RESUMEN
The therapeutic use of autologously prepared platelet-leukocyte gel (PLG) is a relatively new technology which might stimulate and accelerate soft-tissue and bone healing. The effectiveness of this procedure lies in the exogenous delivery of a wide range of platelet growth factors, intentionally released from autologously prepared PLG. The rationale to employ this technique is to mimic physiological wound healing and reparative tissue processes. Despite an increase in clinical PLG applications, the structures and kinetics of this biological material have not been completely examined. Electron microscopic imaging was performed to evaluate platelet-leukocyte gel structures. Furthermore, directions for PLG application are presented, based on results from published articles in various surgical disciplines. In conclusion, PLG can be useful in a wide range of clinical applications to enhance healing following surgical procedures, since exogenous applied PLG releases instantly platelet growth factors, in the presence of leukocytic cells.
Asunto(s)
Pérdida de Sangre Quirúrgica/prevención & control , Adhesivo de Tejido de Fibrina/uso terapéutico , Transfusión de Leucocitos/métodos , Transfusión de Plaquetas/métodos , Plaquetas/fisiología , Plaquetas/ultraestructura , Geles , Humanos , Leucocitos/fisiología , Leucocitos/ultraestructura , Microscopía Electrónica , Cicatrización de HeridasRESUMEN
BACKGROUND: The therapeutic use of autologously prepared, platelet-leukocyte-enriched gel (PLG) is a relatively new technology for the stimulation and acceleration of soft tissue and bone healing. The effectiveness of this procedure lies in the delivery of a wide range of platelet growth factors mimicking the physiologic wound healing and reparative tissue processes. Despite an increase in PLG applications, the structures and kinetics of this autogenously derived biologic material have not been observed. METHODS: A review of the most recent literature was performed to evaluate the use of PLG in various surgical disciplines. RESULTS: The review showed that the application of PLG has been extended to various surgical disciplines including orthopedics, cardiac surgery, plastic and maxillofacial surgery, and recently also endoscopic surgery. CONCLUSION: This review demonstrates the usefulness of PLG in a wide range of clinical applications for improvement of healing after surgical procedures.
Asunto(s)
Productos Biológicos/administración & dosificación , Plaquetas , Leucocitos , Procedimientos Quirúrgicos Operativos , Trasplante Autólogo/métodos , Cicatrización de Heridas/efectos de los fármacos , Animales , Sistemas de Liberación de Medicamentos/instrumentación , Curación de Fractura/efectos de los fármacos , Geles , Hemostasis Endoscópica/instrumentación , Hernia Abdominal/cirugía , Humanos , Factor de Crecimiento Derivado de Plaquetas/uso terapéutico , Traumatismos de los Tejidos Blandos/tratamiento farmacológico , Infección de la Herida Quirúrgica/prevención & control , Ingeniería de Tejidos/instrumentación , Ingeniería de Tejidos/métodos , Resultado del TratamientoRESUMEN
Three commercial systems for whole blood separation were compared to obtain the buffy coat composed of platelet-rich plasma (BC-PRP) and leucocytes . These samples of the buffy coat were used to make a platelet gel (PG), which was used to measure platelet growth factor (PGF) release, to perform a white blood cell (WBC) count and to measure myeloperoxidase (MPO) release from WBCs. Aliquots of whole blood obtained from ten volunteers were distributed either to a blood cell separator (The Electa Cell-Separator, E-CS) or to a tabletop centrifuge (Gravitational Platelet Sequestration System, GPS) to prepare the BC-PRP. The third system combines the BC-PRP production by E-CS with a micro porous filter (Autologous Growth Factor filter, AGF) to enrich for the BC-PRP. Autologous thrombin was used to activate the BC-PRP and to prepare the PG and subsequently to degranulate the platelet concentrate. Platelet-derived growth factor-AB and transforming growth factor-beta1 were present in high levels after thrombin activation of the E-CS or GPS prepared samples. However, the AGF prepared samples released their growth factors before thrombin activation. The WBCs were significantly increased with each of the three systems. Contrary to the AGF, no leucocyte degranulation occurred with the E-CS or GPS prepared samples, based upon the low MPO concentrations in the BC-PRP. The three types of apparatus had different harvesting capacities for collecting the enriched platelets and the release of high concentrations of PGF. When the E-CS and GPS, but not the AGF, were used, low levels of MPO were maintained in the PG, which potentially contributes to antimicrobial properties of platelet gel at the site of application.
