RESUMEN

BACKGROUND/AIM: Tissue pathogenesis of aortic valve (AV) stenosis is research focus in cardiac surgery. Model limitations of conventional 2D culture of human or porcine valvular interstitial/endothelial cells (VIC/VECs) isolated from aortic valve tissues but also limited ability of (small) animal models to reflect human (patho)physiological situation in AV position raise the need to establish an in vitro setup using AV tissues. Resulting aim is to approximate (patho)physiological conditions in a dynamic pulsatile Microphysiological System (MPS) to culture human and porcine AV tissue with preservation of tissue viability but also defined ECM composition. MATERIALS/METHODS: A tissue incubation chamber (TIC) was designed to implement human or porcine tissues (3×5 mm2) in a dynamic pulsatile culture in conventional cell culture ambience in a MPS. Cell viability assays based on lactate dehydrogenase (LDH)-release or resazurin-conversion were tested for applicability in the system and applied for a culture period of 14 days with interval evaluation of tissue viability on every other day. Resazurin-assay setup was compared in static vs. dynamic culture using varying substance saturation settings (50-300µM), incubation times and tissue masses and was consequently adapted. RESULTS: Sterile dynamic culture of human and porcine AV tissue segments was established at a pulsatile flow rate range of 0.9-13.4µl/s. Implementation of tissues was realized by stitching the material in a thermoplastic polyurethane (TPU)-ring and insertion in the TIC-MPS-system. Culture volume of 2 ml caused LDH dilution not detectable in standard membrane integrity assay setup. Therefore, detection of resazurin-conversion of viable tissue was investigated. Optimal incubation time for viability conversion was determined at two hours at a saturated concentration of 300µM resazurin. Measurement in static conditions was shown to offer comparable results as dynamic condition but allowing optimal handling and TIC sterilization protocols for long term culture. Preliminary results revealed favourable porcine AV tissue viability over a 14 day period confirmed via resazurin-assay comparing statically cultured tissue counterparts. CONCLUSIONS: Human and porcine AV tissue can be dynamically cultured in a TIC-MPS with monitoring of tissue viability using an adapted resazurin-assay setup. Preliminary results reveal advantageous viability of porcine AV tissues after dynamic TIC-MPS culture compared to static control.

Asunto(s)

Estenosis de la Válvula Aórtica , Válvula Aórtica , Animales , Células Endoteliales , Humanos , Oxazinas , Porcinos , Supervivencia Tisular , Xantenos

RESUMEN

Adipose tissue is not only a connective tissue but also an endocrine organ secreting adipokines like Leptin and Adiponectin, lipokines such as palmitoileic acid and extracellular vesicles. These factors and the expression of matrix remodeling enzymes impact surrounding tissues via paracrine effects. The expression of selected secretion factors and the effect of adipocyte conditioned media from four thoracal adipose tissue origins - subcutaneous, perivascular, pericardial and epicardial adipose tissues - in a fibroblast proliferation/wound healing scratch assay model were investigated. Results were compared directly and according to the type 2 diabetic mellitus (T2DM) status of the patients the tissues are originated from. Adipocyte conditioned media from non-diabetic patients resulted in a significant higher scratch closure rate compared to the media with T2DM background. Linoleic acid incubation in scratch assay resulted in a reduced scratch closure rate. Leptin, Adiponectin and Visfatin/Nampt expression and MMP2, MMP9 and FSTL1 mRNA levels did not vary according to T2DM subgroups directly, leading to the assumption that these factors are not causal for scratch assay effects observed. In contrast significant mRNA expression differences were monitored between the thoracal tissue origins implying variations in the local effects of the different adipose tissue depots.

