J.Jpn. Surg. Soc.. 89(9): 1446-1449, 1988

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Report on the annual meeting

EXPANDING THE SURGICAL INDICATION TO THE CASES WITH HIGH
RISK VALVE DISEASE

Four hundred and fifty eight cases of valve surgery were performed at this institution over the past 7 years, during which the surgical indicatin has been gradually expanded to cases of three types.
The first type is serious disease complicated by cardiac cachexia; in these cases, in addition to the aggressive use of IABP, we also use the intrapulmonary artery balloon pumping (IPBP) technique we developed. IVH therapy for two months before surgery has been especially effective and given good results to cases with low liver function and low respiratory function.
The second type consists of cases neccessitating special surgical technique, for example, cases with very narrow valvular annuli and cases complicated by acute endocarditis. Good results have been obtained in the former with a new technique that we developed, called“Coupling Valve Grafting”, and in the latter with a technique of “Collared Prosthesis”.
The third type is elderly patients aged 70 years or more.
In particular, the greatest problem now seems to lie in low liver function of which ICG (15 min) is higher than 40％ and total serum bilirubin is over 3mg/dl; in these cases, progression to MOF is frequent and the patient’s life is saved in only 40％ of cases.

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