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  • 1
    Electronic Resource
    Electronic Resource
    Improved Biocompatibility of Bioprosthetic Heart Valves by L-Glutamic Acid Treatment (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 7 (1992), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Treatment of glutaraldehyde-fixed pericardium with L-glutamic acid and storage in bacteriostatic preservatives (paraben) stably antagonizes free, reactive aldehyde groups within the fixed bioprosthetic heart valve tissue. In 63-day subcutaneous implants in rats, the calcification rate of this treatment (13.3 ± 2 mg calcium/g wt tissue) was markedly reduced as compared to conventionally treated tissue (169 ± 24 mg/g; p 〈 0.05). To test the influence of tissue released toxic aldehdyes on spontaneous endothelial cell ingrowth in vivo, vascular grafts (8-cm long, 6-mm diameter) from fixed pericardium treated with L-glutamic acid were interposed into the carotid arteries in ten sheep. They were compared to grafts from conventionally treated pericardium implanted at the contralateral side. Following 3 months of implantation, planimetry revealed 49%± 20% of the surface of conventionally preserved pericardium to be covered with red thrombus, but only 12%± 5% in L-glutamic acid treated pericardium (p 〈 0.05). The ultrastructural findings of a closed endothelial cell layer on the graft surface reveals the new technique to be a promising approach towards increased biocompatibility of aldehyde-fixed bioprosthetic heart valves.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1992.tb00775.x
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  • 2
    Electronic Resource
    Electronic Resource
    Doppler Sonographic Evaluation of the CarboMedics Bileaf let Valve Prosthesis: One-Year Experience (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 7 (1992), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Between April 1989 and March 1991, 237 CarboMedics bileaf let valve prosthesis carriers (165 aortic and 72 mitral valves, mean age 54.4 years) were studied prospectively with pulsed-and continuous-wave Doppler at a mean interval of 11.4 months following surgery in order to establish ranges of normal flow velocities and pressure gradients. Physical examination revealed no signs of prosthetic dysfunction or heart failure. Postoperative left ventricular function as measured by fractional shortening was 37% for aortic valve carriers and 30% for mitral valve carriers (p = N S). Mean peak velocity (± SD) across the aortic valve was 2.6 m/sec (± 0.4) and calculated instantaneous peak pressure gradient ranged from 11 to 58 mmHg (mean 28.1 ± 10.3). It has to be emphasized that occasional patients with normally functioning valve prostheses can show unusual high gradients. Ring diameters between 21 and 27 mm showed no significant difference with regard to flow velocities and pressure gradients, whereas in 19-mm valves, significantly higher values could be demonstrated. The 123 aortic valve carriers with normal left ventricular function (fractional shortening 〉 25%) showed significantly higher pressure gradients than the 19 patients with reduced left ventricular function (28.6 ± 11.6 mmHg vs 16.2 ± 5.1 mmHg, p 〈 0.05). In the mitral position, the mean of peak velocity (± SD) was 1.7 ± 0.4 m/sec and pressure half-time was 108 ± 26 msec, representing a calculated valve area between 1.4 to 3.1 cm2 (mean orifice size 2.1 ± 0.5 cm2). No significant difference between valves of different sizes was found. Additionally, left ventricular function had no influence on Doppler-derived hemodynamic measurements. Minimal valvular or paravalvular backflow (extension 〈 1 cm from the prosthesis ring) as indicated by pulsed-wave or color Doppler was present in 44% of aortic valve and 7% of mitral valve prostheses. Five patients (3%) with aortic valve prostheses and two patients (3%) with mitral valve prostheses demonstrated severe para-valvular regurgitation without clinical abnormalities.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1992.tb00772.x
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  • 3
    Electronic Resource
    Electronic Resource
    Implantation of the Left Ventricular Assist Device (1987)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 2 (1987), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Development of mechanical devices for support of the failing heart is a major goal in cardiac surgery. The application of left ventricular assist device (LVAD) is a promising approach in the case of severe and otherwise untreatable cardiac failure. In our experience we have used two external centrifugal pumps for the extracorporeal biventricular cardiac support in a post-transplantation patient who experienced severe rejection six months after heart transplantation. Our own series includes a total of ten implantations of LVAD's with six patients who could be weaned from the device but only one long-term survivor. The clinical results are not encouraging which suggests that the heart of the patient who needs an LVAD has been damaged beyond any chance for later recovery. Obviously timing is the most crucial aspect of the decision to implant the device. It would appear that orthotopic implantation of the transplanted heart remains the method of definitive treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1987.tb00170.x
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  • 4
    Electronic Resource
