### Conference Program Committee Harlan M. Krumholz, Conference Chair; Eric D. Peterson, Conference Co-chair; John A. Spertus, Conference Co-chair Lawrence M. Brass; John E. Brush; David J. Cohen; Elizabeth R. DeLong; Marjorie Funk; David C. Goff, Jr.; Paul …
会议计划委员会harlan M. Krumholz，会议主席;Eric D. Peterson，会议联合主席;会议联合主席John A. Spertus;约翰·e·布拉什;大卫·j·科恩;伊丽莎白·r·德隆;马约莉恐慌;小大卫·c·高夫;保罗……
{"title":"Abstracts 4th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke","authors":"L. Wilkins","doi":"10.1161/circ.106.16.e76","DOIUrl":"https://doi.org/10.1161/circ.106.16.e76","url":null,"abstract":"### Conference Program Committee\u0000\u0000\u0000\u0000Harlan M. Krumholz, Conference Chair; Eric D. Peterson, Conference Co-chair; John A. Spertus, Conference Co-chair\u0000\u0000\u0000\u0000Lawrence M. Brass; John E. Brush; David J. Cohen; Elizabeth R. DeLong; Marjorie Funk; David C. Goff, Jr.; Paul …","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"4 1","pages":"e76"},"PeriodicalIF":0.0,"publicationDate":"2002-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84557297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032892.55215.B5
F. Eckstein, L. Bonilla, L. Englberger, F. Eberli, S. Windecker, T. Berg, Michel J. Romanens, F. Immer, T. Carrel
BackgroundCoronary anastomoses are currently primarily carried out with the use of running nonabsorbable sutures. Recently, a renewed interest has developed for facilitated mechanical anastomotic devices especially for minimal invasive techniques or limited access surgery. The initial experience with the first successful creation of mechanical vein-to-coronary artery anastomoses in humans is reported. Methods and ResultsBetween November 2000 and June 2001, 14 patients scheduled for multivessel coronary artery bypass grafting (CABG) procedure were investigated. One vein graft-to-coronary artery anastomosis per patient was performed with the St. Jude Medical ATG Symmetry coronary connector system (stainless steel investigational device, not yet commercially available). We evaluated the overall performance of the device. Intraoperative flow measurements of the grafts using transit time methods were measured. A postoperative angiographic control was performed immediately after the procedure in all patients. Hemostasis was instantaneous in all cases and all anastomoses (mechanical n=14, sutured n=40) were patent. Mean intraoperative flow measurements for the mechanical anastomosed vein grafts was 75±25 mL/min. Three month angiogram or MRI angiography is available to date in 11 patients. Ten connector grafts were patent and 1 was occluded. There were no cardiac-related adverse events or return of angina; exercise tolerance tests and stress electrocardiograms were normal in all patients. ConclusionsThe St. Jude Medical ATG Symmetry coronary connector system is a new device for sutureless distal vein graft-to-coronary artery anastomoses in CABG. This system allows the construction of geometrically perfect anastomoses. This technology represents a further step in a new era of sutureless anastomoses in cardiac surgery.
背景:目前冠状动脉吻合术主要采用流动的不可吸收缝合线。最近，人们对便利的机械吻合装置，特别是微创技术或有限通道手术重新产生了兴趣。初步经验与第一次成功创造机械静脉冠状动脉吻合在人类报告。方法与结果对2000年11月至2001年6月行冠状动脉旁路移植术(CABG)的14例患者进行回顾性分析。每位患者使用St. Jude Medical ATG对称冠状动脉连接系统(不锈钢研究设备，尚未商业化)进行一次静脉移植物与冠状动脉吻合。我们对设备的整体性能进行了评估。采用过渡时间法测量移植物术中血流。所有患者手术后立即进行术后血管造影控制。所有病例均即刻止血，所有吻合口(机械吻合口14例，缝合吻合口40例)均通畅。机械吻合静脉移植物的平均术中血流测量为75±25 mL/min。3个月血管造影或MRI血管造影可用于11例患者。10个接物通畅，1个闭塞。无心脏相关不良事件或心绞痛复发;所有患者的运动耐量试验和应激心电图均正常。结论St. Jude Medical ATG对称冠状动脉连接系统是冠状动脉搭桥术中远端静脉与冠状动脉无缝合吻合的一种新型装置。该系统允许构造几何上完美的吻合口。这项技术代表了心脏手术中无缝线吻合术新时代的进一步发展。
