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2.
Ann Thorac Surg ; 94(5): 1741-3, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23098964

RESUMO

The Cabrol fistula, which shunts blood from the perigraft space to the right atrium in cases of refractory bleeding after ascending aortic replacement, is a useful technique. A drawback is the potential for troublesome venous back-bleeding into the perigraft space. We describe a modification using a valved Contegra graft, which obligates unidirectional flow and eliminates venous back-bleeding. This renders the Cabrol fistula an even more useful technique.


Assuntos
Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Hemorragia Pós-Operatória/cirurgia , Adulto , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Pericárdio/transplante
3.
Circulation ; 120(17): 1704-13, 2009 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-19822811

RESUMO

BACKGROUND: Injury to myocytes, endocardium, and the coronary endothelium during harvesting and storage can compromise outcomes after heart transplantation. Safeguarding of structure and function of cardiomyocytes and endothelium in donor hearts may lead to improved patient survival after transplantation. Information gained from porcine hearts stored in standard transplant solution was used to design a superior preservation solution that would optimally protect and maintain organs from beating heart and/or nonbeating heart donors during long-term storage. METHODS AND RESULTS: Multiphoton microscopy was used to image deep within cardiac biopsies and coronary artery tissue harvested from porcine hearts obtained from beating heart and nonbeating heart donors for analysis of myocyte and endothelial cell structure and function. Cell structural integrity and viability, calcium mobilization, and nitric oxide generation were determined with fluorescence viability markers, immunofluorescence, and Western blots. During hypothermic storage in standard preservation solution, Celsior, myocyte, and endothelial viability was markedly attenuated in hearts obtained from beating heart donors. In contrast, hearts from beating and nonbeating heart donors stored in the newly formulated Somah solution demonstrated an increase in high-energy phosphate levels, protection of cardiac myocyte viability, mitochondrial membrane polarization, and structural proteins. Similarly, coronary artery endothelial organization and function, calcium mobilization, and nitric oxide generation were well maintained during temporal storage in Somah. CONCLUSIONS: The Celsior preservation solution in clinical use today has led to a profound decline in cardiomyocyte and endothelial cell viability, whereas the newly designed Somah solution has safeguarded myocyte and endothelial integrity and function during organ storage. Use of Somah as a storage medium may lead to optimized graft function and long-term patient survival after transplantation.


Assuntos
Coração , Soluções para Preservação de Órgãos/química , Soluções para Preservação de Órgãos/farmacologia , Preservação de Órgãos/métodos , Obtenção de Tecidos e Órgãos/métodos , Animais , Avaliação de Medicamentos/métodos , Feminino , Coração/efeitos dos fármacos , Coração/fisiologia , Transplante de Coração/métodos , Transplante de Coração/normas , Miócitos Cardíacos/citologia , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/fisiologia , Preservação de Órgãos/normas , Soluções para Preservação de Órgãos/normas , Suínos , Obtenção de Tecidos e Órgãos/normas
5.
Ann Thorac Surg ; 87(1): 62-70, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19101270

RESUMO

BACKGROUND: Injury to the saphenous vein endothelium during harvest impacts patency after coronary artery bypass graft surgery. Many centers are adopting endoscopic saphenous vein harvest (ESVH) instead of using the traditional open saphenous vein harvest (OSVH) technique. Our objective was to compare the effects of ESVH and OSVH on the structural and functional viability of saphenous vein endothelium using multiphoton imaging, immunofluorescence, and biochemical techniques. METHODS: Ten patients scheduled for coronary artery bypass graft surgery were prospectively identified. Each underwent ESVH for one portion and OSVH for another portion of the saphenous vein. A 1-cm segment from each portion was immediately transported to the laboratory for processing. The vessel segments were labeled with fluorescent markers to quantify cell viability (esterase activity), calcium mobilization, and generation of nitric oxide. Samples were also labeled with immunofluorescent antibodies to visualize caveolin, endothelial nitric oxide synthase, von Willebrand factor, and cadherin, and extracted to identify these proteins using Western blot techniques. All labeling, imaging, and image analysis was done in a blinded fashion. RESULTS: Esterase activity was significantly higher in the OSVH group (p < 0.0001). Similarly, calcium mobilization and nitric oxide production were significantly greater in the OSVH group (p = 0.0209, p < 0.0001, respectively). Immunofluoresence and Western blot techniques demonstrated an abnormal alteration in distribution of caveolin and endothelial nitric oxide synthase in the ESVH group. CONCLUSIONS: Our study indicates that ESVH has a detrimental effect on the saphenous vein endothelium, which may lead to decreased graft patency and worse patient outcomes.


Assuntos
Angioscopia/métodos , Endotélio Vascular/lesões , Veia Safena/patologia , Veia Safena/transplante , Coleta de Tecidos e Órgãos/métodos , Idoso , Idoso de 80 Anos ou mais , Angioscopia/efeitos adversos , Western Blotting , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Endotélio Vascular/patologia , Imunofluorescência , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Medição de Risco , Sensibilidade e Especificidade , Coleta de Tecidos e Órgãos/efeitos adversos , Grau de Desobstrução Vascular/fisiologia , Procedimentos Cirúrgicos Vasculares/métodos
6.
Am J Surg ; 196(5): 703-9, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18789416

RESUMO

BACKGROUND: Myocardial acidosis during cardiac surgery and postoperative troponin I are markers of myocardial damage that have been shown to predict adverse outcomes. We investigated the relationship between troponin I and myocardial tissue pH, patient outcomes, and cost. METHODS: Data were prospectively collected on 205 cardiac surgery patients. Troponin I was sampled upon arrival to the intensive care unit (ICU) and every 6 hours thereafter for 24 hours. The lowest pH encountered during aortic cross clamp (LpH) was related to postoperative troponin I on the multivariate level. Multivariate models were constructed to predict adverse events (AE) and cost. RESULTS: LpH was an independent inverse determinant of postoperative troponin I (P = .0067). Troponin I and its interaction with LpH were multivariate predictors of AE (P = .0012; .0001;odds ratio = 6.9, 10.2, respectively). Troponin I independently predicts surgical ICU (SICU) cost (P = .0256). CONCLUSION: Postoperative troponin I elevation reflects intraoperative myocardial acidosis and damage. The strong relationship between troponin I, AE, and cost indicates the damage incurred is clinically and economically relevant. Strategies to ameliorate intraoperative myocardial tissue acidosis will decrease troponin I release, subsequent AE, and associated costs.


Assuntos
Acidose/sangue , Complicações Intraoperatórias/sangue , Miocárdio/patologia , Cirurgia Torácica , Troponina I/sangue , Idoso , Custos e Análise de Custo , Feminino , Humanos , Concentração de Íons de Hidrogênio , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Estatísticas não Paramétricas , Cirurgia Torácica/economia , Resultado do Tratamento
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