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Background and Aims: This study was undertaken in order to evaluate the usefulness of the Euroscore in the choice and outcome of mitral valve procedures undertaken at the Helsinki University Central Hospital., Material and Methods: Data from 378 patients was collected. predicted mortalities were calculated for all patients using the European System for Cardiac Operative Risk Evaluation and different mitral valve procedures were compared with 30-day mortality, length of hospital care and rate of post-operative complications., Results: The mortality rate in the mitral valve repair (MVP) group decreased gradually from 5.9% (in 1999) to 2.2% (2003). The variation of annual mortality was higher in the mitral valve replacement (MVR) group. The predicted mortality given by Euroscore increased over the years in both groups. The mortality in the MVR group was nearly four times higher than in the MVP group. the length of both intensive and overall hospital stay decreased in patients with MVP procedures. Post-operative survival was 89% in the MVP patients and 74% in mvr patients after three years., Discussion: The results of mitral valve operations have improved. This is observed as decreased mortality rates and lengths of hospital care in the MVP group, although the predicted mortality rate was increased.

In 1982, 364 consecutive adult patients with congenital and acquired heart disease were operated on using cardiopulmonary bypass (CPB). This population was analysed to determine the frequency of neurological complications and possible risk factors. One hundred fifty-four patients were studied prospectively (group I) and the results of 151 patients were reviewed retrospectively (group II). The overall surgical mortality was 4.5%. A neurological event was not the primary cause of death in any patients. Twenty-one patients (5.8%) had clinically significant neurological disturbances postoperatively, of these 85.7% were central and 14.3% peripheral nerve pareses. Patients with neurological complications (21) and the patients who did not survive the operation (16) were compared with a control group (59 cases) with no neurological defects operated on during the same year. Age of the patient, duration of CPB and low CPB pressure were not associated with neurological complications. Previous neurological events seem to have an influence on the postoperative neurological status although this could not be proved statistically. Except for 2 cases the neurological disturbances were transient with complete recovery or improved symptoms at the time of discharge.

Monitoring of the urinary output is mandatory during open-heart surgery and in the immediate postoperative period. During 1980-81 we noticed an alarming rise in the number of post-catheterization urethral strictures affecting men who had undergone open-heart surgery. To avoid this serious complication, we switched from conventional urethral catheterization to suprapubic cystostomy for these patients. The first 93 cases with suprapubic drainage have now been analysed as regards the advantages and complications of this technique. The advantages were clear: The patients were satisfied with the method and no urethral strictures developed. The only side effect was haematuria, which in 9 cases led to occlusion of the catheter and required extraneous maneouvres. Suprapubic cystostomy thus seems to be a good alternative to conventional urethral catheterization in open-heart surgery. The possible causes of the urethral complications in this particular group of patients also are discussed.

Urethral stricture was found in 59 of 478 male patients who had undergone open-heart surgery between June 79 and December 81. In 40/59 cases the stricture showed a string-of-pearls configuration or long narrowing of the penile urethra on the urethrogram. Burning pain and dysuria were the main symptoms, and the urinary stream started to weaken immediately after the removal of the siliconized latex catheter which had been routinely inserted at the time of the heart operation and usually kept indwelling for 3 days. The stricture epidemic stopped after change of the latex catheters to silicone-ones. The different catheters were investigated for cell toxicity. Eluates of catheters were added at different concentrations to cultures of various cell lines. The cell proliferation was measured by thymidine incorporation. The results were uniform and showed marked toxicity of the latex catheters against all investigated cell lines.

Fifty consecutive coronary artery bypass grafting (Group I) and 50 single valve replacement (Group II) procedures were compared with 50 coronary artery bypass grafting with valve replacement (Group III) procedures and 50 multi-valve procedures (Group IV) to determine the frequency of neurological complications after cardiopulmonary bypass (CPB). The possible risks and aetiological implications were studied. The overall surgical mortality rate was 7.5%, being 0%, 4%, 6% and 20%, respectively for the different groups. The neurological event was not the primary cause of death in any of the patients. After CPB, neurological manifestations occurred in 4% of the patients in Gr. I, in 6% in Gr. II, in 4% in Gr. III, and in 8% in Gr. IV. Three patients had peripheral nerve paresis. The age of the patients and the duration of the CPB operation were not factors in the risk of neurological complications. Previous neurological events seemed to increase the frequency of postoperative neurological disorders, whereas combined procedures were no more dangerous in this respect.