{"title":"First Clinical Results With a New Mechanical Connector for Distal Coronary Artery Anastomoses in CABG","authors":"F. Eckstein, L. Bonilla, L. Englberger, F. Eberli, S. Windecker, T. Berg, Michel J. Romanens, F. Immer, T. Carrel","doi":"10.1161/01.CIR.0000032892.55215.B5","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032892.55215.B5","url":null,"abstract":"BackgroundCoronary anastomoses are currently primarily carried out with the use of running nonabsorbable sutures. Recently, a renewed interest has developed for facilitated mechanical anastomotic devices especially for minimal invasive techniques or limited access surgery. The initial experience with the first successful creation of mechanical vein-to-coronary artery anastomoses in humans is reported. Methods and ResultsBetween November 2000 and June 2001, 14 patients scheduled for multivessel coronary artery bypass grafting (CABG) procedure were investigated. One vein graft-to-coronary artery anastomosis per patient was performed with the St. Jude Medical ATG Symmetry coronary connector system (stainless steel investigational device, not yet commercially available). We evaluated the overall performance of the device. Intraoperative flow measurements of the grafts using transit time methods were measured. A postoperative angiographic control was performed immediately after the procedure in all patients. Hemostasis was instantaneous in all cases and all anastomoses (mechanical n=14, sutured n=40) were patent. Mean intraoperative flow measurements for the mechanical anastomosed vein grafts was 75±25 mL/min. Three month angiogram or MRI angiography is available to date in 11 patients. Ten connector grafts were patent and 1 was occluded. There were no cardiac-related adverse events or return of angina; exercise tolerance tests and stress electrocardiograms were normal in all patients. ConclusionsThe St. Jude Medical ATG Symmetry coronary connector system is a new device for sutureless distal vein graft-to-coronary artery anastomoses in CABG. This system allows the construction of geometrically perfect anastomoses. This technology represents a further step in a new era of sutureless anastomoses in cardiac surgery.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"20 1","pages":"I-1-I-4"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73843082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032888.55215.B8
S. Etzion, I. Barbash, M. Feinberg, Parvin Zarin, L. Miller, E. Guetta, R. Holbová, R. Kloner, L. Kedes, J. Leor
BackgroundThe muscle-specific MyoD family of transcription factors function as master genes that are able to prompt myogenesis in a variety of cells. The purpose of our study was to determine whether MyoD could induce primary cardiac fibroblasts, isolated from infarcted myocardium or pericardium, to undergo myogenic conversion in a clinically relevant approach. Methods and ResultsPrimary rat fibroblasts from 7-day-old infarcted myocardium or normal pericardium were transfected by an E1/E3-deleted adenoviral vector carrying both a human MyoD cDNA driven by a CMV promoter and a green fluorescent protein (GFP) reporter gene driven by a second CMV promoter. Expression of MyoD caused myogenic differentiation of cultured fibroblasts, as defined by elongation and fusion into multinucleated myotubes, typical cross striation as identified by electron microscopy, and positive immunostaining for sarcomeric actin, fast myosin heavy chain (MHC), and actinin. The myogenic cells (1.5×106) were transplanted into the infarcted myocardium 7 days after coronary artery occlusion. By 1 month after transplantation, the converted fibroblasts gave rise to a cluster of myogenic cells that in a few hearts occupied a large part of the scar with positive immunostaining for the myogenic proteins fast-MHC and sarcomeric actin. A few cells expressed the gap junction protein connexin 43 in a disorganized manner. There was no positive staining in the control hearts treated with injections of untreated fibroblasts or culture medium. ConclusionsOur work shows that it is possible to exploit the unique capacity of MyoD to activate myogenesis in fibroblasts ex vivo and to create a vast source of autologous myogenic cells for transplantation.
