Bravo stentless procine bioprostehsis model 400 aortic valve

Poster Presentations categorized according to Parsonnet's score into five groups (I-V) in respect to severity of disease and operative risk (I the lowest risk, V the highest risk). 63.8% of patients were in groups I and II and 36.2% of patients in groups III-V. The surgical procedures included: coronary surgery, valvular reconstructive procedures or replacement, combined surgery and correction of congenital heart defects. In more than 37% of coronary patients endarterectomy was performed due to of diffuse and distal coronary disease. This surgical procedure was not included among the risk factors. Observed mortality was significantly lower (P < 0.05) than expected in groups II, llI and IV. Conclusion: Our results concerning predicted and observed mortality in open heart surgery indicate that the mortality risk was significantly lower than predicted even in high risk groups. This suggests the possibility of further extension of the indications for surgical treatment.

test (> 85% T.M.F.) was negative in all patients after one month. Nuclear stress scintigraphy was assessed after 1 year in 69 patients. This was negative in 66 patients and uncertain in 3 patients. Postoperative angiography was performed in 18 patients (postoperative interval: 6 months to 14 months): gastro-epiploic artery grafts were patent in 15 patients, not anterogradly functional in two patients and non opacified in one patient. In situ RGEA is a satisfactory second or third choice coronary arterial conduit even in old patients.

P15 Bravo Stendess Procine Bioprostehsis Model 400 Aortic Valve A. SALA, G.L. POL VANI, M. PORQUEDDU, G. POMPILIO, S. MUSUMECI, M. MURA TON, J. RODRIGUEZ and P. BIGLIOLI, Milan, Italy

P14 C o r o n a r y Artery Bypass Grafting with the In Situ Right Gastro-Epiploic Artery P.M. ROUX, S. ZACCARIA, N. SAAD, K. BAGHDADI, N. AMMANE, S. RESTELLI, P. DAGRENAT, V. DACLIN, K. KHALIFE, M. BOURSIER and J. P. RIANALDI, Bon Secours, Metz, France Between May 1992 and June 1994, 322 patients benefited from multiple arterial conduit grafting and 148 of these had coronary revascularization using the right gastro-epiploic artery (RGEA) as an in situ graft. The mean age was 57.8 years, ranging from 35 to 76 years. Twenty-two patients were over 70 years old. Eighty-five patients had a previous history of myocardial infarction and fifty two had unstable angina. Mean left ventricular ejection fraction was 57% (_ 6) with 23% as the minimum value. Only three patients had previous cardiac surgery. The mean number of total distal anastomoses per patient was 4,34 (+ 0.4) and 3.9 (_+ 0.2) for arterial grafting. The right gastro-epiploic artery was used as an in situ graft to the right coronary artery branches for 120 patients, to circumflex branches in 11 patients and to the left anterior descending artery in three patients (Redo). Sequential gastroepiploic artery grafting was used for 13 other patients. The different arterial conduits used were as follows: RGEA+ 1 I.M.A. RGEA+2I.M.A. RGEA + Radial Art. RGEA+ I.M.A. + Epig.

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(31.7%) (63.5%) (0.6 %) (4%)

One hundred and thirty-two patients did not need any inotropic support; five patients had intra-aortic balloon pumping because of emergency surgery. Postoperative myocardial enzyme levels increased in 10 patients (6.6 %) but a Q wave was observed in only one patient, and this was not in the gastroepiploic artery area. Hospital mortality was 3.3% (two emergency cases, one sepsis, one mediastinitis, one sudden death). The mean follow-up was 14.5 months. Maximal stress

CARDIOVASCULAR SURGERY SEPTEMBER 1995

Between February 1992 and January 1994 we implanted the Bravo 400 porcine valve in 40 patients (23: male, 17 female; mean age 69 - 7 years) at the Centro Cardiologico, I. Monzino Foundation, University of Milan. The valvular pathology was aortic stenosis in 21 patients (52.5%), in aortic regurgitation in eight patients (20%), aortic stenosis and regurgitation in nine patients (22.5%) and annuloaortic ectasia in two patients (5%). The annulus mean diameter of the implanted xenograft was 24.5 mm (range 21-27 mm.). In relation to the surgical techniques, the patients can be divided in three groups: group I-"Free Hand", 14 patients; group II-inclusion technique, 24 patients; group IIl-total aortic root replacement, two patients. In group I there were three subsets of patients: la nine patients with left and right xenograft coronary sinus scalloped and an intact xenograft non coronary sinus (partially scalloped), Ib four patients with left and right xenograft coronary sinus scalloped and an intact xenograft non coronary sinus plus a native aorta enlargement (flange technique), and Ic one patient with three xenograft coronary sinus scalloped (totally scalloped). In all groups of patients no significant aortic regurgitation was detected on post-operative echocardiography. The mean post-operative trans-prosthesic mean gradient was 28.5 + 3 mmHg and no significant difference was revealed in mean trans-prosthesic gradients among the subsets of patients Ia, Ib and Ic; the mean indicized valvular area of all bioprostheses as calculated by continuity equation was 1.48 cm2/m 2. A mean follow-up of 12 months (range 2-23) shows good hemodynamic features of the bioprostheses, no significant regurgitation and further slight reduction of the mean tranprosthesic gradients (21 _+ 6 mmHg). No mortality and no valve-related complications (sudden death, thromboembolic events, endocarditis) were detected No patients required anticoagulant therapy. Post-operative NYHA class was I in 35 (87.5%) patients I and lI in 5 (12.5%) patients. The early performance of the Bravo stentless porcine bioprosthesis aortic valve model 400 is significantly superior to stented porcine bioprostheses and closely resembles the homografts; it represents a good alternative for aortic valve replacement in patients older than 60 years and in patients with severe aortic valve calcification.

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