Minimally invasive approach for aortic arch branch vessel reconstruction.

Minimally invasive aortic arch branch vessel reconstruction was successfully accomplished in four patients over the past 3 years. There were no operative complications. Three patients had an uneventful hospital course, ranging from 3 to 5 days. The fourth patient with multiple medical problems and severe peripheral vascular disease had a prolonged hospital course for reasons unrelated to the surgical procedure. This minimally invasive surgical exposure can be used to effectively and safely repair innominate and left common carotid artery lesions.

Recurrent aortic coarctation: is surgical repair still the gold standard?

OBJECTIVE: We reviewed our experience with surgical repair compared with balloon aortoplasty of recurrent coarctations of the aorta. METHODS: This is a retrospective review of 1 institution's 27-year experience with surgical repair of recurrent aortic coarctation. A thorough chart review was performed of all pediatric patients undergoing surgical repair for recurrent aortic coarctation (n = 56) from January 1970 through July 1996. RESULTS: The vast majority of recoarctations were repaired with a prosthetic patch technique, with a greater than 96% success rate. No deaths or major complications occurred in the 56 patients. Although a direct comparison with balloon aortoplasty cannot be done, we have reviewed the data available in the literature and found higher complication rates and lower success rates than we obtained in our series. CONCLUSIONS: Although the treatment of aortic coarctation has improved significantly during the past decades, persistent hypertension after repairs at an older age and recurrent coarctation after repairs in neonates occur in all institutions. Surgeons have not agreed on the optimal approach to primary coarctation repair, and invasive cardiologists have challenged operative intervention for both recurrent and primary coarctation. This study demonstrates that surgical repair of recurrent coarctation of the aorta can be performed safely and with excellent results. We believe it is still the gold standard in the management of recurrent coarctation of the aorta.

Porcine peripheral blood CD4+/CD8+ dual expressing T-cells.

The porcine T-cell population is unique in that there is a large percentage of CD+CD8+ dual expressing peripheral T-cells. This paper reviews the data available on these porcine T-cells and compares them to the much rarer dual expressing T-cells in humans. The percent of dual expressing cells increases with activation in in vitro culture with various antigens including pseudorabies virus. The percent of resting dual expressing cells also increases with the age of the pig. Flow-cytometric-sorted dual expressing cells responded in culture to the super antigen staphylococcal enterotoxin B. Selected CD4+CD8- cells cultured in vitro developed expression of CD8 and maintained the dual expressing phenotype for the 12 weeks of culture. Dual expressing cells freshly prepared from porcine blood did not express the IL-2 receptor as demonstrated by their failure to bind FITC-IL-2 and an anti-porcine IL-2 receptor monoclonal antibody. In response to activation with phorbol myristic acetate, CD4, but not CD8, was down regulated on the dual expressing T-cells. In summary, porcine dual expressing T-cells constitute a substantial percentage of the porcine peripheral T-cell pool. These cells appear to contain the majority of the memory T-cell with their frequency increasing with blood donor age and in vitro culture. Although the receptor specificity is not known, they have a functional receptor. Finally, the function of the two accessory molecules CD4 and CD8 in these cells is not known, but their regulation is distinct, thereby suggesting no equivalent roles in immune function.