{"title":"Cellular Cardiomyoplasty of Cardiac Fibroblasts by Adenoviral Delivery of MyoD Ex Vivo: An Unlimited Source of Cells for Myocardial Repair","authors":"S. Etzion, I. Barbash, M. Feinberg, Parvin Zarin, L. Miller, E. Guetta, R. Holbová, R. Kloner, L. Kedes, J. Leor","doi":"10.1161/01.CIR.0000032888.55215.B8","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032888.55215.B8","url":null,"abstract":"BackgroundThe muscle-specific MyoD family of transcription factors function as master genes that are able to prompt myogenesis in a variety of cells. The purpose of our study was to determine whether MyoD could induce primary cardiac fibroblasts, isolated from infarcted myocardium or pericardium, to undergo myogenic conversion in a clinically relevant approach. Methods and ResultsPrimary rat fibroblasts from 7-day-old infarcted myocardium or normal pericardium were transfected by an E1/E3-deleted adenoviral vector carrying both a human MyoD cDNA driven by a CMV promoter and a green fluorescent protein (GFP) reporter gene driven by a second CMV promoter. Expression of MyoD caused myogenic differentiation of cultured fibroblasts, as defined by elongation and fusion into multinucleated myotubes, typical cross striation as identified by electron microscopy, and positive immunostaining for sarcomeric actin, fast myosin heavy chain (MHC), and actinin. The myogenic cells (1.5×106) were transplanted into the infarcted myocardium 7 days after coronary artery occlusion. By 1 month after transplantation, the converted fibroblasts gave rise to a cluster of myogenic cells that in a few hearts occupied a large part of the scar with positive immunostaining for the myogenic proteins fast-MHC and sarcomeric actin. A few cells expressed the gap junction protein connexin 43 in a disorganized manner. There was no positive staining in the control hearts treated with injections of untreated fibroblasts or culture medium. ConclusionsOur work shows that it is possible to exploit the unique capacity of MyoD to activate myogenesis in fibroblasts ex vivo and to create a vast source of autologous myogenic cells for transplantation.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"PP 1","pages":"I-125-I-130"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84545946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032883.55215.49
H. Nakajima, J. Kobayashi, K. Bando, K. Niwaya, O. Tagusari, Y. Sasako, T. Nakatani, S. Kitamura
BackgroundThe maze procedure is an effective way to treat atrial fibrillation (AF) associated with mitral valve disease. In a last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, there has been no comparative study to delineate the feasibility of the use of cryoablation. Methods and ResultsWe compared the early and intermediate-term results of the maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM) with our conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins. One hundred and 10 pairs of patients were matched in the age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation and concomitant aortic valve procedures. CM required significantly shorter cardiopulmonary bypass time (186±56 minute versus 214±47 minute, P =0.001) and aortic cross-clamp time (134±43 minute versus 144±37 minute, P =0.03) than KM with less chest tube drainage (590±353 mL versus 745±618 mL, P =0.02) for 12 hours after operation. The sinus rhythm restoration rate in CM group (85.4%) was comparable with KM group (86.4%) at discharge. In the late results, the actuarial freedom from recurrence of sustained AF at 3 years in CM group (97.7%) was not significantly (P =0.11) different from that in KM group (90.4%). The actuarial freedom from stroke at 3 years in CM group was 99.0%. ConclusionThe modification of the maze procedure including cryoablation for pulmonary venous isolation provided less aortic cross-clamp time and less amount of chest tube drainage with the comparable recovery and maintenance of sinus rhythm with KM. CM is a reliable and less invasive surgical option for the AF associated with mitral valve disease.
背景迷宫手术是治疗心房颤动(AF)合并二尖瓣疾病的有效方法。在过去的几年里，在许多报道中，冷冻消融取代了心房切口，以简化迷宫手术过程。然而，还没有比较研究来描述使用冷冻消融的可行性。方法和结果我们比较了冷冻消融(CM)左心房肺静脉隔离迷宫手术的早期和中期结果，以及我们的常规(Kosakai)迷宫手术(KM)，包括肺静脉孔周围的环形切口。110对患者在年龄、左心房尺寸>70 mm、房颤持续时间>0年、既往心脏手术、机械瓣膜植入和伴随主动脉瓣手术等方面匹配。术后12小时，CM所需的体外循环时间(186±56分钟比214±47分钟，P =0.001)和主动脉交叉夹持时间(134±43分钟比144±37分钟，P =0.03)明显短于KM，胸管引流时间(590±353 mL比745±618 mL, P =0.02)。出院时，CM组窦性心律恢复率(85.4%)与KM组(86.4%)相当。在后期结果中，CM组3年持续房颤的精算自由复发率(97.7%)与KM组(90.4%)差异无统计学意义(P =0.11)。CM组3年时中风的精算自由度为99.0%。结论对迷宫手术方法的改进，包括冷冻消融肺静脉隔离，可减少主动脉交叉夹夹时间和胸管引流量，且窦性心律的恢复和维持与KM相当。对于伴有二尖瓣疾病的房颤，CM是一种可靠且微创的手术选择。
{"title":"The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study","authors":"H. Nakajima, J. Kobayashi, K. Bando, K. Niwaya, O. Tagusari, Y. Sasako, T. Nakatani, S. Kitamura","doi":"10.1161/01.CIR.0000032883.55215.49","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032883.55215.49","url":null,"abstract":"BackgroundThe maze procedure is an effective way to treat atrial fibrillation (AF) associated with mitral valve disease. In a last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, there has been no comparative study to delineate the feasibility of the use of cryoablation. Methods and ResultsWe compared the early and intermediate-term results of the maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM) with our conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins. One hundred and 10 pairs of patients were matched in the age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation and concomitant aortic valve procedures. CM required significantly shorter cardiopulmonary bypass time (186±56 minute versus 214±47 minute, P =0.001) and