### 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.0000032874.55215.82
D. Lai, F. Tibayan, T. Myrmel, T. Timek, P. Dagum, G. Daughters, D. Liang, N. Ingels, D. C. Miller
BackgroundThree-dimensional dynamics of the 3 individual scallops within the posterior mitral leaflet during acute ischemic mitral regurgitations have not been previously measured. MethodsRadiopaque markers were sutured to the mitral annulus, papillary muscle tips, and leaflet edges in 13 sheep. Immediately postoperatively, under open-chest conditions, 3-D marker coordinates were obtained using high-speed biplane videofluoroscopy before and during echocardiographically verified acute ischemic mitral regurgitation produced by occlusion of the left circumflex coronary artery. ResultsDuring acute ischemic mitral regurgitation, at end systole, the anterolateral edge of the central scallop was displaced 0.8±0.9 mm laterally and 0.9±0.6 mm apically away from the anterolateral scallop; such displacement correlated with lateral displacement of the lateral annulus (R2=0.7, SEE=0.7 mm, P <0.001) and movement of the right lateral annulus away from the nonischemic anterior papillary tip (R2=0.6, SEE=0.8 mm, P =0.002), respectively. End-systolic displacement of the posteromedial edge of the central scallop was 1.4±0.9 mm anteriorly and 0.9±0.6 mm laterally away from the posteromedial scallop, corresponding to anterior displacement of the mid-lateral annulus (R2=0.5, SEE=1.0 mm, P <0.001). ConclusionsMalcoaptation of the scallops within the posterior leaflet during acute left ventricular ischemia is a novel observation. The primary geometric mechanism underlying scallop malcoaptation in acute ischemic mitral regurgitation was annular dilatation, which hindered leaflet coaptation by drawing the individual scallops apart. These findings support the use of annular reduction in the repair of ischemic mitral regurgitation and also suture closure of prominent subcommissures between posterior leaflet scallops.
背景:在急性缺血性二尖瓣反流期间，3个扇贝在二尖瓣后小叶内的三维动力学尚未被测量。方法在13只羊的二尖瓣环、乳头肌尖端和小叶边缘处缝合不透射线标记物。术后立即在开胸条件下，在超声心动图证实左旋冠状动脉闭塞引起的急性缺血性二尖瓣反流之前和期间，使用高速双翼透视获得三维标记坐标。结果急性缺血性二尖瓣反流时，收缩期终末，中央扇贝前外侧移位0.8±0.9 mm，顶端移位0.9±0.6 mm;这种位移分别与侧环的侧向位移(R2=0.7, SEE=0.7 mm, P <0.001)和右侧侧环远离非缺血前乳头尖(R2=0.6, SEE=0.8 mm, P =0.002)相关。中央扇贝后内侧边缘收缩末期位移距后内侧扇贝前方1.4±0.9 mm，外侧0.9±0.6 mm，与中外侧环前方位移相对应(R2=0.5, SEE=1.0 mm, P <0.001)。结论急性左心室缺血时扇贝后小叶内的闭合是一种新的观察结果。急性缺血性二尖瓣反流中扇贝适应不良的主要几何机制是环形扩张，它通过将单个扇贝分开来阻碍小叶适应。这些发现支持环状复位在缺血性二尖瓣反流修复中的应用，也支持缝合关闭后叶扇贝之间突出的下裂。
{"title":"Mechanistic Insights Into Posterior Mitral Leaflet Inter-Scallop Malcoaptation During Acute Ischemic Mitral Regurgitation","authors":"D. Lai, F. Tibayan, T. Myrmel, T. Timek, P. Dagum, G. Daughters, D. Liang, N. Ingels, D. C. Miller","doi":"10.1161/01.CIR.0000032874.55215.82","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032874.55215.82","url":null,"abstract":"BackgroundThree-dimensional dynamics of the 3 individual scallops within the posterior mitral leaflet during acute ischemic mitral regurgitations have not been previously measured. MethodsRadiopaque markers were sutured to the mitral annulus, papillary muscle tips, and leaflet edges in 13 sheep. Immediately postoperatively, under open-chest conditions, 3-D marker coordinates were obtained using high-speed biplane videofluoroscopy before and during echocardiographically verified acute ischemic mitral regurgitation produced by occlusion of the left circumflex coronary artery. ResultsDuring acute ischemic mitral regurgitation, at end systole, the anterolateral edge of the central scallop was displaced 0.8±0.9 mm laterally and 0.9±0.6 mm apically away from the anterolateral scallop; such displacement correlated with lateral displacement of the lateral annulus (R2=0.7, SEE=0.7 mm, P <0.001) and movement of the right lateral annulus away from the nonischemic anterior papillary tip (R2=0.6, SEE=0.8 mm, P =0.002), respectively. End-systolic displacement of the posteromedial edge of the central scallop was 1.4±0.9 mm anteriorly and 0.9±0.6 mm laterally away from the posteromedial scallop, corresponding to anterior displacement of the mid-lateral annulus (R2=0.5, SEE=1.0 mm, P <0.001). ConclusionsMalcoaptation of the scallops within the posterior leaflet during acute left ventricular ischemia is a novel observation. The primary geometric mechanism underlying scallop malcoaptation in acute ischemic mitral regurgitation was annular dilatation, which hindered leaflet coaptation by drawing the individual scallops apart. These findings support the use of annular reduction in the repair of ischemic mitral regurgitation and also suture closure of prominent subcommissures between posterior leaflet scallops.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"41 1","pages":"I-40-I-45"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82388319","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.0000032915.33237.72