Asunto(s)
Eliminación de Componentes Sanguíneos/métodos , Plaquetas , Adhesivo de Tejido de Fibrina/química , Peroxidasa/análisis , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Factor de Crecimiento Transformador beta/metabolismo , Adulto , Eliminación de Componentes Sanguíneos/instrumentación , Transfusión de Sangre Autóloga , Geles , Humanos , Recuento de Leucocitos , Leucocitos/metabolismo , Activación Plaquetaria , Factor de Crecimiento Transformador beta1 , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease. METHODS: A total of 1205 patients were randomly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique. The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year. The costs of hospital resources used were also determined. RESULTS: At one year, there was no significant difference between the two groups in terms of the rates of death, stroke, or myocardial infarction. Among patients who survived without a stroke or a myocardial infarction, 16.8 percent of those in the stenting group underwent a second revascularization, as compared with 3.5 percent of those in the surgery group. The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery (P<0.001 by the log-rank test). The costs for the initial procedure were $4,212 less for patients assigned to stenting than for those assigned to bypass surgery, but this difference was reduced during follow-up because of the increased need for repeated revascularization; after one year, the net difference in favor of stenting was estimated to be $2,973 per patient. CONCLUSION: As measured one year after the procedure, coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death, stroke, and myocardial infarction. However, stenting is associated with a greater need for repeated revascularization.
Asunto(s)
Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Enfermedad Coronaria/terapia , Stents , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/economía , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/prevención & control , Puente de Arteria Coronaria/economía , Enfermedad Coronaria/mortalidad , Análisis Costo-Beneficio , Creatina Quinasa/sangre , Forma MB de la Creatina-Quinasa , Complicaciones de la Diabetes , Supervivencia sin Enfermedad , Femenino , Costos de Hospital , Humanos , Isoenzimas/sangre , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/prevención & control , Calidad de Vida , Recurrencia , Stents/economía , Resultado del TratamientoRESUMEN
We compared the changes in troponin T, creatine MB isoenzyme mass concentration (CK-MB mass), creatine kinase MB isoenzyme activity (CK-MB activity), creatine kinase (CK), alpha-hydroxybutyrate dehydrogenase (HBD), lactate dehydrogenase (LD) and aspartate aminotransferase (AST) concentrations after coronary artery grafting with saphenous vein grafts, without or in combination with uni- or bilateral internal mammary artery(ies) as bypass vessels in 73 patients. An increase in CK concentration after surgery was highest for the bilateral internal mammary artery bypass patient group and lowest for the group who received only saphenous vein grafts. We present 90th percentile values for the seven tests.
Asunto(s)
Arterias Mamarias/fisiología , Aspartato Aminotransferasas/sangre , Puente de Arteria Coronaria , Creatina Quinasa/sangre , Femenino , Humanos , Hidroxibutirato Deshidrogenasa/sangre , L-Lactato Deshidrogenasa/sangre , Masculino , Factores de Tiempo , Troponina T/sangreRESUMEN
The aim of this study is to differentiate between transmural perioperative myocardial infarction (T-PMI) and subendocardial perioperative myocardial injury (S-PMI) as a complication of coronary artery bypass grafting (CABG). Seventy-three patients undergoing CABG were followed post operatively by measuring troponin T, CK-MB isoenzyme mass concentration (CK-MB mass), creatine kinase MB isoenzyme activity (CK-MB activity), creatine kinase (CK), alpha hydroxybutyrate dehydrogenase (HBD), and aspartate aminotransferase (AST) at five sampling times. Lacking a proper definition of the gold standard for the diagnosis of perioperative myocardial infarction, a statistical procedure was used. Supported by the cluster analysis method of Ward, patients were assigned to a patient group with a perioperative myocardial infarction (PMI) or a patient group without a PMI (non-PMI) as a confirmation of interpretation of the biochemical results. Using the results of electrocardiogram (ECG) and echocardiography, the PMI patient group was split into a T-PMI patient group and a S-PMI patient group. With discriminant analysis, two canonic discriminant functions were drawn up to differentiate between patients suffering from a T-PMI or S-PMI and non-PMI patients.