aortic cross-clamp time (134±43 minute versus 144±37 minute, P =0.03) than KM with less chest tube drainage (590±353 mL versus 745±618 mL, P =0.02) for 12 hours after operation. The sinus rhythm restoration rate in CM group (85.4%) was comparable with KM group (86.4%) at discharge. In the late results, the actuarial freedom from recurrence of sustained AF at 3 years in CM group (97.7%) was not significantly (P =0.11) different from that in KM group (90.4%). The actuarial freedom from stroke at 3 years in CM group was 99.0%. ConclusionThe modification of the maze procedure including cryoablation for pulmonary venous isolation provided less aortic cross-clamp time and less amount of chest tube drainage with the comparable recovery and maintenance of sinus rhythm with KM. CM is a reliable and less invasive surgical option for the AF associated with mitral valve disease.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"23 1","pages":"I-46-I-50"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88423932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032911.33237.67
Jeroen J. Bax, D. Poldermans, A. Schinkel, E. Boersma, A. Elhendy, A. Maat, R. Valkema, E. Krenning, J. Roelandt
BackgroundChronic dysfunctional but viable myocardium may exhibit contractile reserve and/or intact perfusion. Segments with intact perfusion without contractile reserve are frequently observed inpatients with ischemic cardiomyopathy. The clinical relevance of this observation is unclear; in particular, the functional outcome after revascularization is unknown. Thus, contractile reserve (using low-dose dobutamine echocardiography) and perfusion (using resting 99mTc tetrofosmin) were evaluated in 114 patients with ischemic cardiomyopathy and the findings were related to functional outcome (9 to 12 months after revascularization). Methods and ResultsPatients (n=114) with ischemic cardiomyopathy undergoing surgical revascularization were evaluated for perfusion (using 99mTc tetrofosmin) and contractile reserve (using low-dose dobutamine echocardiography). Contractile function (two-dimensional echocardiography) was assessed before and 9 to 12 months after revascularization. In the 1 336 dysfunctional segments, perfusion was preserved in 51% of the segments and contractile reserve in 31% (P <.05); 47% of the segments with perfusion did not exhibit contractile reserve. The majority (66%) of segments with recovery of function postrevascularization had intact perfusion and contractile reserve; the majority (58%) of segments without functional recovery lacked both perfusion and contractile reserve. Interestingly, 22% of segments with functional recovery and 25% of segments without functional recovery showed intact perfusion without contractile reserve. ConclusionSegments with intact perfusion/contractile reserve have a high likelihood of recovery of function postrevascularization; segments without contractile reserve/perfusion have a low likelihood of recovery and segments with intact perfusion without contractile reserve have an intermediate likelihood of recovery.
{"title":"Perfusion and Contractile Reserve in Chronic Dysfunctional Myocardium: Relation to Functional Outcome After Surgical Revascularization","authors":"Jeroen J. Bax, D. Poldermans, A. Schinkel, E. Boersma, A. Elhendy, A. Maat, R. Valkema, E. Krenning, J. Roelandt","doi":"10.1161/01.CIR.0000032911.33237.67","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032911.33237.67","url":null,"abstract":"BackgroundChronic dysfunctional but viable myocardium may exhibit contractile reserve and/or intact perfusion. Segments with intact perfusion without contractile reserve are frequently observed inpatients with ischemic cardiomyopathy. The clinical relevance of this observation is unclear; in particular, the functional outcome after revascularization is unknown. Thus, contractile reserve (using low-dose dobutamine echocardiography) and perfusion (using resting 99mTc tetrofosmin) were evaluated in 114 patients with ischemic cardiomyopathy and the findings were related to functional outcome (9 to 12 months after revascularization). Methods and ResultsPatients (n=114) with ischemic cardiomyopathy undergoing surgical revascularization were evaluated for perfusion (using 99mTc tetrofosmin) and contractile reserve (using low-dose dobutamine echocardiography). Contractile function (two-dimensional echocardiography) was assessed before and 9 to 12 months after revascularization. In the 1 336 dysfunctional segments, perfusion was preserved in 51% of the segments and contractile reserve in 31% (P <.05); 47% of the segments with perfusion did not exhibit contractile reserve. The majority (66%) of segments with recovery of function postrevascularization had intact perfusion and contractile reserve; the majority (58%) of segments without functional recovery lacked both perfusion and contractile reserve. Interestingly, 22% of segments with functional recovery and 25% of segments without functional recovery showed intact perfusion without contractile reserve. ConclusionSegments with intact perfusion/contractile reserve have a high likelihood of recovery of function postrevascularization; segments without contractile reserve/perfusion have a low likelihood of recovery and segments with intact perfusion without contractile reserve have an intermediate likelihood of recovery.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"95 1","pages":"I-14-I-18"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83349894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032877.55215.59
T. Shimono, N. Kato, F. Yasuda, Tomoaki Suzuki, U. Yuasa, K. Onoda, T. Hirano, K. Takeda, I. Yada
