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PubMed1992

Cardiovascular cyclic nucleotide phosphodiesterases and their role in regulating cardiovascular function.

We have described five phosphodiesterase (PDE) isozymes that can be found in cardiac and vascular smooth muscle of animals and humans. Much of the evidence for the role that these isozymes have in the regulation of cellular processes has been generated through, or awaits, the identification of selective and potent PDE inhibitors. While selective inhibitors of the cGMP-inhibitable (cGi)-PDE isozyme have been approved for use in the acute treatment of heart failure, selective inhibitors of the cGMP-PDE have not been extensively explored as potential candidates for the treatment of cardiovascular diseases. More potent selective inhibitors of the cGMP-PDE isozyme are needed to determine whether these pharmacological potentiators of EDRF and ANP will be useful in the therapy of angina, hypertension or heart failure.

1-Methyl-3-isobutylxanthine↗
PubMed1992

Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Cardiovascular Health Study Collaborative Research Group.

Electrocardiographic abnormalities are often found in older patients, but their prevalence in free-living elderly populations is not well-defined. In addition, the clinical significance of many of these abnormalities is uncertain. The prevalence of major electrocardiographic abnormalities was determined in 5,150 adults aged greater than or equal to 65 years from the Cardiovascular Health Study--a study of risk factors for stroke and coronary heart disease in the elderly. Ventricular conduction defects, major Q/QS waves, left ventricular hypertrophy, isolated major ST-T-wave abnormalities, atrial fibrillation and first-degree atrioventricular block were collectively categorized as major electrocardiographic abnormalities. Prevalence of any major electrocardiographic abnormality was 29% in the entire cohort, 19% among 2,413 participants who reported no history of coronary artery disease or systemic hypertension, and 37% among 2,737 participants with a history of coronary artery disease or hypertension. Prevalence of major electrocardiographic abnormalities was higher in men than in women regardless of history, and tended to increase with age. Major Q/QS waves were found in 5.2%, and more than half were in those who did not report a previous myocardial infarction. Major electrocardiographic abnormalities are common in elderly men and women irrespective of the history of heart disease.

Age Factors↗
PubMed2005

beta(2)-Adrenergic receptor polymorphisms and determinants of cardiovascular risk: the Cardiovascular Health Study.

BACKGROUND: Common Arg16Gly and Gln27Glu polymorphisms of the beta(2)-adrenergic receptor (beta(2)AR) have been associated with hypertension and coronary disease. This analysis of older adults in the Cardiovascular Health Study examined whether these polymorphisms were associated with blood pressure (BP), subclinical atherosclerosis, and, among treated hypertensive individuals, differences in coronary disease risk according to antihypertensive drug class. METHODS: Altogether, 5249 participants (4441 white and 808 African American, median follow-up time 10.2 years) were genotyped for both polymorphisms. Ankle-arm index (AAI), carotid intima-media thickness (IMT), and brachial flow-mediated dilation were measured cross-sectionally. All estimates were adjusted for ethnicity. RESULTS: Relative to Gln27 homozygotes, carrying the Glu27 allele was not associated with new-onset hypertension (hazard ratio [HR] = 1.01, 95% confidence interval [CI] = 0.87 to 1.16), BP control (odds ratio [OR] = 0.97, 95% CI = 0.89 to 1.06), AAI (mean difference 0.0042 +/- 0.0052), carotid IMT (mean difference 0.0044 +/- 0.02 mm), or brachial flow-mediated dilation (mean difference in baseline diameter -0.028 +/- 0.036 mm; the most marked of three measures). Among treated hypertensive individuals, coronary disease risk was similar in Glu27 carriers relative to Gln27 homozygotes in subgroups defined by use of beta-blockers (HR = 1.09, 95% CI = 0.64 to 1.87) or other antihypertensive medications (HR = 1.00, 95% CI = 0.78 to 1.28). Results were similar for the Arg16Gly polymorphism. CONCLUSIONS: The association of beta(2)AR genotype with coronary disease previously reported in this older adult population is not likely to be explained by BP levels, subclinical atherosclerosis, or antihypertensive treatment. Other measures of vascular response, gene-gene or gene-environment interactions, or characteristics developing earlier in life may mediate the association between beta(2)AR genotype and coronary disease and merit further research.

Black or African American↗
PubMed2006

G-protein beta3 subunit (GNB3) gene polymorphisms and cardiovascular disease: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study.