    Electronic Resource
    Thoracoabdominal Aneurysm Repair: Spinal Cord Protection Using Profound Hypothermia and Circulatory Arrest (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 9 (1994), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Between January 1991 and February 1993,14 patients (11 male, 3 female) between 21 and 79 years of age (median 50 years) underwent reconstruction of the thoracic (n = 7) and thoracoabdominal aorta (n = 7). Four patients had previously undergone operation of the ascending aorta, and In three patients coronary artery bypass grafting had previously been performed. All patients were operated on via a posterolateral thoracotomy using cardiopulmonary bypass wlth continuous blood cardloplegla and hypothermlc circulatory arrest (11 °C naso-pharyngeal temperature, flat-EEG). All patent lower intercostal and lumbar arteries (T3 to L5) were reimplanted. The 30-day mortality after repair of the thoracic aorta was 0%; after replacement of the thoracoabdomlnal aorta, mortality was 28.5% (n = 2). One patient died 70 days after replacement of the thoracic aorta as a consequence of a perioperative stroke. None of the surviving 11 patients developed a permanent neurological deficit or renal or cardiac dysfunction. The average Intensive care stay was 6 days for patients after replacement of the thoracic aorta and 18 days for patients after replacement of the thoracoabdominal aorta. Our results suggest that use of elective hypothermia and circulatory arrest for spinal cord protection is highly effective. We, therefore, recommend this method for complex reconstructions of the thoracoabdominal aorta. (J Card Surg 1994;9:679–684)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1994.tb00902.x
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  • 5
    Electronic Resource
    Electronic Resource
    The Heart: Location of the Human Soul—Site of Surgical Intervention (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 8 (1993), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Over millennia, the heart has played an important role in philosophy, medicine, literature, art, and theology. Most cultures consider the heart to be the location of the soul or mind, the “center” of the human body. Modern natural sciences, however, downgrade it to a mere organic blood pump and, simply, a site of surgical interventions. Dealing with this central organ of the body, cardiac surgery is a royal discipline among the medical professions and is highly respected by the public.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1993.tb00383.x
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  • 6
    Electronic Resource
    Electronic Resource
    One and One-Half Year Experience with Unilateral and Bilateral Lung Transplantation (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 7 (1992), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Lung transplantation has now become an established form of treatment for end-stage pulmonary parenchymal and vascular diseases. Despite its wide acceptance, technical aspects are still in discussion. We report on the initiation of our own lung transplant program and the technical changes we have performed during our first 1 ½-year experience. During that period of time, we have performed 26 lung transplantations (16 single lung [SLTX] and 10 bilateral lung transplantations [BLTX]). Three-month survival for the whole group was 74% (69% for the SLTX group and 77% for the BLTX group). No instance of bronchial dehiscence was observed; however, there were eight cases of bronchial stenosis: six were managed by silicone stent insertion, one by bronchoplastic correction, and one by retransplantation. Changes in the technique of the bronchial anastomosis together with the addition of prednisone to the immediate postoperative immunosuppressive regime resulted in almost complete avoidance of these problems.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1992.tb00789.x
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  • 7
    Electronic Resource
    Electronic Resource
    Endothelial Cell Lining of Bioprosthetic Heart Valve Material (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 7 (1992), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In this in vitro study, the growth properties of cultured endothelial cells on conventionally treated pericardial valve material were measured. These data were compared to endothelial cell proliferation on an alternatively treated valve material. This alternative preservation procedure was developed in order to bind free, residual glutaraldehyde in the valve tissue by reaction with L-glutamic acid. In order to optimize endothelial cell attachment and proliferation, fibronectin and fibrillar collagen type I were tested as surface precoating substances. Cell viability of the seeded cells was evaluated by means of proliferation kinetics, antithrombotic activity, and morphological appearance. Endothelial cell death occurred within the first 2 days after seeding on conventionally treated valve tissue, independent of the type of precoating. On alternatively treated tissue, regular endothelial cell proliferation was observed. Precoating with fibrillar collagen markedly increased endothelial cell attachment and proliferation as compared to fibronectin. Maintenance of antithrombotic activity of the seeded cells was proven by regular release of prostacyclin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1992.tb00778.x