Asunto(s)

Adipocitos/metabolismo , Adipoquinas/metabolismo , Diabetes Mellitus Tipo 2/complicaciones , Fibroblastos/metabolismo , Grasa Subcutánea/metabolismo , Anciano , Humanos

RESUMEN

AIM: Isolated mitral valve endocarditis (MVE) forms a particular subgroup within native infective valve endocarditis (NVE). We characterized this particular subgroup and analyzed the course of patients undergoing cardiac surgery. METHODS: Between 1997 and 2011, 474 patients underwent cardiac surgery at our institution for NVE treatment. Of these, 89 patients (18.8%) suffered from MVE. Valve replacement was undertaken in 84.2% and valve repair in 15.8%. Follow-up was completed with 267 patient years. RESULTS: A delay between the onset of first symptoms and surgery of 4.7±1.2 weeks was observed. Hence, most patients were in a critical preoperative state characterized by severe sepsis and destruction of the mitral valve. About 19.4% were emergency procedures. The MVE group presented with a higher prevalence of preoperative stroke, atrial fibrillation, coronary artery disease and chronic obstructive pulmonary disease in comparison with remaining NVE cases. MVE was more likely caused by Staphylococcus aureus; Staphylococcus epidermidis and Staphylococcus viridans were less frequent (P<0.01 each). Early mortality (6.7%) was caused by persistent sepsis. ICU stay >7 days and time on artificial ventilation >40 h led to a higher risk of in-hospital death. Five-year survival was 59.6% and affected by extracardiac comorbidities. CONCLUSION: Isolated MVE was characterized by a long delay before surgery, differences in microbiological findings and a higher prevalence of preoperative strokes in comparison to NVE. Surgery for MVE can be conducted with good clinical results, but mid-term outcome is limited by extracardiac comorbidities.

Asunto(s)

Endocarditis Bacteriana/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Anuloplastia de la Válvula Mitral , Válvula Mitral/cirugía , Infecciones Estafilocócicas/cirugía , Comorbilidad , Enfermedad Crítica , Urgencias Médicas , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/microbiología , Anuloplastia de la Válvula Mitral/efectos adversos , Anuloplastia de la Válvula Mitral/mortalidad , Prevalencia , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Sepsis/microbiología , Sepsis/cirugía , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento

RESUMEN

AIM: Identification of patients at high risk for readmission to the Intensive Care Unit (ICU) after cardiac surgery is paramount. We evaluated the clinical characteristics of readmitted patients and identified perioperative prognostic variables for ICU readmission. METHODS: A total of 7105 patients who underwent cardiac surgery between 2007 and 2010 and discharged after a primary stay in the ICU were reviewed retrospectively. Of these, 7.8% (554) patients were readmitted. The reasons for readmission and postoperative course were analyzed. Perioperative risk factors for readmission were determined by multivariate regression analysis. RESULTS: Mortality of patients after readmission was 13.6% compared with 0.2% without recidivism (P<0.0001). Mean length of stay in hospital of patients requiring readmission was 24.9 ± 19.1 days and significantly longer compared to all other patients 12.3±8.4 days (P<0.0001). The main reasons for readmission were respiratory failure (39.0%) and cardiovascular instability (26.2%). Complex cardiac surgery, aortic surgery and extended stay in the ICU were the most powerful variables to predict ICU readmission. CONCLUSION: ICU readmission was related to complex surgery and associated with impaired outcome. Respiratory complications were the most common reasons for readmission. Predictive renal and pulmonary risk factors indicate the need of preoperative preconditioning and patient selection.

Asunto(s)

Procedimientos Quirúrgicos Cardíacos/efectos adversos , Unidades de Cuidados Intensivos , Readmisión del Paciente , Complicaciones Posoperatorias/terapia , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/mortalidad , Distribución de Chi-Cuadrado , Femenino , Alemania , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo

Asunto(s)

Embolia Paradójica/diagnóstico , Hipertensión Pulmonar/diagnóstico , Trombosis de la Vena/diagnóstico , Anciano , Anticoagulantes/uso terapéutico , Disnea/etiología , Ecocardiografía/métodos , Embolia Paradójica/patología , Femenino , Heparina/uso terapéutico , Humanos , Hipertensión Pulmonar/etiología , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/patología

