Grand Ballroom

8:45 A.M. Scientific Session: REGULAR PROGRAM

Grand Ballroom

1. Clinical Homograft Valve Transplantation

W. G. Bigelow, R. O. Heimbecker, and D. W. Gordon Murray*,

Toronto, Canada

Homograft aortic valves have been transplanted in humans (a) into the descending aorta as treatment for aortic insufficiency, (b) as replacement for the mitral valve, and (c) in the subcoronary position to replace the aortic valve. Follow-up haemodynamic studies have been carried out. In six patients the valve has been functioning for 2 to 8 years. Reference will be made to less successful studies with intracardiac homograft valve transplantations in dogs with survival up to 3 years.

2. Clinical Experience and Operative Technique of Valve Replacement with Sutureless Aortic and Mitral Valves

G. J. Magovern, Harry W. Cromie*, E. M. Kent,

and W. B. Cushing*, Pittsburgh, Pa.

The paper describes the operative technique and clinical experience with forty-five patients with sutureless mitral or aortic valves. These valves were previously described at the 1963 American Association for Thoracic Surgery Forum, along with out initial clinical experience. Twenty-nine patients 1 month to 16 months following surgery are living and well. There were six operative deaths, seven hospital deaths and three late deaths, which will be discussed. Preoperative and postoperative catheterization data will be presented. The advantages of a rapid method of valve fixation reducing the period of bypass time, coronary perfusion and hypothermia to a minimum will be stressed in these patients all of whom had preoperative catheterization and were considered totally disabled. Their ages ranged from 19 years to 71 years, and six patients had recurrent disease with previous open heart surgery. The average bypass time and the actual time of insertion will be presented.

3. Aortic Insufficiency Secondary to Aneurysm Changes in the Ascending Aorta: Surgical Management

Laurence K. Groves, Donald B. Effler, and K. Gulati*,

Cleveland, Ohio

This report is based on experience with 11 patients treated for aortic insufficiency secondary to aneurysmal changes in the ascending aorta. Only 2 basic pathologic entities have been recognized in these 11 patients: 3 had syphilitic aortitis, the other 8 had idiopathic medial necrosis. Of these 8 patients, 3 had Marfan's syndrome, but pathologic material was indistinguishable from idiopathic medial necrosis. Ideal treatment for such patients requires (1) treatment of the aortic insufficiency and, (2) treatment of the aneurysm itself. Ten of these 11 patients had normal valve leaflets inadequate to fill the aortic lumen; each had Starr-Edwards prosthetic replacement. The 11th patient had prolapse of the noncoronary cusp due to a dissection behind this cusp. The valve was satisfactorily reconstructed. Unusual care and thoroughness must be exercised in suturing a prosthetic valve in place in these cases where the structures are attenuated, as opposed to the sclerosis of rheumatic valvulitis. Treatment of the aneurysm is influenced by the positions of the coronary ostia. Our approach has varied from no treatment through varying degrees of aneurysmorrhaphy to excision and graft replacement. The methods used are discussed. The authors' experience is presented along with suggestions based thereon.

4. Bilateral Pulmonary Resections for Tuberculosis

Robert D. Sellers*, William R. Scott*, Harlan D. Root*,

and John F. Perry, Jr.*, Minneapolis, Minn.

Sponsored by C. Walton Lillehei

In the 10 year period from 1950 to 1960, bilateral pulmonary resections for tuberculosis were carried out in 100 neuropsychiatric patients. Sixteen of the patients had bilateral resections in one stage while the surgery in the remaining 84 patients was carried out in two stages. A total of 200 operative piocedures were carried out in this group of patients. This included 187 pulmonary resections, 15 thoracoplasties, and 2 decortications (4 of the procedures were simultaneous pulmonary resection and thoracoplasty or thoracoplasty and decortication). There were 3 operative deaths. Thirty-three complications occurred in 29 patients. In 11 of this group additional surgery was required for management of the complication. During the 3to 12 year period of follow-up, relapse of the tuberculosis has occurred in 5 patients. Each of these now has inactive disease. This aggressive surgical approach to the treatment of tuberculosis in the neuropsychiatric patient has been most encouraging. It has allowed the rehabilitation of a difficult group of patients with advanced disease.

5. The Surgical Treatment of Pulmonary Neoplasms: A Ten-Year Experience

O. Theron Clagett, W. Spencer Payne*, Thomas H. Allen*,

and Lewis B. Woolner*, Rochester, Minn.

A very extensive literature concerning the surgical treatment of pulmonary neoplasms has appeared in recent years. Most of the published papers have dealt with the surgical treatment of a particular type of pulmonary neoplasm. We have not been able to find any comprehensive reviews of the entire spectrum of pulmonary tumors that are presently being treated by surgical means. Therefore, we have reviewed a series of approximately 1800 pulmonary benign and malignant neoplasms treated surgically at the Mayo Clinic in the 10-year period, January 1, 1950, to December 31, 1959. This study has afforded (1) a practical pathologic classification of pulmonary neoplasms, (2) an accurate appraisal of the relative incidence of the various pulmonary neoplasms that can be treated surgically, and (3) some knowledge of the clinical behavior of the various pulmonary tumors and the results of surgical treatment. The results of this study will be reported.

6. Bilateral Primary Bronchogenic Carcinoma

T. W. Shields, C. T. Drake*, and J. C. Sherrick*,

Chicago, Ill.

Resectable bilateral primary bronchogenic carcinoma has not been seen frequently in clinical practice, though bilateral lesions have been recognized in the nonresectable state or as an autopsy finding. A review of the literature revealed that 10 bilateral primary lung cancers have been diagnosed during life and reported. Surgical therapy has been carried out in only 5 of these 10 patients. Recently 3 of our patients with lung cancer were discovered to have developed a second primary bronchogenic carcinoma after apparent successful resection of the initial lesion. The time interval was 6 years in one patient and 2½ years in each of the other 2. The initial surgery was a lobectomy in one patient and a pneumonectomy in the others. The subsequent procedure on the second side was a lobectomy in 2 and a wedge resection in the third. Detailed case histories will be presented. The problems of determination of the primary nature of the second lesion and the management of such patients will be discussed. The apparent increase in recognition of nonsimultaneous double primaries will likewise be discussed in relationship to the choice of the initial surgical procedure and the long term evaluation of the patient with bronchogenic cancer.

7. The Results of Raising the Resectability Rate in Operations for Lung Carcinoma

R. Abbey Smith*, Hertford Hill, Nr. Warwick, Warwickshire, England