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Biomedical subjects

J M Bernal

Publications and source records attributed to J M Bernal.

At least 37 records · Page 2Linked to original sources
PubMed1996

Tricuspid valve replacement in rheumatic disease: preoperative predictors of hospital mortality.

BACKGROUND AND AIM OF THE STUDY: The study analyzes the possible predictive power of different clinical and hemodynamic parameters with regard to hospital mortality after the first tricuspid valve replacement. METHODS: A retrospective study of 62 consecutive patients undergoing tricuspid valve replacement from 1974 to 1994 (7.2% of all tricuspid surgery performed at our institution in this period) was completed. Hospital mortality was 37%. Twenty-three patients died in hospital after the first tricuspid valve replacement (group I) and 39 patients (group II) survived this procedure. Tricuspid insufficiency was organic in 87% of group I and 84.6% of group II. RESULTS: The parameters showing significant differences between the two groups were NYHA class IV (p = 0.05), severe congestive heart failure (p = 0.02), mean right atrial pressure (p = 0.05), pulmonary arterial resistance (p = 0.006) and mean pulmonary arterial pressure (p = 0.0001). Cardiopulmonary bypass time (p = 0.005) and aortic cross-clamp time (p = 0.05) were longer in group I. Multiple regression analysis showed that the variables with greatest predictive power for hospital death were preoperative functional class, congestive heart failure and mean pulmonary artery pressure. The model gave a p < 0.001, with r = 0.58. CONCLUSIONS: The high hospital mortality rate after tricuspid valve replacement seems to be related to clinical functional class, severe congestive heart failure, and to chronic hemodynamic changes in the right atrium and pulmonary circulation.

Adult↗
PubMed1995

Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position.

The durability (structural deterioration-free interval) after valve implantation with the first-generation Carpentier-Edwards porcine bioprosthesis has been investigated. From 1978 through 1984, 420 patients (175 male, 245 female) underwent valve replacement with the Carpentier-Edwards standard bioprosthesis. Mean age was 50.6 years (range, 13 to 77 years). Isolated mitral valve replacement (MVR) was performed in 198 patients (47.1%), aortic valve replacement (AVR) in 136 (32.4%), and double valve replacement (DVR) in 86 (20.5%). Hospital mortality was 32 patients (7.6%), 7.5% for MVR, 5.1% for AVR, and 11.6% for DVR. Mean follow-up was 10.8 years (range, 9 to 15 years) and is 96.2% completed. Reoperation for structural deterioration was required in 143 patients. Actuarial curve free from structural deterioration at 15 years is 33.0% +/- 6.5% for MVR, 62.0% +/- 5.1% for AVR, and 44.2% +/- 8.2% for DVR (p < 0.03). Durability of the CE bioprosthesis for MVR was 101.6 +/- 34.5 months, 92.9 +/- 26.4 for AVR, and 84.3 +/- 25.3 for DVR (p = not significant). The regression logistic analysis between age at the time of surgery and durability of the bioprosthesis showed no correlation for the MVR group, but with the following predictive formula for AVR and DVR groups of patients older than 30 years" durability = 46.05 + 0.818 x age, for AVR (r2 = 0.43); durability = 15.81 + 1.122 x age, for DVR (r2 = 0.52). In conclusion, we have found a significant difference in the behavior of the CE porcine bioprosthesis between the mitral and aortic position.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1995

Suppurative mediastinitis after open-heart surgery: a case-control study covering a seven-year period in Santander, Spain.

Suppurative mediastinitis developed in 34 (0.9%) of 3,645 patients who underwent median sternotomy at the Hospital Marqués de Valdecilla in Santander, Spain, from 1985 through 1991. These cases were analyzed in a case-control study designed to identify risk factors for poststernotomy mediastinitis. The significant risk factors were (1) preoperative factors: heavy cigarette smoking and history of endocarditis; (2) intraoperative factors: emergency surgery, prolonged duration of surgery, prolonged bypass pump time, ventricular failure, and tearing of the aortic or femoral artery; and (3) postoperative factors: reoperation, prolonged mechanical ventilation, prolonged stay in the intensive-care unit, and tracheostomy. All patients had abnormal sternal wounds (i.e., signs of wound infection or serous discharge). Twelve patients were bacteremic. Thirty-eight organisms were recovered from 31 patients with mediastinitis; 23 of the isolates were gram-positive and 15 were gram-negative. The infections were treated with extensive debridement and appropriate antibiotics. Mortality was 35%. Chronic sternal osteomyelitis was documented in two cases.

