days (early mortality 4.2%). Non-fatal complications included one hemiparesis, four transient cerebral disorders, two cases of pneumonia which led to ventilatory assistance, three rethoracotomies because of postoperative bleeding, 15 tachycardias and one transient AV block. Late results were obtained after a median follow up time of 22 months. There were eight late deaths (four cardiac related, four not related) and a low incidence of non-fatal complications (two episodes of gastrointestinal bleeding while on oral anticoagulation, one cerebral transient ischemic attack and one acute left ventricular failure). Nine patients are in NYHA Class I, 12 in Class I-II, 11 in Class II, three in Class II-III and three in Class III. Of the surviving 38 patients, four are currently living in a home for the aged or a nursing home, while all the others are living in their own homes and are able to sustain a relatively independent life-style. We conclude that in very old patients with aortic valve disease, AVR can be performed with low mortality and few non-fatal complications.

Between 1978 and 1987, 1270 patients who survived single aortic or mitral valve replacement at the Rehabilitation Center in Bad Krozingen, Germany, underwent a comprehensive rehabilitation program. The preoperative diagnosis was isolated aortic stenosis in 425, isolated aortic regurgitation in 159, mixed aortic lesion in 211, isolated mitral stenosis in 208, isolated mitral insufficiency in 137 and mixed mitral lesion in 130 cases. Follow up examinations were carried out one and six months after surgery, and at yearly intervals thereafter. Exercise testing was performed with an electrically braked bicycle ergometer in the supine position, and the load was increased by 25 or 50 watts every two minutes until fatigue, severe angina, more than 0.3 mV ST-segment depression, or 80% of the age predicted maximum heart rate was achieved. Patients after aortic valve replacement had a better exercise performance one month after operation than did those after mitral valve replacement. Those with mitral stenosis showed more severe impairment of exercise tolerance than did the mitral insufficiency group. There was a steady increase in exercise tolerance between one and six months postoperatively, both in patients with aortic and those with mitral valve replacement, but the difference in performance between the two groups was still present (72% versus 57% of normal). The results of univariate and multivariate analyses showed that the preoperative employment status was the most important factor for postoperative return to work, followed by gender (male > female), exercise tolerance and valualar lesion (aortic > mitral).(ABSTRACT TRUNCATED AT 250 WORDS)

The success of valve surgery has led to a marked improvement in prognosis, quality of life and exercise tolerance in patients with symptomatic valvular heart disease. The degree of subjective and objective improvement depends on multiple preoperative factors like NYHA status, left ventricular function, valve lesion and type of valve replaced as well as peri- and postoperative factors like the occurrence of a perioperative myocardial infarction, the degree of intraoperative myocardial damage, the type of valve replaced and the speed and degree of postoperative regression of left ventricular hypertrophy and dilatation. The postoperative exercise tolerance is a major determinant for postoperative vocational rehabilitation. Therefore the individual functional assessment of patients postoperatively is of major importance.

The informative value of determination of the restoration rate of spiroergometric parameters was examined in cardiosurgical patients who had undergone exercise testing. All the patients were divided into 3 homogeneous groups: (1) those without disorders; (2) those with moderate restoration; and (3) pronounced restoration. There was a moderate relationship between the restoration rate and the function of the oxygen transport system (OTS) and a high relationship between the rate and exercise tolerance in decompensated metabolic acidosis and left ventricular function. Analysis of the restoration of spiroergometric parameters provided a final assessment of the functional reserves of OTS in cardiosurgical patients and serves as a non-invasive technique to study left ventricular function in the patients.

Experience in the application of and disc prostheses in 614 patients in generalized. Mitral prosthetics was conducted in 256, aortic in 229, and mitral++-aortic in 129 patients. Hospital lethality was, respectively, 3.9, 4.8, and 8.5%. In postoperative follow-up periods of up to 7 years 92.1% of patients were examined. Survival was 88.1 +/- 0.71% in the mitral, 87.0 +/- 0.62% in the aortic, and 80.2 +/- 0.84% in the mitral-aortic group. No thromboembolic complications occurred in 88.7 +/- 0.64%, 96.9 +/- 0.31%, and 88.3 +/- 0.68% of patients, respectively. In the mitral position the mid-diastolic gradient was 4.0 +/- 0.31 mm Hg on the prosthesis and 3.8 +/- 0.82 mm Hg on the prosthesis; in the aortic position the peak systolic gradient was, respectively, 23.2 +/- 0.58 and 22.4 +/- 0.7 mm Hg. At the time of examination 97% of patients belonged to I and II functional classes.