J. Forbess, Karen J. Visconti, C. Hancock-Friesen, R. C. Howe, D. Bellinger, R. Jonas
ObjectiveIncreased survival in children with critical congenital heart disease (CHD) has raised interest in the neurodevelopmental sequelae of these lesions. This investigation is part of an institutional effort to examine the neurodevelopment of 5-year-old children following repair or palliation of CHD. MethodsWe performed a battery of neuropsychological tests on a sample of 243 children between 1998 and 2001. ResultsIn the sample as a whole, mean full-scale (FSIQ), verbal (VIQ), and performance (PIQ) IQ scores were in the normal range (96.8±15.9, 97.8±14.6, and 96.3±17.1, respectively). Anatomic, demographic, and perioperative factors were assessed for impact on neurodevelopment. In multiple regression analysis, lower socioeconomic status (SES) and the diagnosis of velocardiofacial syndrome (VCFS) predicted a lower FSIQ (P =0.01, and P =0.001, respectively). A single ventricle diagnosis (P =0.06), longer postoperative ICU stay (P =0.08), and cumulative duration of hypothermic circulatory arrest (HCA) (P =0.09) approached significance as predictors of lower FSIQ. ConclusionChildren with CHD, on the whole, appear to be performing within the average range in terms of intellectual abilities. Lower SES and VCFS are associated with lower IQ scores. Trends toward worse outcomes were observed in single ventricle patients, biventricular patients with longer postrepair ICU stays, and patients subjected to longer periods of HCA.
危重型先天性心脏病(CHD)患儿生存率的提高引起了人们对这些病变的神经发育后遗症的关注。这项调查是一个机构努力的一部分，目的是检查5岁儿童在冠心病修复或缓解后的神经发育情况。方法我们在1998年至2001年间对243名儿童进行了一系列的神经心理测试。结果调查对象的全量表、语言和行为智商得分均在正常范围内(分别为96.8±15.9、97.8±14.6和96.3±17.1)。评估解剖学、人口学和围手术期因素对神经发育的影响。在多元回归分析中，低社会经济地位(SES)和诊断为心面速度综合征(VCFS)预测较低的FSIQ (P =0.01, P =0.001)。单心室诊断(P =0.06)、术后较长的ICU住院时间(P =0.08)和低温循环骤停(HCA)累积时间(P =0.09)作为FSIQ较低的预测因子接近有意义。结论冠心病患儿智力水平总体上处于平均水平。较低的社会地位和VCFS与较低的智商分数有关。在单心室患者、双心室患者(术后ICU住院时间较长)和HCA持续时间较长的患者中，观察到预后较差的趋势。
{"title":"Neurodevelopmental Outcome After Congenital Heart Surgery: Results From an Institutional Registry","authors":"J. Forbess, Karen J. Visconti, C. Hancock-Friesen, R. C. Howe, D. Bellinger, R. Jonas","doi":"10.1161/01.CIR.0000032915.33237.72","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032915.33237.72","url":null,"abstract":"ObjectiveIncreased survival in children with critical congenital heart disease (CHD) has raised interest in the neurodevelopmental sequelae of these lesions. This investigation is part of an institutional effort to examine the neurodevelopment of 5-year-old children following repair or palliation of CHD. MethodsWe performed a battery of neuropsychological tests on a sample of 243 children between 1998 and 2001. ResultsIn the sample as a whole, mean full-scale (FSIQ), verbal (VIQ), and performance (PIQ) IQ scores were in the normal range (96.8±15.9, 97.8±14.6, and 96.3±17.1, respectively). Anatomic, demographic, and perioperative factors were assessed for impact on neurodevelopment. In multiple regression analysis, lower socioeconomic status (SES) and the diagnosis of velocardiofacial syndrome (VCFS) predicted a lower FSIQ (P =0.01, and P =0.001, respectively). A single ventricle diagnosis (P =0.06), longer postoperative ICU stay (P =0.08), and cumulative duration of hypothermic circulatory arrest (HCA) (P =0.09) approached significance as predictors of lower FSIQ. ConclusionChildren with CHD, on the whole, appear to be performing within the average range in terms of intellectual abilities. Lower SES and VCFS are associated with lower IQ scores. Trends toward worse outcomes were observed in single ventricle patients, biventricular patients with longer postrepair ICU stays, and patients subjected to longer periods of HCA.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"102 1","pages":"I-95-I-102"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80519678","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}
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