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Endocardio/lesiones , Infarto del Miocardio/diagnóstico , Aspartato Aminotransferasas/sangre , Análisis por Conglomerados , Creatina Quinasa/sangre , Diagnóstico Diferencial , Análisis Discriminante , Endocardio/enzimología , Femenino , Hemólisis , Humanos , Isoenzimas , Masculino , Persona de Mediana Edad , Infarto del Miocardio/enzimología , Infarto del Miocardio/etiología , Troponina/sangre , Troponina TRESUMEN
At the present time, plastic syringes are most commonly used for collecting arterial blood. The oxygen tension of the arterial blood (Pa,O2) in these syringes may fall. We studied the effect of the type of syringe, metabolism, and storage time on the arterial oxygen pressures measured and on the pulmonary shunt calculated. In 10 patients, 2-3 h after aortacoronary bypass surgery, a 100% oxygen test was performed. Four arterial blood gas samples were withdrawn from each patient in random order, two in glass syringes and two in plastic syringes. One glass and one plastic syringe were stored at room temperature (RT), and the others were stored in ice-water (IW). Each sample was analysed as soon as possible, and repeated 15, 30, 60 and 120 min after sampling. The Pa,O2 measurement in blood in the glass syringe in IW measured as soon as possible after sampling was considered the "gold standard". Pulmonary shunt calculations were performed using the results of the various blood gas analyses. Compared with the "gold standard", all of the other methods showed significant deterioration in the Pa,O2 measurement. The effect due to diffusion was 0.05 kPa x min(-1), and that due to metabolism 0.11 kPa x min(-1). The Pa,O2 in the glass syringes stored in IW remained stable with time. The pulmonary shunt was significantly overestimated when the "gold standard" blood gas results were not used (range 0.8-9.9%). Glass (not plastic) syringes should be used in the 100% oxygen test. The syringe should be cooled immediately, even when the sample is analysed as soon as possible.
Asunto(s)
Análisis de los Gases de la Sangre/métodos , Recolección de Muestras de Sangre/métodos , Vidrio , Consumo de Oxígeno/fisiología , Oxígeno/sangre , Jeringas , Derivación Arteriovenosa Quirúrgica , Recolección de Muestras de Sangre/instrumentación , Dióxido de Carbono/sangre , Puente de Arteria Coronaria , Seguridad de Equipos , Humanos , Ensayo de Materiales , Plásticos , TemperaturaRESUMEN
OBJECTIVES: We attempted to analyze the efficacy and safety of an extensive blood saving program applied in a large cohort of patients. MEASURES: Blood saving included reinfusion of intraoperative predonated blood, aprotinin (2 million KIU) in the prime solution, reinfusion of any residual volume, postoperative acceptance of normovolemic anemia (hematocrit > or = 25%) and autotransfusion of shed blood. SETTING, EXPERIMENTAL DESIGN AND PATIENTS: In our general hospital with a heart surgery service (1150 cases/year), we studied the records of 527 non-selected consecutive patients, who were prospectively treated with this program being applied in primary myocardial revascularization between. RESULTS: We avoided the use of donor blood in 86.9% of the patients requiring a mean of 0.2+/-0.01 unit of donor blood per patient. No repeat thoracotomy for bleeding was needed in any patient. Univariate analysis revealed that female gender, a low level of hematocrit, high age, a small stature, weight, body surface area, and red cell volume prebypass significantly (p<0.001) were correlated to treatment with donor blood. Multiple regression showed that a small red cell volume and a low prebypass hematocrit were the most (p<0.0001) significant predictors for the use of donor blood. Observing a low incidence of morbidity (myocardial infarction, gastrointestinal, neurological thromboembolic, renal and wound complications), the safety of this program seems to be emphasized. CONCLUSIONS: Extensive blood saving including low-dose aprotinin reduced effectively and safely the need for donor blood in a large cohort of patients.
Asunto(s)
Aprotinina/administración & dosificación , Transfusión de Sangre Autóloga , Transfusión Sanguínea , Hemostáticos/administración & dosificación , Revascularización Miocárdica , Anciano , Donantes de Sangre , Pérdida de Sangre Quirúrgica , Volumen de Eritrocitos , Femenino , Hematócrito , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Análisis de Regresión , SeguridadRESUMEN
Retrospectively, the first 143 patients who were operated on with bilateral internal thoracic arteries (BITA group) were matched with 143 patients operated on with only one left internal thoracic artery anastomosed on the left anterior descending artery and additional vein grafts (LITA group) and followed up for a maximum of 8 years. At 5 years follow-up there were no significant differences in event-free survival between the groups. After 8 years, the overall survival was 96% and 92% (not significant [NS]), cardiac survival 99% and 97% (NS), angina-free cardiac survival 51% and 35% (NS), infarction-free cardiac survival 95% and 78% (NS), reintervention-free cardiac survival 87% and 88% (NS), and all cardiac event-free survival 49% and 31% (NS) for the BITA and LITA groups, respectively. The incidence of late pulmonary, wound, and other complications was comparable. Cox proportional hazards analysis showed that a higher left ventricular end-diastolic pressure and female sex were predictors of recurrent angina and late cardiac events. During this intermediate-term follow-up, the use of one or two internal thoracic arteries was of no value in predicting angina-free or cardiac event-free survival.
Asunto(s)
Puente de Arteria Coronaria/métodos , Arterias Torácicas/trasplante , Adulto , Anciano , Causas de Muerte , Puente de Arteria Coronaria/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores Sexuales , Volumen SistólicoRESUMEN
In 20 patients undergoing coronary artery bypass grafting, we studied prospectively systemic blood activation, blood loss, and the need for donor blood when using an extracorporeal circuit equipped at random with one of two different venous reservoirs. In 10 patients we used an open venous reservoir system (ORS) consisting of a hard shell venous reservoir with an integral cardiotomy filter, and in 10 patients we used a closed reservoir system consisting of a collapsible venous reservoir and separate cardiotomy reservoir. Concentrations of complement 3a, elastase, thromboxane B2, and fibrin degradation products showed a biphasic course, especially in ORS patients. During bypass, we observed a first peak of levels of complement 3a, thromboxane B2, fibrin degradation products, and elastase, which was higher in ORS patients than in patients with the closed system, because their blood continuously contacted the foreign materials of the filter and air in the open reservoir, which was avoided in the closed reservoir. Intensive blood-foreign material contact also caused the highest (p < 0.05) hemolysis in ORS patients. The larger amount of hemolytic products in ORS patients theoretically resulted in a temporary decrease in capacity of their Kupffer cells to clear endotoxin released after aortic declamping. This theory might explain the significantly (p < 0.01) higher second peak of activated products after declamping that was observed in ORS patients. Due to increased blood activation, the largest (p < 0.001) amount of shed blood loss, greatest (p < 0.05) need for colloid-crystalloid infusion, and largest (not significant) need for donor blood were found in ORS patients (0.8 +/- 0.4 versus 0.2 +/- 0.2 units of packed cells).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Puente Cardiopulmonar/instrumentación , Hemólisis/fisiología , Anciano , Pérdida de Sangre Quirúrgica , Transfusión Sanguínea , Puente Cardiopulmonar/efectos adversos , Complemento C3a/metabolismo , Puente de Arteria Coronaria , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Persona de Mediana Edad , Elastasa Pancreática/sangre , Estudios Prospectivos , Tromboxano B2/sangreRESUMEN
The hospital morbidity and mortality of 100 patients operated with two internal thoracic arteries with or without additional vein grafts (BITA group) were compared with a matched group of 100 patients operated with one left internal thoracic artery (ITA) on the anterior descending artery with additional vein grafts (LITA control group). In each study group, 3% of the patients had diabetes mellitus. There was no statistical significant difference in hospital mortality (1% versus 0%), perioperative myocardial infarction (5% versus 1%), low cardiac output (3% versus 5%), rethoracotomy (1% versus 0%), lung complications (13% versus 13%), wound complications (8% versus 8%), other cardiac complications (26% versus 16%), other noncardiac complications (1% versus 4%), median duration of stay in the intensive care unit (1 versus 1 day), and mean duration of stay in the hospital (10.4 versus 10.8 days) between the groups. Logistic regression analysis showed that the number of ITAs used was not a predictor of complications. Thus, there is no difference between the BITA and LITA control group in hospital mortality and morbidity (in patients with a low incidence of diabetes). If an improvement in cardiac event-free and reoperation-free survival is to be expected, the use of both ITAs can be continued in similar patients.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Arterias Torácicas/trasplante , Adulto , Anciano , Anastomosis Quirúrgica/métodos , Arritmias Cardíacas/etiología , Gasto Cardíaco Bajo/etiología , Estudios de Casos y Controles , Puente de Arteria Coronaria/mortalidad , Cuidados Críticos , Femenino , Paro Cardíaco Inducido , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Enfermedades Pulmonares/etiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Países Bajos/epidemiología , Estudios Retrospectivos , Vena Safena/trasplante , Tasa de SupervivenciaRESUMEN
To evaluate the extent of shed blood activation in two autotransfusion systems and the effect of circulating blood activation upon autotransfusion, we performed a prospective study in 18 patients undergoing internal mammary artery bypass operation and a control group of 10 patients. The autotransfusion systems were from Sorin (n = 9) consisting of a hard shell reservoir with a filter having a small contact area (0.32 m2), and from Dideco (n = 9) consisting of a hard shell reservoir with a filter having a larger contact area (4.64 m2). We found high concentrations of thromboxane, fibrinogen degradation products, complement split product C3a, and elastase in the shed blood and, with the exception of C3a, in the circulating blood of autotransfused patients. There was no such activation in control patients. The degree of the systemic inflammatory reaction was determined by the type of autotransfusion system and by the amount of infused shed blood. The Dideco system provoked more inflammatory response than did the Sorin. This was reflected by the larger shed blood loss during autotransfusion in the Dideco patients than in Sorin patients, resulting in infusion of more shed blood (means, 737 mL versus 566 mL; not significant). After autotransfusion, Dideco patients shed significantly more blood than did Sorin or control patients (p < 0.05). Dideco patients also needed more colloid/crystalloid solution per 24 hours than Sorin patients (p < 0.05). This became clinically relevant only after infusion of more than 800 mL of shed blood (p < 0.001): hemodilution indicated the need for packed cells in 4 Dideco patients and in 1 Sorin patient.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Transfusión de Sangre Autóloga , Hemostasis , Pérdida de Sangre Quirúrgica , Transfusión Sanguínea , Transfusión de Sangre Autóloga/instrumentación , Complemento C3a/análisis , Puente de Arteria Coronaria , Soluciones Cristaloides , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hemodinámica , Humanos , Soluciones Isotónicas , Masculino , Persona de Mediana Edad , Elastasa Pancreática/sangre , Sustitutos del Plasma/administración & dosificación , Estudios Prospectivos , Tromboxano B2/sangreRESUMEN
Continuous retrograde hypothermic low flow cerebral perfusion (CRCP) with deep hypothermic systemic circulatory arrest (DHSCA) during aortic arch surgery was employed in six patients, aged 21-79 years. From August 1991 to November 1992, five of these patients were operated for ascending and arch aortic dissection type I, and one patient was operated for an aneurysm extending from the ascending aorta into the arch. Cardiopulmonary bypass (CPB) technology included a centrifugal pump and low-dose aprotinin. Venous drainage was established via the superior and inferior caval veins and arterial return via the femoral artery. Prior to CPB, a bypass line connecting the arterial line with the superior vena cava cannula was implemented. Prior to DHSCA, the patients were systemically cooled to a mean nasopharyngeal temperature of 15.2 degrees C. After induction of systemic circulatory arrest, the femoral artery cannula was clamped. Thereafter, the implemented bypass line was opened to achieve reverse flow into the superior vena cava to allow venoarterial perfusion. The perfusate was returned to the CPB circuit through drainage from the inferior caval vein and by aspiration of blood from the opened aortic arch. CRCP flow rate ranged from 250 to 450 ml/min (mean 375 ml/min) maintaining an internal jugular vein pressure between 18 and 25 mmHg. The duration of CRCP ranged from 24 to 55 minutes (mean 39 minutes). Postoperatively, one patient died of cardiac failure. The other five patients regained full consciousness without neurological deficits, as defined by the Glasgow coma score, within 48 hours after the operation. Neither did we see other major organ complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Puente Cardiopulmonar , Circulación Cerebrovascular , Paro Cardíaco Inducido , Hipotermia Inducida/métodos , Perfusión/métodos , Adulto , Anciano , Aneurisma de la Aorta Torácica/cirugía , Diseño de Equipo , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidadRESUMEN
The merits of reinfusing prebypass-removed autologous blood (intraoperative predonation) to salvage blood and improve postoperative hemostasis are still debated, specifically for patients at a higher risk for bleeding. To evaluate the effect of intraoperative predonation on the platelet count, blood hemoglobin content, and blood saving postoperatively, we retrospectively studied 100 matching patients. All patients underwent internal mammary artery bypass surgery resulting in a considerable blood loss postoperatively. Intraoperative predonation (800 ml), reinfusion of the residual volume of the extracorporeal circuit, autotransfusion of shed blood, and acceptance of normovolemic anemia postoperatively was the approach adopted in 50 patients (group 1). A similar blood salvage program, excluding intraoperative predonation, was carried out in the other 50 patients (group 2), and these served as the control group. The platelet counts and blood hemoglobin content were significantly higher postoperatively (p < 0.01) in the predonated patients than in the control patients. However, the net blood loss, the amount of retransfused shed blood, and the blood requirements postoperatively were significantly less (p < 0.01) in the predonated patients than in the control patients, whereas 65% of the predonated patients versus 10% of the control patients did not need any donor blood products. In conclusion, predonation reduces the postoperative blood loss and thereby importantly ameliorates the blood-saving effect of a blood salvage program after IMA procedures.
Asunto(s)
Transfusión de Sangre Autóloga , Hemostasis Quirúrgica/métodos , Revascularización Miocárdica/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Estudios RetrospectivosRESUMEN
All postoperative complications, including transient ischaemic attacks (TIA) and cerebrovascular accidents (CVA) of 259 patients, in whom a total of 301 Monostrut tilting-disc valves were implanted between January 1985 and December 1991 were evaluated retrospectively. The follow-up was maximally 8 years, with a mean of 3.5 years, and totaled 914 patient-years. In this study we found no mechanical deterioration of the Monostrut valve and demonstrated the elimination of valve thrombosis in patients receiving adequate anticoagulation. The actuarial probability of being free of thrombo-embolism was 94.7% +/- 1.7% and free of anticoagulant related hemorrhage 95.4% +/- 1.5% at 8-years. In comparison with earlier reports by others, our findings show a lower ratio of thromboembolic and hemorrhagic events. We demonstrated a correlation (p < 0.05) between thrombo-embolic and hemorrhagic complications. In addition, a lower incidence of CVA's (0.22 per 100 patient-years), but a higher incidence of TIA's (0.66 per 100 patient-years) in comparison with the general Dutch population was found. At eight years follow-up, all patients were in Class I or II of the New York Heart Association Classification. Although the overall valve related event-free survival at eight years was only 47.9%, 93.5% of the patient were satisfied with their operative result. Predictive factors for late mortality were the occurrence of paravalvular leakage (p < 0.01), the age of the patient at the time of operation (p < 0.01) and the number of diseases coronary arteries (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Prótesis Valvulares Cardíacas , Adulto , Anciano , Anciano de 80 o más Años , Válvula Aórtica , Causas de Muerte , Femenino , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/mortalidad , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Válvula Mitral , Países Bajos/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Pronóstico , Diseño de Prótesis/estadística & datos numéricos , Falla de Prótesis , Reoperación/estadística & datos numéricosRESUMEN
The effect of preoperative low-dose aspirin (1 mg/kg of body weight) and intraoperative low-dose aprotinin (2 million kallikrein inactivator units) treatment on perioperative blood loss and blood requirements in patients who undergo internal mammary artery bypass operations is unknown. Therefore, we retrospectively studied 75 matching patients who underwent internal mammary artery operations, and they were allocated to one of three groups: low-dose aspirin and aprotinin treatment (group 1, n = 25), low-dose aspirin treatment without aprotinin (group 2, n = 25), and neither aspirin nor aprotinin treatment (group 3, n = 25). Although the perioperative blood loss was similar, the blood requirements tended to be higher (p = 0.09) in the patients who were treated with aspirin (group 2) than in the control patients (group 3). When aprotinin was added to the priming solution in patients who were treated with aspirin (group 1), blood loss was significantly lower (p < 0.05) than that of group 2 patients but not of control patients. Blood requirements were significantly lower (p < 0.01) than those of patients in groups 2 and 3. Blood products were needed in 29%, 62%, and 75% of patients in groups 1, 2, and 3, respectively.