BackgroundTransluminal stent-graft placement (TSGP) for aortic dissection is a relatively new procedure. We performed TSGPs to seal the primary entry site to treat and prevent complications of aortic dissection. The early to mid-term outcomes were analyzed.Methodsand Results—Thirty-seven patients with a primary intimal tear in descending aorta underwent TSPG. TSGP was performed in 16 acute onset dissections (AOD) with dissection-related complications instead of emergency surgery. Eight AOD without complications were treated to prevent aneurysmal enlargement. Thirteen chronic dissections were treated to prevent rupture. TSGP was technically successful in all cases. One patient with prehospital rupture died. The hospital mortality rate was of 2.7% overall, 6.3% in AOD with complications, 0% in AOD without complications and in chronic dissections. One persistent endoleak required open surgery, and 1 intimal tear was caused by the stent-graft, necessitating an additional TSGP. The primary success rate was 94.4% overall. After hospital discharge, no patient died or suffered aortic rupture during an average follow-up of 24.5 months. New intimal tears caused by the stent-grafts and a secondary endoleak developed in 3 AOD patients. One open procedure and 2 additional TSGPs were performed. Actuarial survival rate and cardiovascular event-free rate at 2 years are 97.3% and 78.3% overall, 93.8% and 48.0% in AOD with complications, 100% and 87.5% in AOD without complications, and both 100% in chronic dissections. ConclusionsTSGP is a reasonable treatment option for aortic dissection. However, delayed intimal tear formations caused by the stent-graft is a problem that requires further investigation.
{"title":"Transluminal Stent-Graft Placements for the Treatments of Acute Onset and Chronic Aortic Dissections","authors":"T. Shimono, N. Kato, F. Yasuda, Tomoaki Suzuki, U. Yuasa, K. Onoda, T. Hirano, K. Takeda, I. Yada","doi":"10.1161/01.CIR.0000032877.55215.59","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032877.55215.59","url":null,"abstract":"BackgroundTransluminal stent-graft placement (TSGP) for aortic dissection is a relatively new procedure. We performed TSGPs to seal the primary entry site to treat and prevent complications of aortic dissection. The early to mid-term outcomes were analyzed.Methodsand Results—Thirty-seven patients with a primary intimal tear in descending aorta underwent TSPG. TSGP was performed in 16 acute onset dissections (AOD) with dissection-related complications instead of emergency surgery. Eight AOD without complications were treated to prevent aneurysmal enlargement. Thirteen chronic dissections were treated to prevent rupture. TSGP was technically successful in all cases. One patient with prehospital rupture died. The hospital mortality rate was of 2.7% overall, 6.3% in AOD with complications, 0% in AOD without complications and in chronic dissections. One persistent endoleak required open surgery, and 1 intimal tear was caused by the stent-graft, necessitating an additional TSGP. The primary success rate was 94.4% overall. After hospital discharge, no patient died or suffered aortic rupture during an average follow-up of 24.5 months. New intimal tears caused by the stent-grafts and a secondary endoleak developed in 3 AOD patients. One open procedure and 2 additional TSGPs were performed. Actuarial survival rate and cardiovascular event-free rate at 2 years are 97.3% and 78.3% overall, 93.8% and 48.0% in AOD with complications, 100% and 87.5% in AOD without complications, and both 100% in chronic dissections. ConclusionsTSGP is a reasonable treatment option for aortic dissection. However, delayed intimal tear formations caused by the stent-graft is a problem that requires further investigation.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"24 1","pages":"I-241-I-247"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81741345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032902.33237.09
R. Jaquiss, N. Ghanayem, M. Zacharisen, K. Mussatto, J. Tweddell, S. Litwin
BackgroundHypersensitivity reactions to aprotinin have been reported in adult cardiac surgical patients undergoing initial and re-exposure to the medication. This study describes the incidence and impact of aprotinin hypersensitivity reactions in children undergoing cardiothoracic surgery. Methods and ResultsIn this retrospective review of our entire experience with aprotinin (n=865), 681 first exposures, 150 second exposures, and 34 third or higher exposures were examined. Reactions were classified as mild (generalized cutaneous erythema, Type A) or severe (unexplained cardiopulmonary instability after aprotinin exposure, Type B). Records of patients sustaining a reaction were reviewed to assess the impact of the reaction on outcome and to survey reaction management strategies. Reactions occurred in 7 of 681 first exposures (1.0%), of which 2 were Type A and 5 were Type B. In second exposures, there were reactions in 2 of 150 (1.3%), of which both were Type B. In 34 third or higher exposures, there was only 1 reaction (2.9%), which was Type B. Reactions were no more likely on second, third, or higher exposure than on initial exposure. Skin testing had a negative predictive value of 98.9% and a positive predictive value of 20%. Anti-aprotinin IgE was undetectable in 7 of 8 reactor cases tested. No adverse sequelae were attributed to aprotinin reaction. ConclusionsThe risk of hypersensitivity reactions to aprotinin is low in children undergoing cardiothoracic surgery, even with multiple exposures to the medication. Reactions are more likely with re-exposure, and risk increases with multiple exposures. Neither skin testing nor assays for IgE identified reactors.