After prosthetics of the aortal valve 30 patients underwent bicycle ergometry training at the sanatorial stage of rehabilitation. 10 patients who did not undergo bicycle ergometry training made up the control group. The efficacy of bicycle ergometry training was assessed according to the time-course of changes in pump and contractile functions of the heart and oxygen consumption at rest and during bicycle ergometry. Transfer of the patients to a higher functional class, a decrease in the number of threshold reactions, attainment of a higher heart rate and a higher oxygen consumption, capacity for an increase of the stroke index up to the load of 1.0 W/kg and of the level of the myocardial reserve up to 1.5-2.0 W/kg were used as criteria for the effectiveness of bicycle ergometry training. The effectiveness of bicycle ergometry training is also supported by the data obtained on comparison of the findings in the main and control groups.

Family interaction is a basic factor in determining the quality of life of patients undergoing heart surgery. The present study investigates the emotional attitudes in the relatives of 10 heart-operated patients. The results indicate that a high amount of relatives' emotional overinvolvement and warmth tends toward a correlation with lower anxiety and depression scores, and with a better 12-month outcome of the illness.

The specific aim of this study is to compare and contrast the biophysical and psychosocial profile of men and women undergoing cardiac surgery (coronary artery bypass graft and valve replacement) during the perioperative and home recovery period. Coronary artery disease appears to be qualitatively worse in women than men although the prevalence in women does not approach that in men until the seventh decade. Valvular disorders also reveal a different profile by sex with the greater valvular problems in women related to the fact that women have more rheumatic heart disease. A prospective, longitudinal design with a convenience sample of 117 patients undergoing cardiac surgery and their spouses (234 subjects) from five Northern California hospitals was used to tap patient response at three critical perioperative data points. Female patients were observed during the perioperative period to have significantly more shortness of breath, poorer cardiac functional status (New York Heart Association), significantly longer intensive care unit stays, and proportionately more deaths. At 1 and 3 months after discharge, however, their recoveries did not differ significantly from men's when they were compared on sexuality, recreation, or return-to-work variables. Surprisingly, female patients had significantly less mood disturbances as measured by the Profile of Mood States than their male counterparts, and they scored higher on measures of family satisfaction than did male patients. Implications of the study involve early recognition of heart disease in women, preparation of families for longer intensive care unit stays, and appreciation of different psychosocial responses to surgery.

Methods and results of physical rehabilitation of 81 patients with prostheses of the aortal valve in conditions of a health resort are reported. The authors revealed a 29.2% increase of physical, working capacity and a reduction (8.2%) of oxygen expenditures per unit of work. Increase of intensity of training loads improved the results of physical rehabilitation. The role of health resort treatment in the system of postoperative rehabilitation of patients with heart valve prostheses is emphasized.

An analysis of results of spiroergometry and radionuclide ventriculography in the mixed group of cardiosurgical patients allowed to reveal a reliable accretion of fraction of expulsion of the left ventricle during transition from the state of rest to work at the level of anaerobic threshold and absence of accretion of this index in further increase of exercise. The results obtained allowed to propose the use of anaerobic threshold equal to 60% of the threshold uptake of oxygen as an indicator in choosing the optimum intensity of the training exercise of patients operated on for heart diseases.

Traditional concepts about the early phase of postoperative remobilization after cardiac surgery favor physical inactivity--as did earlier concepts for rehabilitation after myocardial infarction like the armchair treatment philosophy. For an overwhelming majority of our patients, however, this concept does not hold, according to our experience during the last decade. In contrast, we propose a model of stepwise mobilization and rehabilitation starting the first postoperative days. At the end of the first week most patients are able to climb staircases. In the second week group physical therapy can be started. At the 14th postoperative day, discharge from the surgical ward is warranted. During this step of early mobilization some exceptions have to be made and some special aspects have to be considered. Early mobilization must be postponed in patients with overt heart insufficiency, a low ejection fraction, complex ventricular arrhythmias or pericardial effusions. Cautious mobilization is also required in patients with mitral valve replacement and persistent elevation of pulmonary pressure and resistance. This holds also for patients with valve replacement during acute endocarditis, patients with repair of a dissecting aneurysm of the aorta and patients with perioperative myocardial infarction. The stage of early postoperative mobilization usually ends after the second week and is followed by the next step, the rehabilitation phase during weeks 3 to 6. The goals of the rehabilitation program are; increasing the physical fitness of the patient, thereby increasing his self-assurance and self-esteem; establishing a health-education program, increasing the patients health competence and his coping capacities.(ABSTRACT TRUNCATED AT 250 WORDS)