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  • 8
    Electronic Resource
    Electronic Resource
    The CarboMedics®“Top Hat” Supraannular Prosthesis in the Small Aortic Root (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 10 (1995), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Twenty-three patients, 11 men and 12 women, with a mean age of 64 (range, 34 to 78) underwent aortic valve replacement (AVR) with a CarboMedics®“Top Hat” supraannular prosthesis between March 1993 and August 1994. The top hat supraannular prosthesis, a standard bileaflet valve with the cuff transferred to the valve inflow level, allowed implantation of 21-mm, 23-mm, and 25-mm valves, where a standard 19-mm or 21-mm valve would have usually been placed. One patient who had been in preoperative cardiogenic shock died in the perioperative period. Another had an intraoperative cerebral embolism with permanent impairment. Follow-up on 22 of 23 patients over a mean period of 9 months revealed mean Doppler gradients of 18 ± 6 mmHg, 15 ± 2.8 mmHg, and 11 mmHg, for the 21-mm, 23-mm, and 25-mm valves, respectively. Functional improvement was noted, with 17 patients in New York Heart Association (NYHA) Class I and 6 in NYHA Class II, postoperatively, compared with 0 in Class I, 9 in Class II, 10 in Class III, and 4 in Class IV, preoperatively. One patient showed reduced postoperative ventricular function with fractional shortening below 25%. Pandiastolic regurgitation intrinsic to the valve graded as slight was noted in all patients. Other postoperative complications included one patient with anticoagulant-related gastrointestinal bleeding and one other with prosthetic valve endocarditis successfully treated with antibiotics. The CarboMedics® top hat valve allows a gain in prosthesis size of 2 mm to 4 mm in the aortic position over standard prostheses, resulting in favorable postoperative hemodynamics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1995.tb00599.x
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  • 9
    Electronic Resource
    Electronic Resource
    Experience with intra-aortic balloon pumping and the first clinical application of an ellipsoid left ventricular assist device (1978)
    Springer
    World journal of surgery 2 (1978), S. 873-878 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Entre Décembre, 1969 et Août, 1977, nous avons traité 121 malades par contrepulsion intraaortique (CPIA). Au début, la seule indication était la défaillance cardiaque après infarctus du myocarde. D'autres indications se sont ajoutées ultérierement: défaillance cardiaque après remplacement valvulaire, chirurgie coronaire ou chirurgie générale, angor instable, menace d'infarctus, prophylaxie dans la chirurgie coronarienne à haut risque. La mortalité reste élevée malgré l'utilisation de la CPIA dans le choc cardiogénique après infarctus (87%), dans la défaillance cardiaque après chirurgie valvulaire (90%), chirurgie coronarienne (52%), et chirurgie général (66%). La mortalité est plus faible lorsque la CPIA est utilisée pour menace d'infarctus (17%), syndrome intermédiaire (19%), et dans la prophylaxie de la chirurgie coronarienne à haut risque (18%). Comme 47% des malades en choc cardiogénique ne répondent pas à la CPIA, nous avons testé chez le veau, depuis 1972, un appareil d'assistance ventriculaire implantable (AVI). La première utilisation clinique d'un AVI ellipsoïde a été faite en Juin, 1977, chez un malade de 57 ans après remplacement valvulaire aortique. Après 6 heures de pompage par l'AVI ellipsoïde, le coeur a récupéré et a pu maintenir une circulation satisfaisante sous CPIA. Les mauvais résultats de la CPIA chez les malades en défaillance cardiaque pourraient donc être améliorés par l'utilisation d'appareillages d'assistance ventriculaire gauche plus puissants.
    Notes: Abstract Between December, 1969 and August, 1977, there were 121 patients treated with intraaortic balloon pumping (IABP). Initially, failure of the heart after myocardial infarction was the only indication for IABP. Subsequently, other indications were added, including cardiac failure after cardiac valve replacement or after coronary artery surgery or after general surgery, unstable angina, impending myocardial infarction, and prophylaxis in highrisk patients undergoing coronary artery surgery. Mortality rates were high, despite the use of IABP, for cardiogenic shock following myocardial infarction (87%) and for postoperative cardiac failure after heart valve replacement (90%), coronary artery surgery (52%), and general surgical operations (66%). The mortality rates were lower when IABP was used for impending reinfarction (17%), intermediate syndrome (19%), and as prophylaxis in highrisk patients prior to coronary artery surgery (18%). Because 47% of patients with cardiogenic shock did not respond to IABP, we have evaluated an implantable left ventricular assist device (LVAD) in calf experiments since 1972. The first clinical application of an ellipsoid-LVAD (E-LVAD) occurred in June, 1977 in a 57-year-old patient after aortic valve replacement. After 6 hours of pumping with the E-LVAD, the heart recovered and was able to maintain good circulation with IABP. The poor results of IABP in patients with heart pump failure might be improved by the use of the more powerful left ventricular assist devices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01556545
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