Cardiac Surgical Procedures↗
PubMed1995

[The surgical technic in the orthotopic heart transplant].

Surgical technique of the orthotopic heart transplantation, described in 1961, almost has not been modified since then, due to its efficiency, simplicity, short-time consuming procedure with satisfactory clinical results. Several authors have recently pointed out on the presence of atrioventricular valves insufficiency produces by the distortion of the atrial anatomy and valve function with the standard surgical procedure. A radical technique has been proposed, consisting on a bicaval direct anastomosis after recipient total atrial resection. This operation reduces the supraventricular arrhythmias and the tricuspid and mitral valves incompetence, with hemodynamic and exercise tolerance improvement. Additional clinical studies are necessary to demonstrate the superiority of the radical technique over the standard procedure of heart transplantation.

Anastomosis, Surgical↗
PubMed1994

Partial homograft replacement of mitral valve.

To date, treatment of mitral valve disease with mitral homograft implantation has been unsatisfactory. We describe two cases of mitral valve repair in man with a cryopreserved partial mitral homograft. Massive mitral insufficiency was surgically corrected by replacement of the severely affected posterior leaflet and the subvalvular apparatus with their corresponding mitral-valve homograft tissue. 22 and 4 months after surgery, the repaired valves remain competent with flexible and normal functioning leaflets and subvalvular apparatus, and the patients are symptom-free.

Aged↗
PubMed1993

Open mitral commissurotomy: fourteen- to eighteen-year follow-up clinical study.

From May 1974 to December 1978, 159 patients with mitral stenosis underwent open mitral commissurotomy at our institution. Follow-up data were complete in 96.8%, with a mean follow-up of 13.7 years (range, 14 to 18 years). Preoperatively, most patients (n = 94) were in functional class III or IV. Valve calcification was found in 18 patients (11.3%), left atrial thrombosis was found in 21 (13.2%), and the subvalvular apparatus was affected in 105 (66%). When a residual insufficiency was detected during the operation, a mitral annuloplasty was performed (n = 43). There was one hospital death (0.6%) and 15 late deaths (9.5%). Actuarial survival at 15-year and 18-year follow-up is 89.4% +/- 3% and 75.2% +/- 10.8%. Fifteen patients (9.7%) had a thromboembolic episode 1 to 189 months after operation (mean, 104.3 months). Eleven patients (7%) required reoperation 3 to 183 months after operation (mean, 110.1 months). Freedom from reoperation at 18-year follow-up was 91.9% +/- 2.7%. Event-free actuarial survival at 15-year and 18-year follow-up was 73.4% +/- 4.2% and 54.3% +/- 10.5%. Most patients (n = 131) are in class I or II. Open mitral commissurotomy represents a safe surgical alternative for treating mitral stenosis, allowing a complete removal of atrial thrombosis if present. This long-term follow-up clinical study encourages us to persist in this successful surgical repair of mitral stenosis.

Actuarial Analysis↗
PubMed1993

Mitral valve repair in rheumatic disease. The flexible solution.