{"title":"Safety of Aprotinin Use and Re-Use in Pediatric Cardiothoracic Surgery","authors":"R. Jaquiss, N. Ghanayem, M. Zacharisen, K. Mussatto, J. Tweddell, S. Litwin","doi":"10.1161/01.CIR.0000032902.33237.09","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032902.33237.09","url":null,"abstract":"BackgroundHypersensitivity reactions to aprotinin have been reported in adult cardiac surgical patients undergoing initial and re-exposure to the medication. This study describes the incidence and impact of aprotinin hypersensitivity reactions in children undergoing cardiothoracic surgery. Methods and ResultsIn this retrospective review of our entire experience with aprotinin (n=865), 681 first exposures, 150 second exposures, and 34 third or higher exposures were examined. Reactions were classified as mild (generalized cutaneous erythema, Type A) or severe (unexplained cardiopulmonary instability after aprotinin exposure, Type B). Records of patients sustaining a reaction were reviewed to assess the impact of the reaction on outcome and to survey reaction management strategies. Reactions occurred in 7 of 681 first exposures (1.0%), of which 2 were Type A and 5 were Type B. In second exposures, there were reactions in 2 of 150 (1.3%), of which both were Type B. In 34 third or higher exposures, there was only 1 reaction (2.9%), which was Type B. Reactions were no more likely on second, third, or higher exposure than on initial exposure. Skin testing had a negative predictive value of 98.9% and a positive predictive value of 20%. Anti-aprotinin IgE was undetectable in 7 of 8 reactor cases tested. No adverse sequelae were attributed to aprotinin reaction. ConclusionsThe risk of hypersensitivity reactions to aprotinin is low in children undergoing cardiothoracic surgery, even with multiple exposures to the medication. Reactions are more likely with re-exposure, and risk increases with multiple exposures. Neither skin testing nor assays for IgE identified reactors.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"16 1","pages":"I-90-I-94"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89288398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032905.33237.C7
Y. Sakakibara, K. Tambara, F. Lu, T. Nishina, G. Sakaguchi, N. Nagaya, K. Nishimura, Ren-Ke Li, R. Weisel, M. Komeda
BackgroundThis study was designed to investigate the efficacy of the combined procedure of left ventricular (LV) repair and fetal cardiomyocyte transplantation (CM-TX) in a rat myocardial infarction model. Methods and ResultsA moderate-sized LV aneurysm was created by proximal ligation of the left coronary artery in 47 Lewis rats. Four weeks later, they were underwent another operation and received culture medium injection (n=10; group I), fetal CM-TX (n=10; group II), purse-string LV repair with culture medium injection (n=14; group III), or LV repair with fetal CM-TX (n=13; group IV). They were echocardiographically followed-up during the subsequent 4 weeks, and cardiac catheterization was performed in the final week. In the late period, LV dimension in group IV was smaller than that in group III (end-diastolic dimension, 0.92±0.02 versus 1.01±0.03 cm, P= 0.0090; end-systolic dimension, 0.62±0.02 versus 0.74±0.04 cm, P= 0.0093; at the fourth week), although they initially showed similar decreases in both groups. At the final week, end-systolic elastance was higher in group IV than in groups I, II, or III (0.61±0.10 versus 0.19±0.03, 0.30±0.09, 0.33±0.07 mm Hg/&mgr;L, P= 0.0002, 0.0037, and 0.0042, respectively). ConclusionsFetal CM-TX exerted preventive effects against late LV dilation and dysfunction after LV repair in the rat model. The results suggest that repair surgery combined with fetal CM-TX may enhance the surgical benefits for patients with LV aneurysm in the long term.