Asunto(s)
Aprotinina/administración & dosificación , Aspirina/administración & dosificación , Pérdida de Sangre Quirúrgica/prevención & control , Anastomosis Interna Mamario-Coronaria , Premedicación , Transfusión de Componentes Sanguíneos , Quimioterapia Combinada , Urgencias Médicas , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Plasma , Transfusión de Plaquetas , Estudios RetrospectivosRESUMEN
This prospective trial evaluated the safety and efficacy of a new pulsatile, temporary ventricular assist device, the BVS 5000. Patients were eligible for treatment if they were hemodynamically unstable despite maximal pharmacologic and intraaortic balloon pump therapy, were free of concomitant complications, and were less than 6 hours from the first attempt to separate from cardiopulmonary bypass. Fifty-five postcardiotomy patients were enrolled; 31 met all selection criteria and the remainder failed to meet criteria (n = 15) or were not successfully supported (n = 9). The BVS 5000 effectively restored hemodynamics: Mean arterial pressure increased (77.1 +/- 8.0 mm Hg on-support versus 50.1 +/- 15.3 mm Hg presupport; p = 0.0001). Cardiac index increased (2.3 +/- 0.3 L.min-1.m-2 on-support versus 1.6 +/- 0.6 L.min-1.m-2 presupport; p = 0.0013). Left ventricular filling pressure decreased (11.9 +/- 4.5 mm Hg on-support versus 23.8 +/- 8.7 mm Hg presupport; p = 0.0030). The most frequent complication was bleeding in 42 patients (76%). Of the patients meeting all criteria, 17 (55%) were weaned from support and 9 (29%) were discharged. Survival was significantly influenced by presupport cardiac arrest events. Survival among patients not experiencing arrest was 47%. Eight patients are long-term survivors and were asymptomatic in New York Heart Association class I or II at 1-year follow-up. The BVS 5000 restored hemodynamics, permitted myocardial recovery, and improved survival in a group of patients who would have otherwise died.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Corazón Auxiliar , Choque Cardiogénico/terapia , Adulto , Anciano , Estudios de Evaluación como Asunto , Femenino , Hemodinámica , Humanos , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Choque Cardiogénico/etiología , Choque Cardiogénico/mortalidad , Choque Cardiogénico/fisiopatología , Tasa de SupervivenciaRESUMEN
Thirty patients operated on for aortic coarctation while less than 3 years of age underwent magnetic resonance imaging, digital subtraction angiography, and bicycle exercise testing 14 to 33 years (mean, 22 years) after operation. Diameters of the aorta at the site of the anastomosis, of the distal arch, and of the aorta at the level of the diaphragm were measured in the images. Blood pressures were obtained from the right arm and leg before and after exercise. Patients were divided into three groups according to blood pressure data: group I, resting gradient less than 30 mm Hg and exercise gradient less than 50 mm Hg; group II, resting gradient less than 30 mm Hg and exercise gradient greater than 50 mm Hg; and group III, resting gradient 30 mm Hg or greater. A control group underwent the same test. The frequency of hypertensive patients was greater in groups II (58%) and III (100%) than in group I (20%). The anastomosis/descending aorta ratio seen in digital subtraction angiograms was smaller in group II and III patients. Exercise blood pressure gradient correlated significantly (r = -0.48; p = 0.009) with anastomosis/descending aorta ratio in digital subtraction angiograms but not in magnetic resonance images. Twenty of 30 patients (67%) had a significant anatomic narrowing at the site of the anastomosis. Blood pressure data correlated with diameters measured in digital subtraction angiograms but not with diameters measured in magnetic resonance images.
Asunto(s)
Coartación Aórtica/cirugía , Monitoreo Fisiológico , Adolescente , Adulto , Factores de Edad , Anastomosis Quirúrgica/efectos adversos , Angiografía de Substracción Digital , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Aorta Torácica/cirugía , Coartación Aórtica/diagnóstico por imagen , Coartación Aórtica/patología , Coartación Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/etiología , Brazo/irrigación sanguínea , Presión Sanguínea/fisiología , Dilatación Patológica/etiología , Prueba de Esfuerzo , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Pierna/irrigación sanguínea , Imagen por Resonancia Magnética , Pulso Arterial , Recurrencia , DescansoRESUMEN
In an attempt to perform complete coronary revascularization with only arterial conduits in a 44 year-old male, both internal mammary arteries and the right gastroepiploic artery were harvested. The right gastroepiploic artery, however, showed an anatomical variation that excluded its use as a pedicled graft.