A common 825C>T polymorphism in exon 10 of the gene for the beta-3 subunit of heterotrimeric G-proteins, GNB3, has been associated in some studies with traits of the metabolic syndrome as well as coronary artery disease (CAD), but these associations were refuted by other studies. To investigate the role of GNB3 gene variations in CAD and myocardial infarction (MI), we determined five GNB3 polymorphisms (-1429G>A, IVS5 +41G>A, 657T>A, 814G>A and 825C>T) in the Ludwigshafen Risk and Cardiovascular Health (LURIC) cohort, including 2575 patients with angiographically documented CAD and 731 individuals in whom CAD had been ruled out by angiography. None of the GNB3 polymorphisms was associated with CAD, MI, diabetes, hypertension, blood pressure, body weight or body mass index. We conclude that a major contribution of GNB3 gene variants to CAD or MI risk is unlikely.

Aged↗
PubMed2006

In vitro fabrication of a tissue engineered human cardiovascular patch for future use in cardiovascular surgery.

BACKGROUND: One approach to tissue engineering has been the development of in vitro conditions for the fabrication of functional cardiovascular structures intended for implantation. In this experiment, we developed a pulsatile flow system that provides biochemical and biomechanical signals in order to regulate autologous, human patch-tissue development in vitro. METHODS: We constructed a biodegradable patch scaffold from porous poly-4-hydroxy-butyrate (P4HB; pore size 80 to 150 microm). The scaffold was seeded with pediatric aortic cells. The cell-seeded patch constructs were placed in a self-developed bioreactor for 7 days to observe potential tissue formation under dynamic cell culture conditions. As a control, cell-seeded scaffolds were not conditioned in the bioreactor system. After maturation in vitro, the analysis of the tissue engineered constructs included biochemical, biomechanical, morphologic, and immunohistochemical examination. RESULTS: Macroscopically, all tissue engineered constructs were covered by cells. After conditioning in the bioreactor, the cells were mostly viable, had grown into the pores, and had formed tissue on the patch construct. Electron microscopy showed confluent smooth surfaces. Additionally, we demonstrated the capacity to generate collagen and elastin under in vitro pulsatile flow conditions in biochemical examination. Biomechanical testing showed mechanical properties of the tissue engineered human patch tissue without any statistical differences in strength or resistance to stretch between the static controls and the conditioned patches. Immunohistochemical examination stained positive for alpha smooth muscle actin, collagen type I, and fibronectin. There was minor tissue formation in the nonconditioned control samples. CONCLUSIONS: Porous P4HB may be used to fabricate a biodegradable patch scaffold. Human vascular cells attached themselves to the polymeric scaffold, and extracellular matrix formation was induced under controlled biomechanical and biodynamic stimuli in a self-developed pulsatile bioreactor system.

Absorbable Implants↗
PubMed2004

The cholesteryl ester transfer protein (CETP) TaqIB polymorphism in the cholesterol and recurrent events study: no interaction with the response to pravastatin therapy and no effects on cardiovascular outcome: a prospective analysis of the CETP TaqIB polymorphism on cardiovascular outcome and interaction with cholesterol-lowering therapy.

OBJECTIVES: On the basis of quantitative coronary angiography data, the cholesteryl ester transfer protein (CETP) TaqIB gene polymorphism has been postulated to predict the progression of coronary atherosclerosis and response to cholesterol-lowering therapy. BACKGROUND: Cholesteryl ester transfer protein mediates the exchange of lipids between anti-atherogenic high-density lipoprotein (HDL) and atherogenic apolipoprotein B containing lipoproteins and therefore plays a key role in human lipid metabolism. Hence, CETP gene polymorphisms may alter susceptibility to atherosclerosis. METHODS: To investigate the significance of the CETP TaqIB gene polymorphism with respect to clinical end points, we used the Cholesterol And Recurrent Events (CARE) cohort. The CARE study was designed to investigate the effect of five years of pravastatin therapy on coronary events. RESULTS: We found that the odds ratios for the primary end point were not significantly different from unity for the three genetic subgroups after five years of placebo treatment. Furthermore, pravastatin induced similar changes in total cholesterol, low-density lipoprotein cholesterol, and HDL cholesterol among TaqIB genotypes, and both nonfatal myocardial infarction and deaths from coronary heart disease were reduced to the same extent in all three genotypes. CONCLUSIONS: In the CARE cohort, the CETP TaqIB polymorphism does not predict cardiovascular events or discriminate between those who will or will not benefit from pravastatin treatment.

