The authors examined the frequency of thromboembolism and bleeding complications in cases of mechanical valve replacement during the past 5 years in the Tokyo area. There were 21 cases of thromboembolism and 15 cases of bleeding complications. Analyzing these cases with regard to anticoagulant therapy, 71% of the thromboembolism cases and 47% of the bleeding complication cases had 10∼25% result on the thrombotest at the time of the event. Consequently, in cases of mechanical valve replacement it is necessary to reevaluate the therapeutic range of the thrombotest results. This was a retrospective study of a TAS (The Tokyo area anticoagulation study for cardiac valve replacement by using PT-INR) trial and we intend to carry out a prospective study on the therapeutic range of the thrombotest and PT-INR.

We examined the surgical procedure and long-term results in patients who underwent intraoperative re-do for the completion of mitral valve repair. Between March 1993 and July 1996, 81 patients underwent mitral valve repair for pure MR using TEE evaluation. Of these, 12 patients that were judged to have more than mild residual regurgitation (MRA≥2.0cm² or MRL≥1.0cm) underwent intraoperative re-do. All of the patients were type 2, according to Carpentier's classification. Seven patients had degenerative disease and 2 had infective endocarditis. If the cause of residual MR was localized discoaptation, 5-0 suture plication with beating heart that increased the coaptation zone and resulted in decrease in the residual MR was useful. If the cause of residual MR was leaflet prolapse or dehiscence, intraoperative re-do was performed the cardiac re-arrest. Two patients of billowing valve underwent MVR and the other needed additional resection of leaflet, artificial chorda or suture. After intraoperative re-do, every procedure resulted in a reduction of MR except for 2 patients underwent MVR during the early postoperative stage, and of those all but one remaine no-to-mild MR in the late term (mean follow-up 26.2 months). In conclusion, 5-0 suture plication was effective for intraoperative re-do procedures, and basic mitral valve repair modification was necessary in about half of the cases. Intraoperative re-do was safely performed with no mortality or morbidity and it yielded good long term results. Intraoperative TEE evaluation was considered to be important.

The use of the radial artery (RA) for coronary artery bypass grafting (CABG) is increasing. This study describes mid-term results of the use of RA for CABG. Between March 1996 and March 1999, we performed 134 CABGs using RA or saphenous vein graft (SVG) for the left circumflex branch area or diagonal branch area. The mean age was 62.6±9.6 years in the RA group and 65.0±7.8 years in the SVG group. The average number of anastomoses was 2.7per patient. RA was anastomosed with the postero-lateral branch (PL) in 69 cases, with the obtuse marginal branch (OM) in 29 cases and with the diagonal branch (DB) in 10 cases. SVG was anastomosed with PL in 26 cases, with OM in 14 cases and with DB in 2 cases. The proximal anastomosis was made with the ascending aorta in all cases. No sequential bypass anastomosis was used in any case. The early patency rate of the grafts was 97.9% (93/95) in RA and 91.7% (33/36) in SVG. The clinically negative rate in the treadmill test (TMT) performed later was 99.0% (102/103) in RA and 90.9% (30/33) in SVG. The late patency rate of the grafts was 92.9% (13/14) in RA and 50.0% (3/6) in SVG. Perioperative death occurred in 5 cases. Late cardiac death occurred in 2 cases (0.02%) of the RA group and 1 case (0.03%) of the SVG group. The 3 year-survival rate free of cardiac events was 92.8% in the RA group and 80.9% in the SVG group. The use of RA for CABGs is not only effective for myocardial revascularization, but also can be expected to bring about good patency as a late result.