We present the case of a 40 year old woman, who had an aortic prosthetic valve, of the Björk Shiley type. Three months before admission she began with progressive dyspnea. She was admitted to the Cardiovascular Care Unit with a global cardiac failure. An aortic prosthetic valve thrombosis was diagnosed clinically (absence of the prosthetic click) and by radioscopy (a decrease in the movement of the valve disk, with an incomplete shunt). It was attributed to a secondary failure of the anticoagulant treatment. Despite the treatment she quickly developed a cardiogenic shock. A treatment with 750,000 UI of streptokinase in 30 min was started, followed by 100,000 UI during 12 hours, with total reversion of the hemodynamic features, as judged by clinical examination (recurrence of the prosthetic click), radioscopy (recurrence of the valve movement) and by Doppler echocardiography (reduction of the transvalvular gradient). No complications were observed, and in a follow up of 12 months she persisted asymptomatic. The prosthetic valve thrombosis is an infrequent and almost fatal complication. The classical therapy consists in surgery which is a procedure with a high mortality in patients with severe cardiac failure, and an emergency procedure, as it occurred in our patient. Despite the known success of the thrombolytic therapy in the prosthetic valve thrombosis of the right heart (tricuspid position) it was only in the last years that this treatment was reported in aortic or mitral position. Peripheric embolies were found in 13% of the cases, always with transitory symptoms. There are only 45 cases described in the world, and more experience is needed for definitive conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Since October, 1978, 181 St Jude medical cardiac valves have been implanted in 166 patients throughout Australia. There were 152 single implants, 13 combined mitral and aortic valve implants, and one triple valve implant. Hospital mortality rates were similar to those for all types of prosthetic cardiac valves. Thromboembolic complications occurred less frequently in the patients with St Jude valves than in reports of similar patients with other prostheses, provided that anticoagulation was maintained.

The rehabilitation program for patients who underwent heart valve prosthetics must include restoration of the sinus rhythm. On the basis of the results of electric-pulse therapy and quinidine therapy in 88 patients, it is shown that the first method is more effective than the second, but in view of the sufficient efficacy and safety of quinidine therapy with the use of medium daily doses (not more than 2 g) it may be used in some of the patients. It is advisable to restore the sinus rhythm in periods of 3 months to 3 years after operation on the heart. Restoration of the sinus rhythm improves the general condition of patients after heart valve prosthetics, normalizes hemodynamics, increases the physical capacity for work considerably, and provides greater possibilities for the return of convalescents to their jobs.

Patients after surgery introducing aortal valve prosthesis in cases of rheumatic aortal defect or defect due to bacterial endocarditis were examined using spiro- and bicycle ergometry. Two groups of patients were compared: those subjected to rehabilitation procedures and a control group undergoing no rehabilitation program. Functional results were better in post-rehabilitation patients. By the end of the rehabilitation program, the examined spiroergometric parameters were significantly closer to those of normal subjects, as compared to the controls. Spiroergometric investigation in patients with newly applied aortal valve prostheses supplements clinical data in providing a more profound functional evaluation of surgical results and rehabilitation efficiency.

We have studied the long-term results of valve replacement operations in 591 patients, one year or more after surgery, and also analyzed rates of social return in 523 patients (response rate, 86.1 per cent) by questionnaire. Of the 591 patients, 81 patients suffered early death (mortality rate, 13.7 per cent) and 41 patients late death (mortality rate, 6.9 per cent). The causes of the latter were left atrial thrombus (18 cases), heart failure (10 cases), artificial valve failure (five cases), renal failure (two cases) and hepatic insufficiency, infection and accident (one case each). Second replacement was performed in 18 patients (3.0 per cent), 49 months on average from the first operation. The survival rate at the 12th postoperative year was 68.7 per cent. The overall rate of social return after valve replacement was 64.8 per cent, including 74.8 per cent for mitral valve replacement, 54.3 per cent for aortic and 51.5 for multivalvular. The rate of social return has been improved to 76.4 per cent in the last five years.

