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  • 1
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Background: Reduction of surgical trauma is the aim of minimally invasive cardiac surgery. This can be achieved by reducing the size of the incision or by eliminating or changing the cardiopulmonary bypass system. However, certain cardiac surgical procedures, such as valvular surgery and complex multivessel coronary artery surgery, are not feasible without the use of cardiopulmonary bypass. Therefore endovascular cardiopulmonary bypass may allow reduction of surgical trauma for these patients. Methods: Since its first application in April 1995, more than 1100 procedures have been performed worldwide using the EndoCPBr̀ endovascular cardiopulmonary bypass system. The authors' experience consists of 60 Port-AccessTM coronary artery bypass grafting procedures, 34 Port-AccessTM mitral valve procedures (18 replacements, 16 repairs), 5 atrial septal defect closures, and 3 atrial myxoma removals. Results: The patient survival rate was 99%. the incidence of perioperative stroke was 1%. and the incidence of aortic dissection was 1%. In the Port-AccessTM mitral valve and atrial septal defect patients, the survival rate was 100% with no peri- or postoperative complications. Peri- and postoperative transesophageal echocardiography revealed no perivalvular leak or remaining mitral insufficiency after valve repair. Conclusions: The EndoCPBr̀ endovascular cardiopulmonary bypass system allows the application of true Port-AccessTM minimally invasive cardiac surgery in procedures that require the use of cardiopulmonary bypass and cardioplegic arrest. Sternotomy and its potential complications can be avoided, and the surgical procedures can be performed safely on an empty, arrested heart with adequate myocardial protection. (J Card Surg 1998;13:275–280)
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 13 (1998), S. 0 
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract  Background: Due to aging of the population the upper-age limit for cardiac operations has constantly been extended. In the current era of health care reform the ability to provide appropriate care for geriatric patients at acceptable costs is a major individual and societal concern. The objective of this study was to evaluate the results of cardiac surgery in octogenarians regarding overall morbidity and mortality as well as to quality of life. Methods: Between February 1992 and August 1995,101 consecutive octogenarians underwent several types of cardiac operations. Operative procedures consisted of coronary artery bypass grafting (CABG) in 45 patients, valve replacement or repair in 33 patients, and combined CABG and combined procedures in 19 patients. All surviving patients were mailed a questionnaire 3 to 62 months (22.1 ± 15.4 months) postoperatively concerning the postoperative course and quality of life (97.5% follow-up). Results: The early mortality was 15.5% in the CABG group, 3.0% in the valve group, and 21.7% in the combined procedure group; 5-year actuarial survival was 79.1% in the CABG group, 86.9% in the valve group, and 58.8% in the combined procedure group, respectively. The questionnaire sent to the survivors revealed that 81.0% of patients considered their functional status better or much better than before surgery. Of the survivors, 97.3% stated that according to their opinion the operation was worthwhile. Conclusion: Cardiac surgery is justified for carefully selected patients in the ninth decade of life. Although these patients are at increased risk of operative death and surgical complications compared with younger patients, the majority regain a life expectancy in the range of that of the global population. Furthermore, they are presented the chance to retain or maintain an independent lifestyle.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A canine femoral artery model was used for evaluation of a dialdehyde starch preserved bovine internal mammary artery (BIMA) (3 and 4 mm internal diameter) in comparison to a polytetrafluoroethylene (PTFE) graft. The study comprised three groups for a 2-hour (n = 7, 3 mm), 3-month (n = 10, 4 mm), and 6-month (n = 10, 4 mim) follow-up. The thrombogenicity of the grafts was measured after 2 hours and 3 months using chromium 51 labeled autologous platelets. In addition, compliance studies were done. To control the wall stability of the xenografts, the collagen content before implantation and after explantation was examined together with the diameter of the grafts. Healing characteristics were studied using appropriate histologic methods. The acute platelet adhesion rate (2 