With the revision of the Medical Service Law in April 2005, it has become incumbent on clinical engineers to take charge of medical equipment in their hospital and to run a maintenance check on the equipment at regular intervals.　　However, it is difficult to show what clinical engineers have done as visualized achievements, for no insurance mark to the maintenance and management business itself.　　By using the accumulated maintenance records and a new medical equipment management system - the Arcadia company’s “CEIA system” installed in April 2010. We considered the cost performance of the medical equipment could be enhanced through the efforts of clinical engineers.　　For this purpose, we made the list of technical fees to be paid if a clinical engineer should entrust temporarily the maintenance management to an equipment maker and calculated the cost item by item.　　Moreover, the items which were checked and repaired were divided into those “outsourced” and those taken care of by hospital clinical engineers. When trial calculations were made using “in-house processing-outsourcing＝achievements” formula, we had about 50 million yen or more.

The combined method of antegrade and retrograde administration of cardioplegic solution has been established for coronary bypass surgery. We applied this technique in patients undergoing aortic and mitral valve surgery. Between January 1989 and December 1990, 28 patients underwent both aortic and mitral valve replacements. To compare the myocardial protective effect according to the method of cardioplegic administration, they were divided into two groups; Ante group (antegrade, n=15) and Retro group (combined method of antegrade and retrograde, n=13). Aortic occlusion time and cardiopulmonary bypass time were shorter in Retro group. The mean interval of each cardioplegic administration was significantly shorter in Retro group (Ante group, 29.2±4.8min vs Retro group, 24.0±3.8min; p<0.01). These results suggest that retrograde cardioplegia method never disturbs ongoing operation during each delivery while antegrade method often does. Serum CPK-MB at 6hr of reperfusion tended to be less in Retro group (Ante group, 120±80IU/l vs Retro group, 78±50IU/l; p=0.09). The results of postoperative cardiac functions were the same in both groups. We therefore believe that this method is an optimal strategy even in patients with valvular heart disease.