EMERGENCY REOPERATION FOLLOWING OPEN-HEART SURGERY.
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Biomedical subjects
Publications and source records attributed to E DONG.
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Four hundred and fifty consecutive open heart operations on 437 patients, using cardiopulmonary by-pass, were done at the Stanford Medical Center from January 8, 1960, to July 15, 1964. The in-hospital mortality was 6.4 per cent. Of the patients who survived, 18.4 per cent had a major complication. In 57 per cent of the cases the lesions were congenital, in 42 per cent acquired, and in 1 per cent both congenital and acquired.The correction of nearly all intracardiac and serious vascular defects is now possible with the use of extracorporeal circulation. The mortality and morbidity rates are low enough so that every person with a cardiovascular defect should be seriously considered for surgical correction.
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Probably the most important continuing advance in the treatment of congenital heart disease is the ever-diminishing risk of operations on the open heart. The uncomplicated septal defect or valvular stenosis is now corrected under direct vision with essentially the same risk as that which attends the routine operation for patent ductus arteriosus. Perfusion systems, and corrective heart operations, are now available for any patient who weighs 10 kilograms or more; palliative operations are often prescribed for critically ill patients weighing less than 10 kilograms. With respect to the future, successful removal and replantation of the heart in dogs opens the door for imaginative approaches to many states now considered inoperable. Still more inspiring is the realization that cardiac homotransplantation is surgically feasible and immunologically possible, if specific transplantation antigens can be isolated.
In one hundred consecutive cases in which operations were done on the heart with the surgical field exposed to view and circulation was shunted to extracorporeal apparatus, there were six deaths. None were attributable to the by-pass procedure. The lesions were of various kinds, congenital and acquired. In one case a fibromyxosarcoma that was obstructing the right ventricular outflow tract and invading the main pulmonary artery was successfully excised.
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