Adult↗
PubMed1975

Applications of diagnostic ultrasound and radionuclides to cardiovascular diagnosis. Part I. Acquired cardiovascular disease in the adult.

Noninvasive methods have become an important part of the diagnostic process for evaluation of cardiovascular anatomy and function in adults and in the young. Because there is a multiplicity of noninvasive methods presently available, in some cases with overlapping capabilities, there has been some confusion as to which constitutes the method of choice in a given clinical circumstance. The reviews that follow outline some of the practical strengths and limitations of two methods (echocardiography and radionuclide cardiography), hopefully thereby providing some rationale for choosing the more appropriate technique in the approach to specific clinical problems. We have found that the information available from radionuclide and from ultrasound studies frequently is complementary and that the most optimal diagnostic results often are obtained when they are combined. Since advances in technique and improvements in instrumentation are occurring continually in both of these areas, we have tried to provide only an overview. Further investigations and clinical experience will help to define the specificity, sensitivity, and capabilities of these methods in terms of present and future applications.

Aortic Valve Insufficiency↗
PubMed1997

Sulfonylurea derivatives in cardiovascular research and in cardiovascular patients.

Sulfonylurea derivatives are hypoglycemic drugs frequently used in the treatment of non-insulin-dependent diabetes mellitus (NIDDM). In the beta-cell sulfonylureas act by blocking ATP-sensitive potassium channels (K.ATP channels). In several organ systems, including the cardiovascular system, sulfonylurea receptors and functional K.ATP channels have been identified. In the heart their role is not clear: an endogenous cardioprotective effect has been suggested. There is no doubt that K.ATP channels are effectively blocked by sulfonylureas. In the last decade sulfonylureas have been widely used as a pharmacological tool in experimental (cardiac) research. Blockade of K.ATP channels is the proposed cellular mechanism of action for all sulfonylurea-related effects. However, other membrane currents are affected as well. In addition, myocardial metabolism is modified by sulfonylurea pretreatment. Hence, it should seriously be questioned whether these drugs are suitable in assessing involvement of cardiac K.ATP channels in, for example, ischemia-related events. The detrimental effects of sulfonylureas in experimental studies on myocardial ischemia have led to speculation whether the widespread use of these drugs in patients with NIDDM, most often suffering from accompanying ischemic heart disease, should be reconsidered. However, a review of the clinical literature reveals that the most consistent finding is a lower incidence of ventricular arrhythmias associated with the use of glibenclamide, while no excess mortality has been shown for this agent in NIDDM with ischemic heart disease. Despite some direct effects on systemic and coronary vasculature, there are, at present, no firm clinical data on the basis of which sulfonylurea derivatives should be withheld from the cardiac patient.

Animals↗
PubMed1998

Improving care for acute myocardial infarction: experience from the Cooperative Cardiovascular Project. The Cooperative Cardiovascular Project Best Practices Working Group.

BACKGROUND: The Cooperative Cardiovascular Project (CCP) was initiated by the Health Care Financing Administration to improve the quality of care for Medicare beneficiaries admitted to the hospital with acute myocardial infarction (AMI). Four peer review organizations formed the CCP Best Practices Working Group (Working Group) to identify effective intervention strategies that enable a hospital staff to improve AMI care. METHODS: The peer review organization in each state was asked to identify six hospitals with exemplary quality improvement (QI) plans for AMI care; 33 states responded. Data about the hospitals' baseline performance on the CCP quality indicators and components of the QI plans were collected from each hospital. Thirty-six of 40 randomly selected hospitals from this group were interviewed. RESULTS: The Working Group identified 191 hospitals in 33 states with exemplary QI plans. Administration of thrombolytic therapy and aspirin were the quality indicators most commonly addressed. Staff education, development or revision of clinical pathways and standing orders, and ongoing data collection were the most common QI plan components. The need to develop interdisciplinary teams and to identify a strong physician champion for the QI efforts were the most common recommendations for other hospitals considering implementation of the CCP. CONCLUSIONS: The CCP stimulated interest in QI activities for AMI care in the institutions identified for the Working Group. The characteristics of the hospitals' improvement plans were consistent with those identified by contemporary leaders of clinical QI as central to improving care. These plans focused on changes in clinical processes, deployment of interdisciplinary teams, identification of project champions, and ongoing data collection to assess and improve quality of care.

