CLINICAL HIGHLIGHTS
As with most clinical programs, incremental changes in medical management and surgical techniques occur almost without recognition. Although perhaps not worthy of singling out, the cumulative effect of each small change results in steady improvement in the overall parameters of patient care including the traditionally monitored variables of cost and length of stay. Our adult cardiac surgical service has served as an exemplary model for the institution in this respect. Singular highlights have emerged in the past year, however, and these also have occurred on the adult cardiac surgical service.
At a time when it seemed like there would be little new on the horizon in options for prosthetic valve replacement, an exciting new type of bioprosthesis was released by the FDA about three years ago. These pig valves have been treated by very low-pressure or even zero-pressure fixation with glutaraldehyde and can be implanted in virtually the same position and space as was taken up by the native aortic valve. This configuration enables the surgeon to maximize the functional opening of the new prosthesis to minimize the pressure gradient across the valve. Early results suggest that left ventricular mass that has increased as a response to native aortic valve disease may regress more rapidly and completely to normal. The inference from these observations is that overall left ventricular function and longevity may be improved. Led by Dr. Nicolosi, these prostheses have been introduced and are now used regularly in appropriate patients with aortic valve disease presenting at both the Froedtert Hospital (FH) and at the Zablocki VA Medical Center. Early results suggest excellent clinical recovery and highly reproducible and reliable prosthetic valve function.
Traditional coronary artery bypass surgery has necessarily employed the use of the heart-lung machine. An increasing trend throughout the country has been the attempt to perform coronary artery bypass operations without the use of the heart-lung machine, so-called off pump coronary artery bypass or opCAB. Institution of these techniques has been led by Dr. Almassi at FH and at the VAMC. Prudent, careful application of these new technologies has resulted to date in satisfactory results that suggest that expanded application may be justified in certain groups of patients. At the same time, we continue to apply highly advanced techniques for coronary vascularization in particularly complicated and difficult cases.
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