RESUMEN

BACKGROUND: Intra-aortic balloon pump (IABP) is an established therapy to support patients with heart failure during coronary artery bypass grafting (CABG). The impact of the timing of IABP on the hospital course and on follow-up is of particular clinical interest. The purpose of this study was to analyze the relationship between the time of IABP implantation and its impact on early, mid- and long-term survival in patients with acute myocardial infarction (AMI) who underwent emergent CABG for NSTEMI and STEMI. METHODS: A total of 472 patients with AMI (NSTEMI and STEMI) underwent emergency CABG at our institution; 158 of them additionally received IABP support. Fifty-seven (36 %) patients received preoperative and 101 (64 %) patients underwent intraoperative IABP implantation. Endpoints were in-hospital und follow-up (mean duration 37 ± 28 months) survival. RESULTS: Overall in-hospital mortality was 17.1 % (n = 27): 17.6 % (n = 10) in the preoperative group and 16.8 % (n = 17) in the intraoperative group ( P = ns). Mid- and long-term survival rates were comparable for both groups 78.6 % vs. 73.7 %, 71.4 % vs. 68.7 % and 64.3 % vs. 54.6 % at 1, 3 and 5 years, respectively ( P = ns). CONCLUSION: This study demonstrates that CABG with IABP support in high-risk patients with AMI can be performed with acceptable in-hospital and long-term survival rates. The decision for IABP placement should consider the preoperative clinical condition and the intraoperative course of each patient. IABP placement does not appear to affect the long-term outcome after isolated CABG in patients with AMI.

Asunto(s)

Puente de Arteria Coronaria , Contrapulsador Intraaórtico , Infarto del Miocardio/cirugía , Sobrevivientes , Anciano , Distribución de Chi-Cuadrado , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Femenino , Alemania , Mortalidad Hospitalaria , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/mortalidad , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Sobrevivientes/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento

Asunto(s)

Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Prótesis Valvulares Cardíacas/microbiología , Lactococcus/aislamiento & purificación , Zoonosis/microbiología , Animales , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Explotaciones Pesqueras , Gentamicinas/uso terapéutico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Rifampin/uso terapéutico , Vancomicina/uso terapéutico

RESUMEN

Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. Therefore, the most adequate and gentle treatment is needed especially for this population. Since the first transcatheter aortic valve implantation (TAVI) was performed in 2002, the main implanting routes are the transfemoral, retrograde access through the common femoral artery, and the antegrade, transapical approach via anterolateral minithoracotomy. Meanwhile, TAVI has become an alternative treatment for patients who are not suitable candidates for surgical therapy in some centers.The initial clinical results are promising and have confirmed the feasibility of this technique. Due to the restricted long-term data, conventional aortic valve replacement still remains the standard for the treatment of aortic stenosis. Selection of the suitable therapy approach (surgical replacement, transfemoral or transapical aortic valve implantation) must consider each patient's specific risk profile and individual indication. Prospective, randomized trials will be necessary to assess the individual survival benefit of TAVI for various risk populations and to extend the indication.

Asunto(s)

Estenosis de la Válvula Aórtica/terapia , Calcinosis/terapia , Cateterismo Cardíaco , Implantación de Prótesis de Válvulas Cardíacas/métodos , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/mortalidad , Calcinosis/diagnóstico , Calcinosis/mortalidad , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/mortalidad , Femenino , Alemania , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Masculino , Selección de Paciente , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento

Asunto(s)

Aneurisma Roto/microbiología , Endocarditis Bacteriana/etiología , Hepatectomía/efectos adversos , Arteria Pulmonar/patología , Válvula Pulmonar/microbiología , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus/aislamiento & purificación , Anciano , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Antibacterianos/uso terapéutico , Antiinfecciosos/administración & dosificación , Carcinoma Hepatocelular/cirugía , Cilastatina/administración & dosificación , Ciprofloxacina/administración & dosificación , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Resultado Fatal , Humanos , Imipenem/administración & dosificación , Neoplasias Hepáticas/cirugía , Masculino , Inhibidores de Proteasas/administración & dosificación , Arteria Pulmonar/microbiología , Válvula Pulmonar/cirugía , Rotura Espontánea , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/terapia , Resultado del Tratamiento