hours) of the BIMA graft was 181 ± 69 × 104 platelets/mm2 as compared to 57 ± 43 × 104 for PTFE (p 〈 0.05, t-test). However, after 3 months the thrombogenicity of the biograft had decreased whereas the platelet count at the PTFE graft had increased (BIMA: 79 ± 48 × 104; PTFE: 179 ± 102 × 104, p 〈 0.05). At implantation, the compliance of the BIMA graft was 0.028%± 0.009% per mmHg as compared to 0.06%± 0.0025% of the femoral artery. The PTFE graft was uncompliant (0.008 ± 0.005). After 6 months, the compliance of the femoral artery had decreased to 0.039%± 0.013% per mmHg, which was now well matched to the nearly unchanged compliance of the biograft (0.0027 ± 0.005). The external diameters and the collagen contents of the xenografts remained unchanged. In contrast to PTFE, the xenografts developed no diameter-reducing neointima. After 6 months, six out of ten BIMA grafts and only two out often PTFE grafts remained patent.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: LEWALTER, T., et al.: Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve Surgery. Sustained monomorphic ventricular tachycardia (VT) after valve surgery represents a clinical entity with different tachycardia mechanisms. This case report describes an incessant VT after tricuspid and aortic valve replacement that did not respond to antiarrhythmic drug treatment. The tachycardia exhibited VA block and a right bundle branch block pattern with left-axis deviation, suggesting ventricular excitation via the left posterior fascicle. The electrophysiological study was limited by the prosthetic tricuspid and aortic valve replacement, therefore a transseptal approach was necessary to obtain access to the ventricular myocardium. Radiofrequency catheter ablation was performed in the proximal left bundle or distal His region with termination of the incessant VT followed by complete AV block. After pacemaker implantation using a transvenous right atrial and an epicardial ventricular lead, no VT reoccurrence could be documented.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: MELLERT, F., et al.: An Unusual Case of Pacemaker Failure: Complete Disconnection of Connector Block and Battery of a Subpectorally Implanted Dual Chamber Pacemaker. Local trauma to patients with implanted pacemaker devices may result in lead fracture or breakage of the lead socket with leakage of fluid into the connector system. This report describes an unusual case of complete entrance and exit block in a subpectorally implanted dual chamber pacemaker due to total disconnection and dislodgement of header block and battery part. Damage may be caused by an interaction of machine fatigue/manufacturing defective and fixation of the header with unusual movability of the battery, leading to breakage with intermittent malfunction and consecutive bradycardia and syncope.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: YANG, A., et al.: Advanced Pacemaker Diagnostic Features in the Characterization of Atrial Fibrillation: Impact on Preventive Pacing Algorithms. Pacing algorithms to prevent PAF are mainly based on the suppression of premature atrial complexes (PACs), which play an important role in its initiation. In contrast to 24-hour ambulatory electrocardiograms, advanced pacemaker (PM) diagnostic features are capable of recording AF episodes during long follow-up periods and of characterizing AF in a detailed fashion. For the specific use of these algorithms, a detailed characterization of AF was performed in 91 dual chamber PM recipients with histories of AF. Fifteen patients with episodes of oversensing due to far-field signals or frequent episodes of “2:1-undersensing” of atrial flutter were excluded. The remaining 76 patients had high recurrence rates of AF (median 0.8 episodes/day), however, the majority of episodes lasted 〈7 minutes. Despite frequent PACs (median 10.8/hour) during sinus rhythm, a median of 66.4% of the AF episodes were preceded by 〈2 PACs/min before onset. In conclusion, frequent, short-lived AF episodes seem best suited for AF preventive pacing therapies. However, the small number of PACs preceding many AF episodes may limit the efficacy of PAC suppressing algorithms. (PACE 2003; 26[Pt. II]:310–313)
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] Ventricular tachyarrhythmias are the main cause of sudden death in patients after myocardial infarction. Here we show that transplantation of embryonic cardiomyocytes (eCMs) in myocardial infarcts protects against the induction of ventricular tachycardia (VT) in mice. Engraftment of eCMs, but not ...
    Type of Medium: Electronic Resource
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