Valve replacement with an Angell-Shiley bioprosthesis was accomplished in 449 patients. To evaluate the bioprostheses from this total series, 344 patients who did not undergo associated operation, had no previous operations, or had no other valve substitutes were selected. Hospital mortality was 2.6% for aortic (4 out of 156), 7.2% for mitral (9 out of 125), and 12.7% for multiple-valve replacements (8 out of 63). The 323 patients discharged from the hospital were followed for 6 to 36 months. There were 15 late deaths. Hepatitis, bleeding, thromboembolism, endocarditis, and residual valvular incompetence, always periprosthetic, were the major complications. Forty-five patients with single-valve replacement (16 mitral and 29 aortic) without clinical valve dysfunction were electively recatheterized to assess hemodynamic performance. Measurements were recorded at rest and during exercise on a bicycle ergometer. Functional aortic valve orifice averaged 1.23 +/- 0.33 cm2 and the mean systolic gradient was 21.51 +/- 6.68 mm Hg at rest. During exercise, aortic gradient increased to 26.60 +/- 7.54 mm Hg and mean functional area to 1.51 +/- 0.34 cm2. In the mitral position, the mean diastolic gradient at rest was 8.44 +/- 3.17 mm Hg and the functional orifice area averaged 1.67 +/- 0.51 cm2. Exercise increased the mean gradient to 11.92 +/- 3.8 mm Hg and the mean orifice area to 2.05 +/- 0.57 cm2.

Based on the results of an ergometric stress testing performed in 22 patients with mitral replacement, the author concludes that this method is a highly reproductive and safe to evaluate the functional improvement of patients undergoing a mitral replacement. The results are similar for Bjork-Shiley (11 patients) and Starr-Edwards prothesis (11 patients), slurring that the only parameter that can affect functional results can be a controlled rehabilitation program.

Patients recovering after heart valve surgery are not in an optimum state of 'cardiorespiratory fitness'. To examine this proposition a controlled trial of physical training was undertaken in patients recovering from the replacement of a single heart valve. Patients were allocated to a test or control group two weeks after operation. Each patient performed a submaximal exercise test at entry, and twelve and twenty-four weeks after this test. The Canadian Air Force exercise programme was undertaken by the test group, while the control group continued normal activities for the twenty-four weeks between the first and last exercise test. A regression line of submaximal heart rate on oxygen consumption was calculated from the data of each exercise test in each patient. Alterations in this line were used as an 'index' of changes in 'cardiorespiratory fitness'. The individual results showed a consistent improvement in 'cardiorespiratory fitness' over the first 12 weeks in both groups. Only patients in the test group continued to improve between 12 and 24 weeks. Thus the exercise programme modified the recovery of 'cardiorespiratory fitness' after operation. A physical fitness rehabilitation programme may help these patients gain maximum benefit from correctiv surgery.

The article deals with the problem of coronary insufficiency in patients who underwent operation for aortal valve prosthetics. Dynamic follow-up of patients with prosthesis of the aortal valve for a period of 2 years after the operation showed that signs of coronary insufficiency persist in some of them. These signs restrict the functional possibilities of the patient during entire follow-up period, and coronary insufficiency in some patients is of a latent character. The bicycle ergometry test is a primary importance in detecting latent coronary insufficiency and in appraising the degree of the insufficiency. The more severe the coronary insufficiency, the lower is the tolerance to exercise. It proves possible to reduce the degree of coronary insufficiency and increase tolerance to exercise in most patients during rehabilitation.

One hundred and thirteen patients operated during the years 1971 to 1976, were re-examined at an average of 26.3 months after heart valve replacement. The functional capacity assessed by the NYHA-classification improved in about 40% of the patients. About 80% considered their symptoms and well-being to have improved after the operation. At the re-examination, heart size was most often enlarged in patients with mitral valve replacement. The average work load measured in bicycle ergometer test was higher in patients with aortic valve replacement compared to those with mitral valve replacement. Patients with aortic valve replacements were working more often (54%) than those with mitral valve replacements (37%). The mean age of patients who were working was significantly lower than in patients who were retired. There was a statistically significant relation between the physical working capacity and the working status. The employability assessed by history and clinical findings corresponded well to the actual work situation in individual patients.