RESUMEN

UNLABELLED: Immunosuppression using calcineurin inhibitors (CNIs) is accompanied by neuropsychiatric side effects, which counteract longevity and quality of life benefits in 10% to 28% of patients. Following the availability of the mammalian target of rapamycin (mTOR) inhibitors, it became possible to replace CNI without increasing the risk of acute graft rejection. mTOR, a member of the phosphatidyl inositol 3' kinase family, is a downstream target of brain-derived neurotrophic factor, which has been implicated in the pathophysiology and treatment of several psychiatric disorders. Preclinical evidence has implicated the mTOR pathway in synaptic plasticity and fear memory consolidation and reconsolidation. METHODS: In the present study we prospectively evaluated the psychiatric outcomes of CNI-free immunosuppression in adult maintenance heart transplant recipients (n = 9; age: 66.1 +/- 6.1) using the Wechsler Memory Scale-Revised (WMS-R), Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Trail Making Tests A and B, Digit Span (DS), and Hamilton Depression Scale (HAMD). RESULTS: Four weeks after switching to CNI-free immunosuppression using everolimus, BDI (Z = -1.14; P = .048), Trail Making tests A and B (Z = -2.52; P = .012), WMS-R (Z = 2.37; P = .018), and SCL-90-R (Z = -2.37; P = .018) were all significantly improved while DS (Z = -1.18; P = .236) and HAMD (Z = -0.595; P = .552) remained unchanged. CONCLUSION: This report describes favorable psychiatric outcome variables using everolimus in maintenance heart transplant recipients. CNI-free immunosuppression with everolimus might provide significant improvement in memory, concentration, and overall psychiatric symptoms among heart transplant recipients.

Asunto(s)

Afecto , Cognición/efectos de los fármacos , Trasplante de Corazón/inmunología , Trasplante de Corazón/psicología , Inmunosupresores/uso terapéutico , Péptidos y Proteínas de Señalización Intracelular/antagonistas & inhibidores , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Sirolimus/análogos & derivados , Adulto , Inhibidores de la Calcineurina , Depresión/prevención & control , Everolimus , Humanos , Terapia de Inmunosupresión/efectos adversos , Terapia de Inmunosupresión/métodos , Inmunosupresores/efectos adversos , Pruebas Psicológicas , Sirolimus/uso terapéutico , Serina-Treonina Quinasas TOR

RESUMEN

BACKGROUND: The mortality risk associated with coronary artery bypass grafting (CABG) after acute myocardial infarction remains controversial. The objective of the present study was therefore to analyze the outcome and predictors of in-hospital mortality in patients (pts) referred to CABG with acute coronary syndrome (ACS). PATIENTS AND METHODS: Between January 2003 and May 2005, a total of 3,127 pts underwent primary isolated CABG at our institution, including 220 pts with ACS. Out of these, unstable angina pectoris was present in 88 pts (group I), 97 pts (group II) had non-ST-elevation infarction, whereas 35 pts (group III) had ST-elevation infarction. Clinical data, in-hospital morbidity and mortality were recorded and studied retrospectively. RESULTS: Overall in-hospital mortality was 6.4% (n = 14) in the complete cohort, being 2.2% in group I (n = 2), 9.2% in group II (n = 9) and 8.5% (n = 3) in group III (P < 0.05). Logistic regression and receiver operating characteristic analyses identified age, NYHA, ejection fraction < 45%, catecholamine support, cardiogenic shock, renal disease and the additive EuroSCORE > 10 (P < 0.0001) as significant predictors related to in-hospital mortality. The mean time from the onset of symptoms to revascularization differed significantly between survivors (5.1 +/- 2.7 h) and no survivors (11.4 +/- 3.2 h) (P < 0.0007) in the STEMI group. Preoperative cTnI did not provide any prognostic information. CONCLUSION: CABG in pts with ACS can be performed with good clinical results. The clinical outcome is particular depending on the different groups of ACS. Therefore an individual risk stratification of each pts in ACS is necessary. The time interval of 6 h seems to be crucial as prognostic variable in the STEMI-group.

