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Biomedical subjects

R H Blank

Publications and source records attributed to R H Blank.

35 records · Page 2Linked to original sources
PubMed1976

Local deep hypothermia for combined valvular and coronary heart disease.

Local deep hypothermia was utilized as the sole method of myocardial protection in 113 consecutive aortic valve replacements. Thirty-six patients had simultaneous revascularization, mitral valve replacement, tricuspid valve replacement, or a combination of these. In follow-up for as long as 36 months there have been 3 hospital deaths (2.6%), all occurring in the group having isolated aortic valve replacement. No hospital deaths occurred among patients undergoing a combined procedure.

Adolescent↗
PubMed1976

Method of managing the small aortic annulus during valve replacement.

In a series of 130 patients undergoing aortic valve replacement, 20 had the ascending aorta enlarged with a Dacron patch. Eight of these required division of the annulus with extension of the incision inferiorly to the anterior leaflet of the mitral valve. The resulting separation of the annulus allowed a larger size valve to be inserted. Glutaraldehyde-fixed procine heterografts were used in all patients having the annulus enlarged. No deaths occurred in those patients having annular enlargement, and the post-operative studies show no evidence of mitral valve dysfunction.

Adolescent↗
PubMed1975

Fifty-two consecutive aortic valve replacements employing local deep hypothermia.

From August, 1972, to May, 1974, 52 consecutive aortic valves were replaced with the Björk-Shiley tilting-disc prosthesis. The hospital mortality was zero. Patients ranged in age from 14 to 77 years, and 19 patients had simultaneous correction of associated cardiac lesions. Using techniques of low flow and local deep hypothermia, aortic valve replacement can be accomplished with little risk even in patients with associated coronary arteriosclerosis. Coronary artery perfusion is unnecessary and often hazardous. Follow-up periods vary from one to twenty-one months. Forty-nine patients are alive and substantially improved.

Adolescent↗
PubMed1975

Resection of the ascending aorta using profound local hypothermia for myocardial protection.

Resection of the ascending aorta with or without aortic valve replacement requires prolonged interruption of myocardial blood flow. Profound local cardiac hypothermia was used in 8 patients, 5 of whom had simultaneous aortic valve replacement. Three patients with acute dissections were encountered, one with cardiac tamponade secondary to intrapericardial rupture. The duration of aortic cross-clamp time varied from 43 to 122 minutes. There were no complications related to the cooling technique. There were no operative or hospital deaths. One patient died of myocardial infarction at 6 weeks. These results coupled with the experience of others suggest that coronary perfusion during periods of obligatory anoxia in unnecessary. Local cardiac hypothermia offers a satisfactory alternative for myocardial protection during prolonged aortic crossclamping.

Adult↗
PubMedDate not supplied

Valve replacement in the elderly: a long term appraisal.

From July 1972 through July 1983, 360 consecutive patients 70 years of age and older (mean age 74.1; range 70-88 years) underwent 362 valve replacement procedures. There were 122 isolated aortic valve replacements (33.7%; Group I); 70 isolated mitral valve replacements (19.3%; Group II); and 170 patients had combined procedures (47.0%; Group III), which included the replacement of at least one valve. Eighteen patients (5.0%) had previous cardiac surgery. Thirty-two patients (8.8%) were operated as emergencies. Three hundred and thirty-two (86.5%) of all valves implanted were porcine heterografts. Pre-operatively, over one-half (53.6%) of the patients were in New York Heart Association Functional Class IV. The overall hospital mortality was 13.8% (50 patients). The aortic valve mortality was 11.5%, the mitral valve mortality was 15.7%, and the combined procedures 14.7%. The follow-up period for hospital survivors (312 patients) extended from 2 weeks to 127.2 months, with a mean of 38.7 months or a total of 1,006 patient-years. The long term survival computed up to six years shows a 65 +/- 3.8% (standard error of the mean) for the entire group. The aortic valve group survival was 71 +/- 5.6%; the mitral valve group 60 +/- 8.2%; and the combined procedures group was 64 +/- 5.3%. Postoperative functional improvement was significant with 71.8% of the survivors in Class I and 19.6% in Class II. Based on these results, advanced age can no longer be considered a deterrant to cardiac surgery. The porcine heterograft appears to be the valve substitute of choice for this age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