A controlled trial was undertaken to examine the efficacy of physical training in patients recovering from the replacement of a single heart valve. Patients were allocated to a test or control group two weeks after operation. Each patient performed a submaximal exercise test at entry, and 12 and 24 weeks after this test. The Canadian Air Force exercise programme was undertaken by the test group, while the control group continued normal activities for the 24 weeks between the first and last exercise group. A regression line of submaximal heart rate on oxygen consumption was calculated from the data of each exercise test in each patient. Alterations in this line were used as an "index" of changes in "cardiorespiratory fitness". The individual results showed a consistent improvement in "cardiorespiratory fitness" over the first 12 weeks in both groups. Only patients in the test group continued to improve between 12 and 24 weeks. Thus the exercise programme modified the recovery of "cardiorespiratory fitness" after operation. Results in patients who developed clinical complications, and were excluded from the trial, predicted a deteriorating clinical condition. This finding suggested that sequential exercise tests are of value after cardiac surgery.

The purpose of this retrospective study was to assess the clinical performance of the Medtronic-Hall prosthesis based on a review of all valve related complications over a period of nine years. From January 1978 until December 1986, 502 prostheses were implanted in 450 patients. There were 200 aortic valve replacements, 198 mitral valve replacements and 52 double valve replacements. There were 234 associated procedures performed, the most frequent being coronary grafting in 129 patients and tricuspid annuloplasty in 35 patients. The mean age of the patients (230 men and 220 women) was 54.08 +/- 11.7 years. Preoperatively, 92.2% were in NYHA class III or IV. Early mortality was 7.1% and late mortality 16.7%. The follow-up totalled 1733 patient-years (mean 49.8 +/- 31.7 months). Over a period of nine years, the valve related complication rate was 4.4% per patient-year. Thromboembolic events occurred in 37 patients (2.1% per patient-year), anticoagulant related hemorrhage in 23 patients (1.3% per patient-year), endocarditis in 11 patients (0.6% per patient-year), perivalvular leak in six patients (0.3% per patient-year) and death and reoperation in 28 patients (1.6% per patient-year). At eight and one-half years, the survival rate was 71.28 +/- 2.7% for the whole group. The actuarial rate of patients free from all valve related complications was 75.92 +/- 2.7%, rate of freedom from thromboembolism was 86.01 +/- 2.4%, freedom from anticoagulant related hemorrhage was 92.7 +/- 1.6%, freedom from endocarditis was 97.17 +/- 0.8%, freedom from perivalvular leak was 98.27 +/- 0.7% and freedom from death and reoperation was 90.70 +/- 1.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

A follow-up study to assess the quality of life after cardiac surgery was begun in 1973. The results, for a total of 383 patients followed up for a maximum of 44 months after surgery, showed an overall improvement in all aspects of life for most patients.

To find out how well informed they were about their disease and operation, 104 patients who had undergone aortocoronary bypass surgery (group A) or heart valve replacement (group B) were asked to complete a questionnaire on discharge from the operating hospital and, after patient briefing during in-hospital rehabilitation, again 3 months after the operation. The level of anxiety and presence of depression were also assessed. We found the following percentages of wrongly or inadequately answered questions (the figures in brackets are from the second questionnaire 3 months after the operation): all questions 40 (27), anticoagulation 26 (15), prophylaxis of endocarditis 54 (29), risk factors 21 (21), nutrition 56 (38), exercise 47 (32), anatomy/physiology 35 (21), postoperative course 40 (24). The learning effect was significant (p less than 0.005) for all but the risk factor questions. There were no significant differences between men and women or between group A and group B. With a proportion of 14% (13%) anxiety was a common problem which had subsided by the end of rehabilitation. With percentiles of 3% (5%), depression was rare.

The value of prosthetic valve replacement is determined not only by the improvement in life expectancy but also by the quality of life. This statement resulted from an analysis of 168 patients undergoing isolated aortic -- or mitral -- valve replacement between 1970 and 1976. Besides numerous complications -- probably often avoidable such as side effects of incorrect anticoagulation -- long term results of 125 surviving patients were satisfactory over a period of 3-9 years after surgery. Though complete restitution was rare, subjective and objective improvement -- different and dependent on type and degree of valve disease -- was persisting and the effect on social and professional incorporation surprisingly positive.