[Current problems in the surgical treatment of acquired heart disease]

Despite recent progress in surgical treatment for acquired heart disease, there still remain some problems to be solved. Recently, incidence of the aged and serious cases are increasing. In order to detect the limitation of surgical indication for these cases, a multivariate analysis for prediction of low cardiac output syndrome (LOS) after prosthetic valve replacement was performed. Variables with significant relationship to LOS were different from the types of disease and it seemed difficult to decide indication from single factor such as age or cardiac function alone. Mechanical assist for the postoperative failing heart was carried out for 45 cases. Of these 45, 3 cases underwent clinical application of partial artificial heart (PAH). Two cases weaned from PAH and there was one long-term survival. Duration of cardiac assist in one case who did not wean from PAH was as long as 70 days. Incidence of re-replacement of prosthetic valve due to malfunction was higher in recent 5 years when compared to that in former years. Incidence and type of malfunction of prosthetic valve were different according to the types of prosthesis. Survival and event-free rates in long-term follow-up period were markedly embellished by the types of prosthesis.