Alabama↗
PubMed1998

The Northern New England Cardiovascular Disease Study Group: a regional collaborative effort for continuous quality improvement in cardiovascular disease.

BACKGROUND: The Northern New England Cardiovascular Disease Study Group, a voluntary regional consortium, includes all cardiothoracic surgeons and interventional cardiologists, as well as nurses, anesthesiologists, perfusionists, administrators, and scientists associated with the six medical centers in Maine, New Hampshire, and Vermont and one Massachusetts-based medical center that support coronary artery bypass graft (CABG) surgery and percutaneous coronary interventions (PCI). Since 1987 the group has met at least three times a year to foster improvements in patient care. PROGRESS IN THE STUDY OF CABG SURGERY: The group's activities have included continued monitoring of outcomes, training in continuous quality improvement, and a benchmarking effort that allowed institutions to learn from one another. In the postintervention period (mid-1991 through early 1992) there were 293 fewer deaths (n = 575) than the 868 expected. In 1995 a new cycle of quality improvement work aimed at identifying the causes and correlates of postoperative mortality began. Study groups for each institution were organized to examine issues related to death from low-output states. PROGRESS IN THE STUDY OF PCIS: Major improvement in hospital outcomes have occurred in relation to the improving technology (primarily coronary stenting). Near-twofold variability in the use of stents has led to vigorous discussions about the role of new devices. LESSONS LEARNED: Randomized clinical trials are very important to assessing the effects of specific treatments, but most of what is known about actual clinical care will come from observational studies. Demonstrating the variability in practice patterns can be a potent stimulus to try to answer the important questions.

Academic Medical Centers↗
PubMed2000

C-reactive protein: relation to total mortality, cardiovascular mortality and cardiovascular risk factors in men.

BACKGROUND: There is much interest in reported associations between serum C-reactive protein and incident ischaemic heart disease. It is uncertain what this association represents. We aimed to assess the effect of confounding from a number of different sources in the Caerphilly Prospective Heart Disease Study and in particular whether the low grade inflammation indicated by C-reactive protein may be the mechanism whereby non-circulating risk factors may influence pathogenesis of ischaemic heart disease. METHODS: Plasma specimens collected during 1979-83 from 1395 men with sufficient sample remaining were assayed for serum C-reactive protein by ELISA. Subsequent mortality and incident ischaemic heart disease events were ascertained from death certificates, hospital records and electrocardiographic changes at 5-yearly follow-up examinations. RESULTS: There was a positive association between C-reactive protein and incident ischaemic heart disease (P<0.005) mainly with fatal disease (P<0.002). There was also a positive association with all-cause mortality (P<0.0001). C-reactive protein was significantly associated with a number of non-circulating risk factors including body mass index (P<0.0001), smoking (P<0.0001), low forced expiratory volume in 1 s (P<0.0001), height (P=0.025), low childhood social class (P=0.014) and age (P=0.036). C-reactive protein was also associated positively with circulating risk factors including viscosity, leukocyte count, fibrinogen (all P<0.0001) and insulin (P=0.0058). After adjustment for non-circulating risk factors the association with all-incident ischaemic heart disease and ischaemic heart disease death became non-significant, but the association with all-cause mortality remained (P=0.033). Further adjustment for fibrinogen however removed any hint of an increasing trend in odds for all three outcomes. CONCLUSION: C-reactive protein levels are raised in association with a variety of established cardiovascular risk factors. Neither C-reactive protein nor the systemic inflammation it represents appears to play a direct role in the development of ischaemic heart disease.

Biomarkers↗
PubMed1993

Effects of NG-nitro-L-arginine methyl ester on the cardiovascular system of the anaesthetized rabbit and on the cardiovascular response to thyrotropin-releasing hormone.

1. The effects of 300 mg kg-1 of the nitric oxide (NO) inhibitor NG-nitro-L-arginine methyl ester (L-NAME) on the regional blood flow, on the flow response to 1 mg kg-1 of thyrotropin-releasing hormone (TRH) and on cerebral blood flow autoregulation were studied in urethane anesthetized rabbits subjected to unilateral sectioning of the cervical sympathetic claim. The blood flow measurements were performed by the tracer microspheres method. 2. The cerebral arteriovenous difference in oxygen saturation (CAVOD) was measured before and after the administration of L-NAME and TRH in order to ascertain whether the effects on cerebral blood flow that were observed were secondary to changes in cerebral metabolism. 3. L-NAME caused a significant decrease in blood flow in several cerebral regions; CBFtot decreased to 72 +/- 4% of control (P < 0.001). An increase in blood pressure and a concurrent decrease in heart rate and cardiac output were noted. 4. In the eye, L-NAME caused a reduction in uveal blood flow which was more pronounced on the sympathetically intact side; in the retina the blood flow decreased to 50% of control on both sides. 5. The administration of TRH in animals pretreated with L-NAME caused a significant increase in blood pressure and cerebral blood flow. 6. In L-NAME-treated animals the CBF was not affected when the mean arterial blood pressure was increased by ligation of the abdominal aorta. 7. The CAVOD increased from 56.0 +/- 5.2 to 73.6 +/- 3.5%, 20 min after the administration of L-NAME. In animals given 1 mg kg-1 TRH after L-NAME the CAVOD decreased to 54.6 +/- 4.6%, 5 min after the injection of TRH.8. The results of the present study indicate that endogenous NO is involved in the regulation of regional blood flow and blood pressure in the anaesthetized rabbit. The reduction in cerebral blood flow that was caused by L-NAME was not due to a reduction in cerebral metabolism. An interaction between the NO synthesis/release/effect and the sympathetic nervous system was found in the uvea. There was no evidence for a major involvement of NO in the cardiovascular responses to TRH and autoregulation of cerebral blood flow was not abolished by L-NAME.

Anesthesia↗
PubMedDate not supplied

Medicare's Cooperative Cardiovascular Project: can we trust our MetaStar report cards? Cardiovascular Care Committee of Wausau Hospital.

The purpose of Medicare's Cooperative Cardiovascular Project (CCP) is to improve the care of Medicare patients presenting with acute myocardial infarction (AMI). MetaStar is Wisconsin's Medicare peer review organization that administers Phase II of the CCP. A major Phase II objective is to increase the use of reperfusion strategies (thrombolysis and angioplasty) and angiotensin converting enzyme (ACE) inhibitors (when the ejection fractions is < 40%) in patients presenting with AMI. After MetaStar presented Wausau Hospital's baseline Phase II data to us, we were asked to define a plan to improve the use of reperfusion therapy and ACE inhibitors. To verify the accuracy of the data presented to us, we reviewed the patient records used by MetaStar to calculate our baseline data for these 2 quality-of-care indicators. Our MetaStar reported reperfusion rate (48.4%) and ACE inhibitor rate (20.9%) were significantly different from that which we calculated (100% and 97%). Causes for the discrepancy included MetaStar abstractor's failure to exclude two patients who did not have an AMI, failure to correctly count patients who received the targeted treatment, and an inability of the abstractors to identify important CCP exclusion criteria. Thus, numerous patients who should have been excluded were inappropriately classified as "ideal" candidates for the targeted therapy. WE CONCLUDE: There are major flaws in the data collection techniques used by MetaStar in Phase II of the CCP. These flaws produced erroneous conclusions concerning our use of reperfusion strategies and ACE inhibitors. Since these quality-of-care indicators are major targeted goals of Phase II, the errors are of special concern. We believe better-designed abstract forms, due diligence, and more thorough training could have prevented the errors. In presenting our concerns, we hope to foster a response by MetaStar to improve the quality of the peer review process.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1988

Pathogenesis of cardiovascular disorders in streptozotocin-induced diabetes in rat. I. Cardiovascular, renal and morphologic changes in different stages of diabetes.

Some cardiovascular (heart rate and mean arterial pressure), and renal (glomerular filtration rate-GFR; renal plasma flow-RPF; filtration fraction-FF; blood urea nitrogen-BUN and albuminuria) parameters, coupled with morphologic examination, was undertaken in early (2 months) and late (6 months) stage of streptozotocin-induced diabetes mellitus in rats. The results showed a temporally (early) bradycardia and gradually increase of blood pressure with morphologic changes typical for diabetic cardiopathy. The increased GFR (by 92%), associated with significantly decreased RPF (by 37%), increased FF (by 133%), increased kidney weight/body weight ratio (by 88%), increased BUN (by 52%) and distinct albuminuria (13.53 +/- 2.08 mg/24 h/100 g b. w.), together with typical morphologic changes, suggested the development of diabetic nephropathy which was progressive with the duration of the disease.

Animals↗
PubMed1994

[Cardiovascular surgery in Spain in 1992. The Registry of Operations of the Spanish Society of Cardiovascular Surgery (SECCV)].

The Spanish Society of Cardiovascular Surgery Registry of 1992 includes data from 41 centers. Within this year a total of 24,127 patients were operated on, with an average of 588 operations/center. Twelve thousand twenty-two of these were cardiac operations under extracorporeal circulation, with an average of 300 cases/hospital. The average of cardiac surgeons/hospital was 5.9 and the average of open heart operations/surgeon was 50. For the first time, the number of coronary bypass surgeries was superior to that of valvular procedures (5,049 vs 4,951). In the coronary bypass patients the average of grafts/patient was 2.43. The number of valvular prostheses implanted was 5,526 and 81% of these were mechanical. The number of patients operated on for congenital cardiac defects was 2,251 (1,278 open heart surgeries and 973 closed). The global mortality in the patients operated on under extracorporeal circulation was 7.6% (7.0% in valvular, 7.9% in congenital and 5.4% in coronary bypass). There were 6,054 patients subjected to surgery for peripheral vascular disease.

Cardiac Surgical Procedures↗
PubMed1994

[Percutaneous cardiovascular intervention procedures in Brazil (1992-1993). Report of the National Registry-National Center for Cardiovascular Interventions].

PURPOSE: To report the data on the first 2 years (1992-1993) of activity of the National Registry of Cardiovascular Interventions (CENIC) of the Hemodynamic and Angiography Department (DHA) of the Brazilian Society of Cardiology (SBC). METHODS: The full members of the DHA of the SBC sent their data on seven types of interventions: balloon angioplasty (PTCA), mitral balloon valvoplasty (MBV), pulmonary balloon valvoplasty (PBV), aortic balloon valvoplasty (ABV), tricuspid balloon valvoplasty (TBV), aortic balloon dilation (AoB) and balloon dilation of pulmonary branches (PBB), to the CENIC. RESULTS: Ninety-seven interventional cardiologists and 71 hospitals in 14 states, participated in this data bank. During this time, 16,429 PTCA, 551 MBV, 347 PBV, 62 ABV, 61 AoB, 3 TBV and 3 PBB were registered. PTCA was therefore the most performed procedure (94%); primary success rate was 89.7%. As for the major complications, there were 2.5% acute myocardial infarction; 0.8% emergency bypass surgery and 1.8% death. As for the other interventions, the primary success rate was 92.9% for MBV, 88.5% for PBV, 80.3% for AoB, 72.6% for ABV, 66.7% for TBV with 0.54% deaths for MBV patients and 3.23% for ABV patients. CONCLUSION: The performance of the interventional cardiology in Brazil reflects the difusion of intervention methods in the main hospitals of the country. The results demonstrate a high efficacy and safety rate, characterizing an excellent performance.

Adolescent↗
PubMed1996

[Cardiovascular surgery in Spain in 1994. Registry of Interventions of the Spanish Society of Cardiovascular Surgery (SECCV)].

The Spanish Society of Cardiovascular Surgery Registry of 1994 includes data from 44 hospitals. Within this year a total of 25,385 patients were operated on, with an average of 577 operations/ center. Fourteen thousand one hundred and fifteen of these were cardiac operations under extracorporeal circulation, with an average of 320 cases/hospital. The number of coronary surgeries was greater to that of valvular procedures (6,660 vs 5,386). The average of coronary graft/patient was 2.67. The 67.6% of these were arterial grafts. The hospital mortality was 7.8%, 5.9%, 6.6%, 7.0% and 4.1% for 1, 2, 3, 4 and 5 or more grafts, respectively. The number of valvular prothesis implanted was 6,243 and 80.7% of these were mechanical. There were 2,274 (58.2%) patients operated on aortic valvular surgery and 1,582 by mitral surgery, with a mortality of 5.9 and 8.6%, respectively. The number of patients operated on for congenital cardiac defects was 1,993 (1,367 open heart surgeries and 626 closed). There were 5,023 operations by peripheral vascular surgery. The number of aneurysms operated on during this year was 506.

Cardiac Surgical Procedures↗