本研究旨在探讨左心室(LV)修复和胎儿心肌细胞移植(CM-TX)联合治疗大鼠心肌梗死模型的疗效。方法与结果47只Lewis大鼠采用左冠状动脉近端结扎术制造中等大小左室动脉瘤。4周后再次手术并注射培养基(n=10;I组)，胎儿CM-TX (n=10;II组)、荷包包注射培养基修复LV (n=14;III组)或胎儿CM-TX修复左室(n=13;IV组)。术后4周超声心动图随访，最后一周行心导管插管。晚期IV组左室径小于III组(舒张末期径，0.92±0.02 vs 1.01±0.03 cm, P= 0.0090;收缩期末尺寸:0.62±0.02 vs 0.74±0.04 cm, P= 0.0093;在第四周)，尽管他们最初在两组中表现出相似的下降。在最后一周，IV组的收缩末期弹性高于I、II或III组(0.61±0.10 vs 0.19±0.03、0.30±0.09、0.33±0.07 mmhg /&mgr;L, P分别= 0.0002、0.0037和0.0042)。结论胎儿CM-TX对大鼠左室晚期扩张和左室修复后功能障碍具有预防作用。结果表明，修复手术联合胎儿CM-TX可长期提高左室动脉瘤患者的手术效益。
{"title":"Combined Procedure of Surgical Repair and Cell Transplantation for Left Ventricular Aneurysm: An Experimental Study","authors":"Y. Sakakibara, K. Tambara, F. Lu, T. Nishina, G. Sakaguchi, N. Nagaya, K. Nishimura, Ren-Ke Li, R. Weisel, M. Komeda","doi":"10.1161/01.CIR.0000032905.33237.C7","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032905.33237.C7","url":null,"abstract":"BackgroundThis study was designed to investigate the efficacy of the combined procedure of left ventricular (LV) repair and fetal cardiomyocyte transplantation (CM-TX) in a rat myocardial infarction model. Methods and ResultsA moderate-sized LV aneurysm was created by proximal ligation of the left coronary artery in 47 Lewis rats. Four weeks later, they were underwent another operation and received culture medium injection (n=10; group I), fetal CM-TX (n=10; group II), purse-string LV repair with culture medium injection (n=14; group III), or LV repair with fetal CM-TX (n=13; group IV). They were echocardiographically followed-up during the subsequent 4 weeks, and cardiac catheterization was performed in the final week. In the late period, LV dimension in group IV was smaller than that in group III (end-diastolic dimension, 0.92±0.02 versus 1.01±0.03 cm, P= 0.0090; end-systolic dimension, 0.62±0.02 versus 0.74±0.04 cm, P= 0.0093; at the fourth week), although they initially showed similar decreases in both groups. At the final week, end-systolic elastance was higher in group IV than in groups I, II, or III (0.61±0.10 versus 0.19±0.03, 0.30±0.09, 0.33±0.07 mm Hg/&mgr;L, P= 0.0002, 0.0037, and 0.0042, respectively). ConclusionsFetal CM-TX exerted preventive effects against late LV dilation and dysfunction after LV repair in the rat model. The results suggest that repair surgery combined with fetal CM-TX may enhance the surgical benefits for patients with LV aneurysm in the long term.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"10 1","pages":"I-193-I-197"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76191530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032917.33237.E0
Heath U. Jones, J. Muhlestein, Kent W. Jones, T. Bair, F. Lavasani, Mahtab Sohrevardi, B. Horne, D. Doty, D. Lappé
BackgroundEnoxaparin has become an attractive therapy for use during acute coronary syndrome (ACS) because of its potential superior efficacy over unfractionated heparin (UFH), its longer activity, and its subcutaneous route of administration. However, because a significant number of patients presenting with ACS may be sent directly to open heart surgery while still on anticoagulation, it is important to understand any potential bleeding risks that may be associated with the use of enoxaparin under these circumstances. MethodsFrom 1998 to 2001, 1159 consecutive patients presenting with an acute coronary syndrome who received either UFH (n=1008) or enoxaparin (n=151) before proceeding to open heart surgery for urgent therapy during the same hospitalization were included in this study. Incidence of perioperative bleeding as evidenced by the units of blood products (packed red blood cells or platelets) transfused or the need for surgical re-exploration for postoperative bleeding was recorded. ResultsAverage age was 65±11 and 67±11 years for patients receiving UFH and enoxaparin, respectively (P= 0.005). Seventy-five percent of those receiving UFH and 64% of those receiving enoxaparin (P <0.005) were males. After discharge, the incidence of rehospitalization for hemorrhage requiring return to surgery for re-exploration was 7.9% in the enoxaparin group and 3.7% in the UFH group (adjusted hazard ratio=2.6, P =0.03). The use of blood products did not differ between groups (UFH=2.7±6.5 U and enoxaparin=2.3±4.5 U;P =NS). ConclusionThe preoperative use of enoxaparin compared with UFH in patients presenting with an ACS who undergo open-heart surgery during the same hospitalization is associated with a significantly increased incidence of re-exploration for postoperative bleeding. Further study is needed to understand the mechanism of this phenomenon and to develop appropriate guidelines to address this potentially important issue.