Asunto(s)

Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/cirugía , Puente de Arteria Coronaria/mortalidad , Evaluación de Resultado en la Atención de Salud/métodos , Medición de Riesgo/métodos , Anciano , Femenino , Alemania/epidemiología , Humanos , Masculino , Pronóstico , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

Clozapine is the drug of choice for treatment-resistant schizophrenia. Prompted by a patient who developed reversible clozapine-induced myocarditis after long-term treatment with clozapine for several years for chronic-resistant schizophrenia, we undertook a review of the relevant literature. Concerning the myocarditis, the patient recovered rapidly by withdrawal of clozapine and with supportive management. Psychiatric stabilisation of the patient was at least possible with a combination of quetiapine (600 mg) and amisulpride (800 mg). Well-designed studies with the aim to specifically investigate treatment options after clozapine are limited and clinical possibilities are discussed in this paper. Olanzapine and combinations using non-clozapine atypical neuroleptics have partly shown improvement, whereas evidence for successful augmentation with mood stabilisers, anticonvulsants or electroconvulsive therapy in treatment-resistant schizophrenia is limited.

Asunto(s)

Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Miocarditis/inducido químicamente , Amisulprida , Antipsicóticos/uso terapéutico , Clozapina/uso terapéutico , Dibenzotiazepinas/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Fumarato de Quetiapina , Esquizofrenia/tratamiento farmacológico , Sulpirida/análogos & derivados , Sulpirida/uso terapéutico

Asunto(s)

Resistencia a la Proteína C Activada/genética , Oclusión Coronaria/genética , Factor V/genética , Infarto del Miocardio/etiología , Altitud , Resultado Fatal , Heterocigoto , Humanos , Masculino , Persona de Mediana Edad , Montañismo , Trombosis/etiología

RESUMEN

Octogenarians are increasingly considered for coronary artery bypass grafting (CABG), but still represent a high-risk patient group with increased mortality and morbidity. In recent years off-pump surgery has been successfully established in CABG. The avoidance of extracorporeal circulation (ECC) seems to be of particular benefit for this patient group. We retrospectively analyzed our experience with CABG surgery with and without ECC in octogenarians to define the potential benefit of these different approaches in this high-risk group of patients. We analyzed the outcome after isolated CABG of 344 consecutive patients (219 male, 125 female, age: 82 +/- 2.4 years) who were aged 80 or older. Patients were divided into two groups according to the use of ECC. The on-pump group consisted of 237 patients (151 male, 86 female, 82 +/- 2.8 years) and the off-pump group consisted of 107 patients (68 male, 39 female, 82 +/- 1.9 years). The predicted EuroSCORE and EuroSCORE mortality risk were similar for both patient groups. The overall hospital mortality rate was 5.5 % (n = 17): 14 patients (5.9 %) in the on-pump group (n = 237, 100 %) and five patients (4.6 %) in the off-pump group (n = 107, 100 %). The average number of grafts in the on-pump group was 2.8 +/- 0.4 and it was 2.4 +/- 0.6 in the off-pump group ( P = 0.05). Morbidity was comparable in both groups. Significant variables in multivariate regression were preoperative atrial fibrillation ( P = 0.03; RR = 2.7), COPD ( P = 0.0001; RR = 6.5) and prolonged intubation ( P = 0.005; RR = 4.1). Isolated CABG in octogenarians can be performed with good clinical results, although a substantial mortality remains. The results of coronary surgery in this patient group with and without ECC are comparable with respect to mortality and morbidity.

Asunto(s)

Puente de Arteria Coronaria Off-Pump , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Selección de Paciente , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria Off-Pump/efectos adversos , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Intubación Intratraqueal/efectos adversos , Modelos Logísticos , Masculino , Infarto del Miocardio/etiología , Enfermedades del Sistema Nervioso/etiología , Oportunidad Relativa , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento

RESUMEN

Coronary artery bypass grafting (CABG) in dialysis-dependent patients with end-stage renal failure (ESRF) has become the standard treatment for CAD in this patient group, but is still considered as a risk procedure due to the increased mortality and morbidity. The avoidance of extracorporeal circulation in dialysis-dependent patients seems to be an attractive alternative. This retrospective study analyzed and compared our experience with CABG surgery with and without extracorporeal circulation in dialysis-dependent patients with ESRF. We analyzed the clinical results of isolated CABG in 73 dialysis-dependent patients with ESRF with and without the use of extracorporeal circulation. The on-pump group consisted of 43 patients (7 female and 36 male, 65 +/- 7.3 years) and the off-pump group included 30 patients (4 female and 26 male, 67 +/- 7.2 years). Demographic and preoperative data were comparable in both groups. Overall hospital mortality rate was 4.2 % (n = 3), two patients (4.6 %) in the on-pump group and one patient (3.3 %) in the off-pump group died due to noncardiac reasons. Morbidity was comparable in both groups. The mean number of grafts was 3.1 +/- 0.9 in the on-pump group and 2.9 +/- 0.8 in the off-pump group. During follow-up, 13 patients (30.2 %) in the on-pump group died, nine of these patients (69.2 %) due to cardiac reasons; eight patients (26.7 %) in the off-pump group died, mostly due to cardiac reasons (n = 5, 62.5 %). CABG can be performed in patients with dialysis-dependent ESRF with good clinical results and low morbidity with two different surgical approaches. Midterm results are still affected by cardiac events.

Asunto(s)

Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Circulación Extracorporea , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Diálisis Renal , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Proyectos de Investigación , Estudios Retrospectivos , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Surgical therapy of prosthetic valve endocarditis (PVE) is still associated with a high mortality of up to 80 %. Further risk analysis and characterization of clinical features are important for a further improvement of surgical results. The aim of this retrospective study was a risk analysis of clinical features of the pre-, intra-, and postoperative period. Between February 1998 and December 2004, 70 patients (52 male, 18 female, age 62 +/- 11 years) were referred to our institution for surgical therapy of PVE. This cohort included 16 patients with early PVE and 54 patients with late PVE. Preoperative, intraoperative and postoperative features were evaluated with respect to their influence on the early postoperative course and the midterm follow-up. The aortic valve was affected in 41 patients (58.6 %) and the mitral valve in 15 patients (21.4 %). Double valve infection was recorded in 14 patients (20.0 %). Staphylococci (n = 36, 51.4 %), Streptococci (n = 9, 12.9 %) and others (n = 24, 14.5 %) were identified as causative agents in blood cultures. The hospital mortality rate was 20.0 % (n = 14), during follow-up (mean follow up: 3.3 +/- 2.5 years), a further 11 patients (15.7 %) died, resulting in an overall mortality of 35.7 %. The main predictors for hospital mortality were preoperative heart failure ( P = 0.01) and Staphylococci infection ( P = 0.01). Predictors of overall mortality were Staphylococci infection ( P = 0.01), heart failure ( P = 0.02) and abscess formation ( P = 0.02). Surgical therapy of prosthetic valve endocarditis is still associated with quite a high mortality during the early and midterm follow-up. Predictors of outcome particularly include preoperative risk constellations (heart failure, Staphylococci infection).

Asunto(s)

Puente Cardiopulmonar , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Análisis de Varianza , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Endocarditis Bacteriana/epidemiología , Femenino , Estudios de Seguimiento , Alemania , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/microbiología , Mortalidad Hospitalaria , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Válvula Mitral/microbiología , Válvula Mitral/cirugía , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Infecciones Relacionadas con Prótesis/epidemiología , Análisis de Regresión , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Experimental data have shown the potential risk of cellular damage of the myocardium during extra corporeal circulation (ECC). The influence of ECC on myocardial oxygen tension however remained unclear. Therefore, the influence of ECC on the oxygen tension in a beating heart was investigated. METHODS: In a pig animal model flexible pO2 microcatheters were positioned in the midmyocardium of the left ventricle and the skeletal muscle and tissue oxygen tension during ECC were monitored and compared with data of a control group without ECC. RESULTS: ECC and unload of the heart caused a significantly higher increase of myocardial pO2 than in a non-ECC control group. CONCLUSION: Our findings show the beneficial effect of ECC on myocardial pO2. This may support the use of ECC in coronary artery bypass grafting because the potential myocardial injury due to ECC is not related to myocardial ischemia. On the contrary, myocardial pO2 was even increased during extracorporeal circulation in this study.

