DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

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Figure 10. Multi-vessel reconstruction employing bilateral internal thoracic artery and venous grafts. 200 150 100 50 0 0 1 100% 1965-1975 Cases 1 40 10 20% 1976-1985 Cases 50 Redo CABG with associated procedures = 361 OP survival = 287 OP death = 74 20.4% Figure 12. Redo CABG with associated procedures struction, and left ventricular aneurysm repair. (Other associated procedures included arch aneurysm resection, lung resection, cholecystectomy, utilization of the intraaortic balloon pump IABP and 233 other miscellaneous operations.) The operative mortality remained little changed over four decades, averaging 11.5% for these higher risk, complex procedures. Long-term graft patency studies demonstrated arterial grafts to be superior to venous grafts at 5- and 10-year follow up. In the last two decades of the series, almost 100% of patients received a combination of arterial and venous grafts particularly in redo coronary artery operations (Figure 10). Internal thoracic and radial arteries were most frequently utilized. 176 45 20.3% 1986-1995 Cases 221 71 18 18.3% 1996-2005 Cases 87 Figure 11. Redo CABG only; STS benchmark 2002 = 5%; 2006 = 4% Bjork Shiley Carpentier 0 250 500 750 1,000 Total operative procedures = 1,516 OP deaths = 96 Figure 13. Aortic valves Combined carotid and coronary artery revascularization were performed in 293 patients presenting with symptoms of both cerebral vascular insufficiency and coronary artery ischemia or with severe structural abnormalities of the carotid artery; mortality and morbidity were 6% in this high-risk group. The rationale of the combined procedure was to reduce the risk of stroke near and long term. Redo Coronary Artery Bypass Alone Reoperative coronary artery bypass procedures accounted for 1,077 cases (Figure 11), the majority of which occurred in the third decade of Dr. Howell’s practice. There were 1,047 survivors and 30 hospital 6 vII (1) 2011 | MDCvJ 600 500 400 300 200 100 0 20 0 1965-1975 Cases 20 Cutter DeBakey Duramedics Hancock McGovern Pericardial Bioprosthesis Starr Edwards St. Jude Redo CABG only = 1,077 OP survival = 1,047 OP death = 30 2.7% Unnamed Values 8 1 8 6 6 25 10 8 271 130 11 3.9% 1976-1985 Cases 282 460 563 14 2.4% 1986-1995 Cases 77 854 193 5 2.5% 1996-2005 Cases 198
Baxter Edwards Beall Bjork Shiley Carpentier Cooley Cutter Cutter Duramedics Gott Hancock Kay Shiley Pericardial Bioprothesis Starr Edwards St. Jude Unnamed Values 1 24 9 6 1 1 6 3 2 44 58 64 111 0 Operative procedures = 789 OP deaths = 78 Figure 14. Mitral valves 250 500 Image provided courtesy of St. Jude Medical Inc. 459 Figure 15. St. Jude mechanical valve and St. Jude biological tissue valve. deaths for a 30-day mortality of 2.7%. This mortality remained well below the STS benchmark of 5% over all four decades. Redo Coronary Artery Bypass with Associated Procedures Redo coronary artery bypass surgery with associated procedures was performed on 361 patients (Figure 12). There were 287 survivors with 74 operative deaths for a 30-day mortality of 20.4%. The added degree of surgical complexity accounted for the higher risk compared to redo coronary artery bypass alone. valve replacement, reconstruction of left ventricular chamber, and carotid artery revascularization accounted for the majority of the associated procedures. Intra-aortic balloon pump was employed in 50% of these procedures. Valve Operations Operations on heart valves were performed in 2,745 AVR only = 695 OP survival = 667 OP death = 28 4.0% Figure 16. AVR only; STS benchmark 2001 = 4.0% MVR only = 455 OP survival = 424 OP death = 31 6.8% Figure 17. MVR only; STS benchmark 2001 = 6.5% cases and consisted of replacement, repair, or a combined procedure utilizing mechanical or bioprosthetic valves. A variety of valves were utilized over the four decades (Figures 13 and 14), with St. Jude mechanical being the most frequently used (Figure 15). Isolated aortic valve replacement procedures were performed on 695 patients. There were 667 30-day survivors and 28 deaths for a 30-day operative mortality of 4.0% for the four decades. This is comparable to the STS benchmark of 4% in 2001. However, over the last three decades, the average mortality averaged 2.7% and distinctly less than the STS benchmark (Figure 16). There were 455 operations for isolated mitral valve replacement; 424 survived and 31 expired for a total 30-day operative mortality of 6.8% compared to the STS benchmark in 2001 of 6.5%. The 30-day mortality over the last three decades steadily improved (Figure 17). Approximately one-sixth of the valve procedures MDCvJ | vII (1) 2011 7 200 150 100 50 0 200 150 100 50 0 142 13 8.3% 1965-1975 Cases 155 103 12 10.4% 1965-1975 Cases 115 196 5 2.4% 1976-1985 Cases 201 186 13 6.5% 1976-1985 Cases 199 187 6 3.1% 1986-1995 Cases 193 110 5 4.3% 1986-1995 Cases 115 142 4 2.7% 1996-2005 Cases 146 25 1 3.8% 1996-2005 Cases 26
Page 1 and 2: Volume 7, Number 1 • Jan. - Mar.
Page 3 and 4: W.L. Winters Jr., M.D. EDITOR’S N
Page 5 and 6: Every generation has its heroes. Dr
Page 7: OTHER CHEST 8.96% Figure 5. Surgica
Page 11 and 12: mitral valve operations. In most ca
Page 13 and 14: Figure 30. Myxoma filling the left
Page 15 and 16: Figure 37. Left: Preoperative aorto
Page 17 and 18: 15 12 9 6 3 0 10 1 9% 1965-1975 Cas
Page 19 and 20: Lower Extremity Revascularization R
Page 21 and 22: W.S. Henly, M.D. PRIvATE PRACTICE O
Page 23 and 24: P.A. Stonebridge, Ch.M. Introductio
Page 25 and 26: As a consequence of the above work,
Page 27 and 28: References 1. Buckberg GD. Basic sc
Page 29 and 30: P.E. Sovelius Jr. Overview PLATO’
Page 31 and 32: Figure 4. Plato, in The Republic, B
Page 33 and 34: Figure 9. The Artery of Adamkiewicz
Page 35 and 36: Figure 14. Reconstructed left breas
Page 37 and 38: M.E. Bertrand, M.D. Introduction WH
Page 39 and 40: Vascular Access Complications A num
Page 41 and 42: 6. Segal AZ, Abernethy WB, Palacios
Page 43 and 44: Case Report Clinical course The pat
Page 45 and 46: Figure 6. Surgical view of dual Hea
Page 47 and 48: A.B. Lumsden, M.D. Introduction PuM
Page 49 and 50: one mile below the ocean surface fo
Page 51 and 52: N. Kleiman, M.D. M.J. Reardon Intro
Page 53 and 54: Figure 3. CoreValve (Medtronic, Inc
Page 55 and 56: H.J. Safi, M.D. IN TRIBuTE: ERNEST
Page 57 and 58: MuseuM of tMH MultiModality iMaging
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Introduction CT Coronary Angiograph
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sequences that offer superior signa
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MetHodist de Bakey Heart & VasCular
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My yEARS WITH MICHAEL E. DeBAKEy Lo
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poet’s pen WHY I AM NOT A BUDDHIS
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To the Editor: After reading Dr. Be
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6565 Fannin Street Houston, Texas 7
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