{"title":"Preoperative Use of Enoxaparin Compared With Unfractionated Heparin Increases the Incidence of Re-Exploration for Postoperative Bleeding After Open-Heart Surgery in Patients Who Present With an Acute Coronary Syndrome: Clinical Investigation and Reports","authors":"Heath U. Jones, J. Muhlestein, Kent W. Jones, T. Bair, F. Lavasani, Mahtab Sohrevardi, B. Horne, D. Doty, D. Lappé","doi":"10.1161/01.CIR.0000032917.33237.E0","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032917.33237.E0","url":null,"abstract":"BackgroundEnoxaparin has become an attractive therapy for use during acute coronary syndrome (ACS) because of its potential superior efficacy over unfractionated heparin (UFH), its longer activity, and its subcutaneous route of administration. However, because a significant number of patients presenting with ACS may be sent directly to open heart surgery while still on anticoagulation, it is important to understand any potential bleeding risks that may be associated with the use of enoxaparin under these circumstances. MethodsFrom 1998 to 2001, 1159 consecutive patients presenting with an acute coronary syndrome who received either UFH (n=1008) or enoxaparin (n=151) before proceeding to open heart surgery for urgent therapy during the same hospitalization were included in this study. Incidence of perioperative bleeding as evidenced by the units of blood products (packed red blood cells or platelets) transfused or the need for surgical re-exploration for postoperative bleeding was recorded. ResultsAverage age was 65±11 and 67±11 years for patients receiving UFH and enoxaparin, respectively (P= 0.005). Seventy-five percent of those receiving UFH and 64% of those receiving enoxaparin (P <0.005) were males. After discharge, the incidence of rehospitalization for hemorrhage requiring return to surgery for re-exploration was 7.9% in the enoxaparin group and 3.7% in the UFH group (adjusted hazard ratio=2.6, P =0.03). The use of blood products did not differ between groups (UFH=2.7±6.5 U and enoxaparin=2.3±4.5 U;P =NS). ConclusionThe preoperative use of enoxaparin compared with UFH in patients presenting with an ACS who undergo open-heart surgery during the same hospitalization is associated with a significantly increased incidence of re-exploration for postoperative bleeding. Further study is needed to understand the mechanism of this phenomenon and to develop appropriate guidelines to address this potentially important issue.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"86 1","pages":"I-19-I-22"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73194167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-09-24DOI: 10.1161/01.CIR.0000032909.33237.F8
H. Hausmann, E. Potapov, A. Koster, T. Krabatsch, J. Stein, R. Yeter, M. Kukucka, R. Sodian, H. Kuppe, R. Hetzer
BackgroundOver the past decade, the use of a ventricular-assist device (VAD) in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40% and is improving. Nevertheless, indications for and timing of the implantation of a VAD in patients who have received an intra-aortic balloon pump (IABP) remain unclear. Methods and ResultsFrom July 1996 to March 2000, 391 patients with cardiac low-output syndrome who underwent open-heart surgery and had an IABP implanted were analyzed in a retrospective pilot study. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 &mgr;g · kg−1 · min−1, a left atrial pressure >15 mm Hg, urine output <100 mL/h, and mixed venous saturation (SvO2) <60% had poor outcomes. Using this data, we developed an IABP score (0 to 5 points) to predict survival early after IABP implantation in cardiac surgery. We evaluated our score by monitoring another 101 patients as a control group prospectively. Additionally, 210 patients who received coronary artery bypass grafting (CABG) exclusively were analyzed. All investigations confirmed the validity of the score. ConclusionsThe IABP score can predict survival early after IABP implantation. In patients with a high IABP score, implantation of a VAD should be considered.
{"title":"Prognosis After the Implantation of an Intra-Aortic Balloon Pump in Cardiac Surgery Calculated With a New Score","authors":"H. Hausmann, E. Potapov, A. Koster, T. Krabatsch, J. Stein, R. Yeter, M. Kukucka, R. Sodian, H. Kuppe, R. Hetzer","doi":"10.1161/01.CIR.0000032909.33237.F8","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032909.33237.F8","url":null,"abstract":"BackgroundOver the past decade, the use of a ventricular-assist device (VAD) in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40% and is improving. Nevertheless, indications for and timing of the implantation of a VAD in patients who have received an intra-aortic balloon pump (IABP) remain unclear. Methods and ResultsFrom July 1996 to March 2000, 391 patients with cardiac low-output syndrome who underwent open-heart surgery and had an IABP implanted were analyzed in a retrospective pilot study. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 &mgr;g · kg−1 · min−1, a left atrial pressure >15 mm Hg, urine output <100 mL/h, and mixed venous saturation (SvO2) <60% had poor outcomes. Using this data, we developed an IABP score (0 to 5 points) to predict survival early after IABP implantation in cardiac surgery. We evaluated our score by monitoring another 101 patients as a control group prospectively. Additionally, 210 patients who received coronary artery bypass grafting (CABG) exclusively were analyzed. All investigations confirmed the validity of the score. ConclusionsThe IABP score can predict survival early after IABP implantation. In patients with a high IABP score, implantation of a VAD should be considered.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"19 1","pages":"I-203-I-206"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74527091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：