BACKGROUND: Mitral valve repair in rheumatic disease is technically more difficult, and there is little information on the long-term stability of this technique. METHODS AND RESULTS: From January 1975 to December 1990, 327 patients underwent mitral valve repair with the Duran flexible ring annuloplasty for rheumatic valve disease. Mean age was 45.4 +/- 12.6 years (range, 23 to 73 years). The techniques used for valve repair include a Duran flexible ring annuloplasty in all cases, commissurotomy in 272 (83.2%), papillary muscle splitting in 171 (52.3%), and subvalvular apparatus repair in 59 patients (18.0%). One hundred one patients required associated tricuspid valve surgery (30.8%). Hospital mortality was 3.36%, being lower for patients with isolated mitral valve repair (2.7%) than those with mitrotricuspid surgery (4.9%). Mean follow-up was 8.6 years (range, 1 to 17 years) and was 96.5% completed. Thirty-four patients required reoperation for severe mitral insufficiency in 12, mitral restenosis in 18, and aortic valve disease in 4. The actuarial curve free from reoperation for mitral cause at 16 years is 89.9 +/- 3.2%. Late mortality occurred in 42 patients (13.2%). Actuarial survival curve at 16 years is 84.0 +/- 3.2% for isolated mitral valve repair and 64.6 +/- 6.7% for mitrotricuspid patients. CONCLUSIONS: Mitral valve reconstruction with Duran flexible ring annuloplasty in rheumatic valve disease entails a low hospital mortality with satisfactory long-term clinical results.

Actuarial Analysis↗
PubMed1992

Early structural deterioration with the mitroflow pericardial xenograft in the mitral position.

Early structural deterioration with the mitral Mitroflow pericardial valve requiring reoperation occurred in 6 patients. Clinical diagnosis of prosthetic failure was made 5 to 58 months after valve implantation (mean, 38 months). Re-replacement was carried out 22 to 80 months (mean, 55 months) after the initial operation. Mode of failures were cuspal tear without calcification in three valves and massive calcifications in the remaining bioprostheses. High incidence of early structural deterioration of the Mitroflow pericardial valve makes this new prosthesis an unsatisfactory alternative as a substitute in the mitral position.

Adult↗
PubMed1992

Partial replacement of mitral valve by homograft. An experimental study.

Satisfactory long-term clinical results with heart valves have renewed the interest in the use of mitral homografts, despite the technical difficulties with their surgical implantation. This report describes the behavior and viability of the partial mitral homograft in the ortotopic position in a chronic sheep model (n = 25). The 20 surviving animals were studied hemodynamically and were anesthetized and electively put to death 3, 6, 9, and 12 months after the operation. All specimens had a normal mitral valve without signs of infection or thrombosis. Light, scanning, and transmission electron microscopy showed the presence of viable endothelial cells from the recipient covering the graft, signs of reendothelialization, and organized dense collagen tissue. The structural integrity was more evident in the fresh mitral homografts. This method may provide consider improvement in the viability of the mitral homograft, and it could be a valid alternative for repair of mitral valve localized pathology.

Animals↗
PubMed1991

Reoperation for bioprosthetic valve dysfunction. A decade of clinical experience.

During the 1970s, initial clinical experience with bioprostheses determined their worldwide use. However, bioprosthetic reoperation (BPR) is now common, particularly in groups with extensive implantation of these valve substitutes. From January 1980 to December 1989, a total of 470 patients had a total of 618 reoperations for bioprosthetic dysfunction and were retrospectively analyzed. Eighty-seven patients required a second BPR, 21 a third BPR, 5 a fourth BPR and 1 patient a fifth BPR. Structural deterioration was the main cause of valve dysfunction for the first and second BPR. However, paravalvular leak and infective endocarditis were more frequent for the remaining additional reoperations. Hospital mortality was 12.6%, 14.9% and 37% after the first, second and third or subsequent BPR, respectively. Univariate statistical analysis shows as hospital mortality risk factors: age at the time of the surgery, preoperative NYHA functional class IV, emergency surgery, concomitant tricuspid surgery, double (mitro-aortic) valve dysfunction, active infective endocarditis as the cause of failure and prolonged aortic cross-clamping time. Hospital mortality declined from 19.8% to 11.8% for the first and second half decade, respectively (P less than 0.005). In conclusion, bioprosthetic valve reoperation entailed a higher hospital mortality, particularly in the risk group of patients. In our hands, surgical experience has determined the improvement of the clinical results in this group of patients.

Adult↗
PubMed1991

Valve-related complications with the Hancock I porcine bioprosthesis. A twelve- to fourteen-year follow-up study.

Valve-related morbidity and mortality after heart valve replacement with the Hancock I porcine bioprosthesis has been retrospectively analyzed. From June 1974 through December 1976, 253 Hancock I bioprostheses (150 mitral and 103 aortic) were inserted in 220 selected patients who survived the operation and had follow-up until June 1989 (mean follow-up 13.5 years, with an accumulative follow-up of 2956.4 patient-years). One hundred seventeen patients had mitral valve replacement, 70 had aortic valve replacement, and 33 had combined mitral and aortic valve replacement. There were 27 thromboembolic events. The probability of being free from thromboembolism at 14 years was 81.0% +/- 7.4% for the mitral valve replacement group, 85.4% +/- 6.7% for the aortic group, and 67.1% +/- 18.4% for the mitral-aortic group. Fifteen episodes of prosthetic valve endocarditis occurred. There were 10 instances of nonstructural dysfunction (paravalvular leaks) in seven mitral valves (4.6%) and in three aortic valves (2.9%). One hundred twenty-two bioprostheses in 106 patients resulted in structural deterioration. The probability of freedom from structural deterioration at 14 years was 37.2% +/- 3.9% for the mitral group, 43.9% +/- 7.1% for the aortic group, and 30.1% +/- 8.9% for the mitral-aortic group. The logistic regression analysis between age at the time of operation and bioprosthetic life (structural deterioration-free period) demonstrates a linear regression curve (r = 0.53). There were 56 late deaths (27 patients died at reoperation). The actuarial survival rate (including hospital mortality) at 14 years was 57.2% +/- 5.4% for the entire series, with no statistically significant difference between groups. The probability of remaining free from valve-related morbidity and mortality at 14 years was 16.7% +/- 4.8% for the mitral group, 20.8% +/- 6.2% for the aortic group, and 14.0% +/- 7.0% for the mitral-aortic group. The long-term results of this series show that the clinical performance of the Hancock I porcine valve appears satisfactory during the first 6 years. The behavior of this bioprosthesis at 14 years' follow-up changes drastically, because only a minor group of patients is free from valve-related complications, justifying the restriction of its use for selected patients.

Adult↗
PubMed1990

[Factors affecting early graft patency after coronary grafts].

From June 1984 to December 1987, an early postoperative angiographic study was performed in 247 patients who underwent isolated coronary artery bypass surgery. The average age of these patients was 58.6 years, range 31 to 75 years. Preoperatively 50.8% of patients had myocardial infarction and 43.2% of them had unstable angina before surgery. Early coronary artery bypass angiogram was performed in 683 grafts (2.76 grafts per patient): 74 internal mammary artery grafts and 609 saphenous vein grafts. The distribution, location and type of the stenosis, distal coronary artery diameter, segmental myocardial contractility, and distal angiographic coronary filling are analyzed with a matching statistical method. Multivariate analysis showed significant predictors of early graft occlusion to be right coronary and circumflex artery, poor or non visible distal angiographic filling, coronary arteries smaller than 1.5 mm. The univariate analysis associates as risk factors hypokinetic or akinetic territories and multiple stenosis coronary arteries. It can be concluded that the early angiographic study demonstrate that coronary arteries with multiple stenosis, poor distal angiographic filling, smaller than 1.5 mm in diameter, coronary arteries perfusing hypokinetic or akinetic territories and the right coronary and left circumflex artery grafts have significantly lower early cumulative patency rates.

Adult↗
PubMed1989

[The Ionescu-Shiley bioprosthesis in the aortic position. Medium to long-term evaluation].

From August 1977 through October 1984, 241 patients underwent aortic valve replacement with the Ionescu-Shiley prosthesis. The average age was 50.8 years (range 15 to 78). Aortic valve replacement was performed alone in 121 patients (50.2%) and with associated surgery in 120 (49.8%). Cumulative duration of follow-up was 1,260.08 patient-years, with a mean follow-up of 5.32 years per patient. Five patients were lost to follow-up. There were 26 hospital deaths and 15 late deaths (1.19% per patient-year). The expected 10.5 year actuarial survival rate was 82 +/- 2.9%. Twelve thromboembolic episodes occurred in 7 patients (7 central and 5 peripheral). The linearized thromboembolic rate was 0.95% per patient-year: 0.32% for patients with isolated aortic valve replacement and 0.63% for patients with concomitant surgery. Freedom from thromboembolic events at 10.5 years was 78 +/- 12%. Structural valve failure was found in 24 patients (1.9% per patient-year) with an actuarial rate of freedom for primary tissue failure of 72.6 +/- 6.1% at 10.5 years. Reoperation was required in 39 cases (3.09% per patient-year) due to primary tissue failure (n:24), paravalvular leak (n:7), infective endocarditis (n:6) and valve thrombosis (n:2). In conclusion, this pericardial bioprosthesis has demonstrated an adequate performance at mid and long-term follow-up, but somehow less satisfactory than previously reported.

Adolescent↗
PubMed1989

[The Mitroflow bioprosthesis. Results after 6 years].

From March 1982 through December 1986, 139 Mitroflow pericardial heart valves were utilized in 129 patients. There were 69 males and 60 females, with an average age of 55.2 years (range 26 to 74 years). Eighty-nine patients underwent isolated aortic valve replacement, 27 isolated mitral valve replacement, three isolated tricuspid valve replacement and ten mitral-aortic valve replacement. In 20.9% additional cardiac surgery was performed. Maximum follow-up was 6 years with a mean of 43.9 months. The cumulative follow-up was 491 patients/year. Overall hospital mortality was 1.6% (2 cases). There were 3 late deaths in this series (2.4%). The linearized incidence of late mortality was 0.49% per patient/year. The survival actuarial curve was 96% +/- 1.8. The incidence of thromboembolism was 1.22% per patient/year, and the actuarial thromboembolism-free rate was 93% +/- 2.7. Three patients developed primary tissue failure of the Mitroflow valve in the mitral position. The linearized incidence of primary tissue failure was 0.73% per patient-year and the actuarial freedom from primary tissue failure was 95% +/- 3.2%. A total of 4 patients underwent reoperation (0.49% per patient/year). In conclusion, the clinical performance of the Mitroflow pericardial heart valve at medium-term follow-up is satisfactory; however a significant number of early primary tissue failures have already occurred in the mitral position.

Adult↗
PubMed1988

Mitroflow heart valve: 5.5 years clinical experience.

From March 1982 through December 1986, 139 Mitroflow pericardial heart valves were utilized in 129 patients. There were 69 males and 60 females, with an average age of 55.2, range 26 to 74 years. Eighty-nine patients underwent isolated aortic valve replacements, 27 isolated mitral valve replacements, 3 isolated tricuspid valve replacements, 10 mitro-aortic valve replacements. In 27 cases (20.9%) additional cardiac surgery was performed. Maximum follow-up was 5.5 years with a mean of 37.9 months. The cumulative follow-up was 407.25 patient-years. Overall hospital mortality was 1.6% (2 cases). There were 3 late deaths in this series (2.4%). The linearized incidence of late mortality was 0.49% per patient-year. The survival actuarial curve was 96% +/- 1.8. The incidence of thromboembolism was 1.22% per patient-year, and the actuarial thromboembolism-free rates was 93% +/- 2.7. Prosthetic endocarditis occurred in one patient. Three patients developed primary tissue failure of the Mitroflow valve in the mitral position. The linearized incidence of primary tissue failure was 0.73% per patient-year and the actuarial freedom from primary tissue failure was 95% +/- 3.2. A total of 4 patients underwent reoperation (0.49% per patient-year). In conclusion, the clinical performance of the Mitroflow pericardial heart valve at medium-term follow-up is satisfactory, however a significant number of early mitral primary tissue failures have already occurred.

Adult↗