Asunto(s)

Circulación Extracorporea , Corazón/fisiología , Microcirculación , Miocardio/química , Oxígeno/sangre , Animales , Puente de Arteria Coronaria , Masculino , Microcirculación/química , Microcirculación/fisiología , Microelectrodos , Modelos Animales , Monitoreo Fisiológico/métodos , Porcinos

RESUMEN

Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality compared to primary operation. Myocardial protection is one of the key issues in redo on pump CABG and is still a matter of debate. Off pump redo CABG seems to be an attractive alternative as native coronary blood flow remains and cross clamping of the aorta is avoided. The aim of this retrospective study was to compare the outcome of redo CABG with and without CPB. From 1/1998 to 5/2004 redo CABG was performed in 195 patients (pts): 162 male (83.1%) and 33 female (16.9%) pts, age 66 +/- 9 years. In 160 pts, CPB with isolated antegrade myocardial protection was used for redo CABG. Off pump redo CABG was performed in 35 pts (30 male (85.7%) and 5 female (14.3%), age 67 +/- 8 years). Perioperative overall mortality rate was 3.6% (n = 7) and comparable in both groups (on pump 3.8% versus off pump 2.9%; p = 0.90), as well as perioperative myocardial infarction, intraaortic balloon pump implantation rate and secondary morbidity. Complete revascularization was achieved in 139 pts (86.9%) after on pump CABG and in 17 pts (48.6%) of the off pump group (p < 0.01). The average number of grafts was significantly higher in the on pump group (2.8 +/- 0.78 versus 1.6 +/- 0.6; p = 0.04).Furthermore, 20 pts (12.5%) in the on pump group died during follow-up (50 +/- 16 months). Five pts (25.0%) died due to cardiac reasons. In the off pump group 3 pts (8.6%) died during follow-up (44 +/- 13 months), noncardiac related. Overall survival was 83.8% in the on pump group and 88.6% in the off pump group (p = 0.92). On pump redo CABG and off pump redo CABG can be safely performed with low mortality and morbidity. Off pump redo CABG might be limited due to incomplete revascularization.

Asunto(s)

Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Anciano , Puente Cardiopulmonar , Puente de Arteria Coronaria Off-Pump , Enfermedad Coronaria/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Resultado del Tratamiento

RESUMEN

Intravascular stenting of the superior vena cava (SVC) is an established therapy in patients with SVC syndrome. Late complications include re-occlusion, stent infection, migration, and perforation. Affection of the greater thoracic vessels is rare and life-threatening when it occurs. We present a case of ascending aorta laceration as a late complication of SVC stenting. Surgical therapy included excision of the aortic lesion and pericardial patch repair. This case illustrates successful management of a complication after palliative stenting of the SVC.

Asunto(s)

Aorta/lesiones , Enfermedades de la Aorta/etiología , Implantación de Prótesis Vascular/efectos adversos , Stents/efectos adversos , Síndrome de la Vena Cava Superior/cirugía , Anciano , Aneurisma Falso/etiología , Aorta/cirugía , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Humanos , Masculino , Falla de Prótesis , Reoperación

RESUMEN

The number of patients with dialysis-dependent end stage renal failure (ESRF) and coronary heart disease (CAD) has increased in recent years. Coronary artery bypass grafting (CABG) has become the standard treatment for CAD in this patient group, but is still considered as a risk procedure due to increased mortality and morbidity. In a retrospective study we analyzed our clinical results of isolated CABG in 40 dialysis-dependent patients with ESRF (5 female and 35 male, mean age 65+/-8.4 years) and the use of extracorporeal circulation. The perioperative control group comprised 51 patients (10 female and 41 male, mean age 67+/-7.3 years) with normal renal function and isolated CABG. Demographic and preoperative data were comparable in both groups. Hospital mortality was 2.5% in patients with ESRF and 0% in patients with normal renal function. Morbidity was comparable in both groups. The mean number of grafts was 3.1+/-0.9 in the dialysis group and 2.9+/-0.8 in the control group. In the follow-up of the dialysis group (34+/-23 months) 8 patients died. CABG in patients with dialysis-dependent ESRF can be performed with good clinical results and morbidity comparable to patients with normal renal function.

Asunto(s)

Puente de Arteria Coronaria/mortalidad , Circulación Extracorporea/mortalidad , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/rehabilitación , Diálisis Renal/mortalidad , Medición de Riesgo/métodos , Anciano , Femenino , Alemania/epidemiología , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento