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2.
Clin Hemorheol Microcirc ; 71(4): 451-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30248048

RESUMO

Endovascular repair of aortic aneurysms (EVAR) has become an established treatment option currently applied in an increasing numbers of patients with aortic aneurysms. Advantages include reduced surgical trauma, procedural time, intensive care unit and hospital lengths of stay, blood loss as well as morbidity and mortality.The optimal imaging modalities in EVAR follow-up as well as the appropriate intervals between these follow-ups remain subject of controversial discussion. Objective of this study was the evaluation of the realistic radiation exposure and risk estimate postop EVAR treatment.Of the follow-ups required according to the surveillance schedule during the first year post-EVAR, only 68.3% were actually implemented. Of those required from the second year onwards, an average of 70% was actually performed. During the observation period, each patient underwent a mean of 4.3 CTAs. The median ED calculated from all CTAs was 24. 5 mSv. The minimum and maximum cumulative EDs for the entire observation period were 55 mSv and 310 mSv, respectively.


Assuntos
Aneurisma da Aorta Abdominal/radioterapia , Exposição à Radiação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
Int J Vasc Med ; 2017: 9763075, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29250445

RESUMO

Patients who undergo endovascular repair of aortic aneurysms (EVAR) require life-long surveillance because complications including, in particular, endoleaks, aneurysm rupture, and graft dislocation are diagnosed in a certain share of the patient population and may occur at any time after the original procedure. Radiation exposure in patients undergoing EVAR and post-EVAR surveillance has been investigated by previous authors. Arriving at realistic exposure data is essential because radiation doses resulting from CT were shown to be not irrelevant. Efforts directed at identification of factors impacting the level of radiation exposure in both the course of the EVAR procedure and post-EVAR endovascular interventions and CTAs are warranted as potentially modifiable factors may offer opportunities to reduce the radiation. In the light of the risks found to be associated with radiation exposure and considering the findings above, those involved in EVAR and post-EVAR surveillance should aim at optimal dose management.

4.
J Cardiothorac Surg ; 11(1): 120, 2016 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-27488025

RESUMO

BACKGROUND: Infection is a main cause of morbidity and mortality after heart surgery, with multi-resistant pathogens increasingly representing a challenge. Daptomycin provides bactericidal activity against gram-positive organisms that are resistant to standard treatment including vancomycin. METHODS: A cohort of cardiac surgical patients, treated with daptomycin for major infection at two tertiary care centers, were retrospectively studied with a particular focus on the type of infection, causative pathogens and co-infections, daptomycin dosage, adverse events and outcome in order to provide evidence for the efficiency and safety of daptomycin in a distinct high-risk patient population. RESULTS: Sixty-five patients (87.7 % males, 60.4 ± 13.5 years) who had undergone aortic surgery (20.0 %), ventricular assist device (VAD) implantation (21.5 %), combined procedures (21.5 %), coronary artery bypass grafting (12.3 %), isolated valve surgery (15.4 %) and heart transplantation (7.7 %) were diagnosed with catheter-related infection (26.1 %), valve endocarditis (18.8 %), sternal wound (13.0 %), VAD-associated (11.6 %), cardiac implantable electrophysiological device (CIED)-associated (4.1 %), respiratory tract (4.3 %), bloodstream (4.3 %) and other infection (4.3 %). In 13.0 %, no focus of infection was identified though symptoms of severe infection were present. The most frequent pathogens were Staphylococcus epidermidis (30.4 %), Staphylococcus aureus (23.1 %) and Enterococcus species (10.1 %). Daptomycin doses ranging from 3 mg/kg every 48 h to 10 mg/kg every 24 h were administered for 15.4 ± 11.8 days. 87.0 % of the cases were classified as success, 7.2 % as treatment failure and 5.8 as non-evaluable. Adverse events were limited to one case of mild and one case of moderate neutropenia with recovery upon termination of treatment. CONCLUSION: Daptomycin proved safe and effective in major infection in high-risk cardiac surgical patients.


Assuntos
Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Daptomicina/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Idoso , Feminino , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Open Cardiovasc Med J ; 10: 148-57, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27499818

RESUMO

AIM: Intraoperative allogeneic blood product transfusion (ABPT) in cardiac surgery is associated with worse overall outcome, including mortality. The objective of this study was to evaluate the ABPTs in minimalized extracorporeal cardiopulmonary (MECC(TM)) compared with standard open system on-pump coronary revascularization. METHODS: Data of 156 patients undergoing myocardial revascularization between September 2008 and September 2010 were reviewed. 83 patients were operated by the MECC technique and 73 were treated by standard extracorporeal circulation (sECC). ABPT and overall early postoperative complications were analyzed. RESULTS: Operative mortality and morbidity were similar in both groups. ABPT in the MECC group was significantly lower than in the sECC group both intraoperatively (7.2 vs. 60.3% of patients p<0.001) and during the first five postoperative days (19.3 vs. 57.5%; p<0.001). "Skin to skin"- (214 ± 45 vs. 232 ± 45 min; p=0.012), cardiopulmonary bypass (CPB) - (82 ± 25 vs. 95 ± 26 min; p=0.014), and X-clamp- times (50 ± 16 vs. 56 ± 17 min; p=0.024) were significantly lower in the MECC group than in the sECC group. Length of ICU (intensive care unit) - and hospital stay were also significantly lower in the MECC group vs. the sECC group (26.7 ± 20.2 vs. 54.5 ± 68.9 h; p<0.001, and 12.0 ± 4.1 vs. 14.5 ± 4.6 days; p<0.001). CONCLUSION: Application of MECC as on-pump coronary artery bypass graft (CABG) results in significantly lower ABPT as well as shorter ICU and in-hospital stay. In order to achieve these benefits of MECC autologous retrograde priming, Bispectral index (BIS) monitoring, intraoperative cell salvage, meticulous hemostasis and strict peri- and postoperative volume management are crucial.

6.
J Cardiothorac Surg ; 11(1): 108, 2016 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-27422642

RESUMO

BACKGROUND: In patients with left ventricular non-compaction (LVNC), implantation of a left ventricular assist device (LVAD) may be performed as a bridge to transplantation. In this respect, the particular characteristics of the left ventricular myocardium may represent a challenge. CASE PRESENTATION: We report a patient with LVNC who required urgent heart transplantation for inflow cannula obstruction nine months after receiving a LVAD. LVAD parameters, echocardiography and examination of the explanted heart suggested changes of left ventricular configuration brought about by LVAD support as the most likely cause of inflow cannula obstruction. CONCLUSIONS: We conclude that changes experienced by non-compacted myocardium during LVAD support may give rise to inflow cannula obstruction and flow reduction. Presence of LVNC mandates tight surveillance for changes in LV configuration and LVAD flow characteristics and may justify urgent transplantation listing status.


Assuntos
Cardiomiopatias/fisiopatologia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/fisiopatologia , Coração Auxiliar , Adulto , Cardiomiopatias/complicações , Cardiomiopatias/cirurgia , Ecocardiografia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Ventrículos do Coração/cirurgia , Humanos , Masculino , Miocárdio
7.
Artigo em Inglês | MEDLINE | ID: mdl-26846598

RESUMO

Because aortic occlusion is arguably one of the most dangerous aortic manipulation maneuvers during cardiac surgery in terms of perioperative ischemic neurological injury, the purpose of this investigation is to assess the structural mechanical impact resulting from the use of existing and newly proposed occluders. Existing (clinically used) occluders considered include different cross-clamps (CCs) and endo-aortic balloon occlusion (EABO). A novel occluder is also introduced, namely, constrained EABO (CEABO), which consists of applying a constrainer externally around the aorta when performing EABO. Computational solid mechanics are employed to investigate each occluder according to a comprehensive list of functional requirements. The potential of a state of occlusion is also considered for the first time. Three different constrainer designs are evaluated for CEABO. Although the CCs were responsible for the highest strains, largest deformation, and most inefficient increase of the occlusion potential, it remains the most stable, simplest, and cheapest occluder. The different CC hinge geometries resulted in poorer performance of CC used for minimally invasive procedures than conventional ones. CEABO with a profiled constrainer successfully addresses the EABO shortcomings of safety, stability, and positioning accuracy, while maintaining its complexities of operation (disadvantage) and yielding additional functionalities (advantage). Moreover, CEABO is able to achieve the previously unattainable potential to provide a clinically determinable state of occlusion. CEABO offers an attractive alternative to the shortcomings of existing occluders, with its design rooted in achieving the highest patient safety. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Aorta/fisiologia , Aorta/cirurgia , Oclusão com Balão/instrumentação , Oclusão com Balão/métodos , Modelos Cardiovasculares , Adulto , Animais , Oclusão com Balão/efeitos adversos , Simulação por Computador , Humanos , Pessoa de Meia-Idade , Ovinos
8.
J Cardiothorac Surg ; 10: 99, 2015 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-26183430

RESUMO

Device-related infections in recipients of left ventricular assist devices (LVAD) have been recognized as a major source of morbidity and mortality. They require a high level of diagnostic effort as part of the overall burden resulting from infectious complications in LVAD recipients. We present a multi-allergic patient who was treated for persistent sterile intrathoracic abscess formation and pericardial empyema following minimally invasive LVAD implantation including use of a sheet of e-polytetrafluoroethylene (ePTFE) membrane to restore pericardial integrity. Sterile abscess formation and pericardial empyema recurred after surgical removal until the ePTFE membrane was removed, suggesting that in disposed patients, ePTFE may be related to sterile abscess formation or sterile empyema.


Assuntos
Abscesso/etiologia , Empiema/etiologia , Coração Auxiliar/efeitos adversos , Pericárdio , Politetrafluoretileno/efeitos adversos , Cavidade Torácica , Abscesso/diagnóstico , Adulto , Empiema/diagnóstico , Humanos , Masculino , Tomografia Computadorizada por Raios X
9.
Transpl Infect Dis ; 17(5): 737-43, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26224318

RESUMO

Necrotizing pulmonary aspergillosis and Aspergillus device infection are rare and have potentially fatal complications after left ventricular assist device (LVAD) implantation. To date, few cases of patients surviving Aspergillus device infection have been published, with survival reported only after device removal. We present a patient implanted with an LVAD in whom necrotizing pulmonary aspergillosis with device involvement was successfully treated by segmentectomy and prolonged antifungal treatment without device exchange or removal. Similar cases in the literature were searched for and are discussed in view of the severity of this complication.


Assuntos
Coração Auxiliar/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Aspergilose Pulmonar/diagnóstico , Adulto , Humanos , Masculino
10.
Minerva Cardioangiol ; 63(2): 91-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24941962

RESUMO

AIM: The aim of the study was to examine risks, implications and outcomes of coronary sinus (CS) lead extraction in patients with infections of cardiac resynchronization therapy (CRT) systems. METHODS: The study included 40 (65.5 ± 11.1 years; 80% male) transvenous CS lead extraction procedures performed between 2000-2011. Nine (22.5%) patients suffered from infection and included one sepsis (11.1%), two (22.2%) of lead and valve endocarditis, and four (44.4%) cases of pocket infection. CS lead extraction in the infection subgroup was performed between 14 days and more than five years after the last CIED-related surgical procedure. RESULTS: Totally 42 CS and 35 non-CS leads were extracted. Leads extracted in the infection subgroup were significantly longer in situ (49.7 ± 30.7 months) compared to the non-infection subgroup (19.2 ± 28.6 months). Extraction in infected patients required more aggressive methods and longer exposure to radiation than non-infected. Procedural success without major complications was achieved in all patients. Minor post-procedural complications occurred in four (44.4%) of the infected and one (3.2%) of the non-infected patients and were surgical-related in three cases. Overall hospitalization times were significantly longer for the infection than for the non-infection subgroup (21.4 ± 15 versus 9.6 ± 6.9 days). CONCLUSION: Our results support the concept of complete CIED-system removal in CIED-associated infection, regardless of whether or not infection appears to be limited to the generator pocket site, despite risk of heart failure, patient frailty and a high level of comorbidity. An interdisciplinary approach encompassing appropriate diagnostic, procedural and safety standards allows CS lead extraction in this high-risk subpopulation to be performed with excellent outcomes and low complication rates.


Assuntos
Terapia de Ressincronização Cardíaca/efeitos adversos , Remoção de Dispositivo/métodos , Eletrodos Implantados/efeitos adversos , Idoso , Seio Coronário , Remoção de Dispositivo/efeitos adversos , Endocardite/epidemiologia , Endocardite/etiologia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/etiologia , Fatores de Tempo
11.
Transplant Proc ; 46(9): 2953-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25420800

RESUMO

BACKGROUND: Polyclonal anti-thymocyte globulins (ATGs) and anti-CD25 antibodies are agents used for induction of immunosuppression in solid-organ transplantation. We aimed to investigate the effect of different regimens of these immunosuppressive induction agents on transendothelial migration of peripheral blood mononuclear cells (PBMC) and evaluated the endothelial apoptosis after treatment. METHODS: Human microvascular endothelial cells were either activated with tumor necrosis factor-α/interferon-γ or not and further treated with 25 or 125 µg/mL ATG (Thymoglobulin, Sanofi-Aventis, Germany) for 2 hours or 24 hours, or with 5 µg/mL Basiliximab (Simulect, Novartis, Germany) for 2 hours or 24 hours. PBMC were either activated with phytohaemagglutinin (PHA) or not and further treated with 25 or 125 µg/mL ATG or with 5 µg/mL Basiliximab for 2 h and then used for transendothelial migration assays. Apoptosis of endothelial cells was detected by means of Annexin-V staining after 2-hour incubation with either 25 or 125 µg/mL ATG or 5 µg/mL Basiliximab. RESULTS: Prophylactic 24-hour administration of ATG to naive endothelial cells without PBMC treatment reduced transendothelial migration. Prophylactic 24-hour administration of ATG and Basiliximab to naive endothelial cells after PBMC treatment with the same agents reduced the transendothelial migration after 24 hours. In both cases, no effect could be observed after 2-hour treatment. Basiliximab but not ATG showed a reduction of transmigration after 2-hour treatment of PBMCs without naive EC treatment. Apoptosis of endothelial cells after treatment increased in both cases, being in case of ATG dose-dependent, increasing from 1.2% after either 25 µg/mL ATG to 8.7% after 125 µg/mL ATG. CONCLUSIONS: Immunosuppressive induction agents modulate the endothelial activity in a dose- and time-dependent manner. Our results suggest that administration of induction agents over longer time periods could provide a potential benefit regarding endothelial immunomodulation. Increased doses may, however, show a deleterious effect on endothelial survival.


Assuntos
Anticorpos Monoclonais/farmacologia , Soro Antilinfocitário/farmacologia , Apoptose/efeitos dos fármacos , Células Endoteliais/efeitos dos fármacos , Imunossupressores/farmacologia , Leucócitos Mononucleares/efeitos dos fármacos , Proteínas Recombinantes de Fusão/farmacologia , Migração Transendotelial e Transepitelial/efeitos dos fármacos , Anticorpos Monoclonais/uso terapêutico , Soro Antilinfocitário/uso terapêutico , Basiliximab , Relação Dose-Resposta a Droga , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Proteínas Recombinantes de Fusão/uso terapêutico , Fatores de Tempo
12.
Perfusion ; 27(5): 371-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22635965

RESUMO

OBJECTIVES: Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass circuit represents a major risk factor for blood transfusions in high-risk cardiac surgery patients. We designed this study to evaluate the effects of antegrade autologous priming (AAP) on reducing perioperative blood transfusion and markers of the inflammatory response in older patients (>75 years). METHODS: Seventy-two patients undergoing first-time coronary bypass and/or aortic valve replacement were prospectively randomised to a cardiopulmonary bypass (CPB) with or without AAP. AAP was performed by adding the patient's own blood to the prime solution (mean 280 ml). Perfusion and anaesthetic techniques were as usual. The haematocrit was maintained at a minimum of 21% during CPB. Patients were well matched for all preoperative variables, including established transfusion risk factors. The primary endpoint was the requirement of red cell transfusion. The surrogate endpoints were renal function, inflammatory response and ischaemic parameters. Blood samples were drawn pre- and intraoperatively and at intervals of 6 hours till POD 6. RESULTS: Current analysis shows no differences in patients receiving homologous packed red cell transfusions. Also, markers of the inflammatory response (IL6, IL8), renal function (cystatin C, creatinine) and myocardial ischaemia (troponin T, CK-MB) were comparable in both groups (p>0.05). Clinical outcomes were similar with respect to pulmonary, renal and hepatic function, length of ICU stay and hospital stay. CONCLUSION: These data suggest that antegrade autologous priming is a safe procedure, but an ineffective way for improving biocompatibility and reducing the need for blood transfusion in older patients.


Assuntos
Transfusão de Sangue Autóloga/métodos , Ponte de Artéria Coronária/efeitos adversos , Circulação Extracorpórea/métodos , Hemodiluição/métodos , Perfusão/métodos , Idoso , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
13.
Diabetologia ; 55(5): 1514-25, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22327346

RESUMO

AIMS/HYPOTHESIS: We have previously found that the mass of perivascular adipose tissue (PVAT) correlates negatively with insulin sensitivity and post-ischaemic increase in blood flow. To understand how PVAT communicates with vascular vessels, interactions between perivascular, subcutaneous and visceral fat cells with endothelial cells (ECs) were examined with regard to inflammatory, metabolic and angiogenic proteins. To test for possible in vivo relevance of these findings, circulating levels of the predominant secretion product, hepatocyte growth factor (HGF), was measured in individuals carefully phenotyped for fat distribution patterns. METHODS: Mono- and co-cultures of human primary fat cells with ECs were performed. mRNA expression and protein production were studied using Luminex, cytokine array, RealTime Ready and ELISA systems. Effects of HGF on vascular cells were determined by WST assays. In patients, HGF levels were measured by ELISA, and the mass of different fat compartments was determined by whole-body MRI. RESULTS: In contrast with other fat cell types, PVAT cells released higher amounts of angiogenic factors, e.g. HGF, acidic fibroblast growth factor, thrombospondin-1, serpin-E1, monocyte chemotactic protein-1 and insulin-like growth factor-binding protein -3. Cocultures showed different expression profiles from monocultures, and mature adipocytes differed from pre-adipocytes. HGF was preferentially released by PVAT cells and stimulated EC growth and smooth muscle cell cytokine release. Finally, in 95 patients, only PVAT, not visceral or subcutaneous mass, correlated independently with serum HGF levels (p = 0.03; r = 0.225). CONCLUSIONS: Perivascular (pre-)adipocytes differ substantially from other fat cells with regard to mRNA expression and protein production of angiogenic factors. This may contribute to fat tissue growth and atherosclerotic plaque complications. Higher levels of angiogenic factors, such as HGF, in patients with increased perivascular fat mass may have pathological relevance.


Assuntos
Adipócitos/metabolismo , Fator de Crescimento de Hepatócito/metabolismo , Gordura Abdominal/metabolismo , Adulto , Idoso , Indutores da Angiogênese/metabolismo , Proteínas Angiogênicas/metabolismo , Células Cultivadas , Técnicas de Cocultura , Células Endoteliais/metabolismo , Feminino , Perfilação da Expressão Gênica , Fator de Crescimento de Hepatócito/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Gordura Subcutânea/metabolismo , Adulto Jovem
14.
Thorac Cardiovasc Surg ; 57(7): 379-85, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19795322

RESUMO

BACKGROUND: Nitric oxide (NO) production by both coronary endothelial cells and cardiomyocytes is thought to play a significant role in myocardial pathophysiology following ischemia/reperfusion (I/R). METHODS: In thirteen pigs subjected to 1 hour cardioplegic arrest (CA) on CPB, left ventricular (LV) biopsies were collected prior to CPB (baseline), at 60 min CPA, at 15 and 30 min reperfusion on CPB, and at 120 min post CPB. LV specimens were immunocytochemically stained against phospho-eNOS (Ser1177), phospho-eNOS (Thr495), phosphorylated ERK1/2, and AKT/PKB. Four additional pigs without CA served as controls. Cardiomyocytes were quantitatively investigated using TV densitometry (gray units: U). RESULTS: After 60 min CA phosphorylation of eNOS (Ser1177) increased significantly and remained elevated until 30 min of reperfusion. In contrast, eNOS (Thr495) phosphorylation remained unchanged during CA and throughout reperfusion. In control animals, eNOS phosphorylation remained unchanged. Akt/PKB activity significantly increased after 60 min CA and decreased thereafter. ERK1/2 activity remained unchanged during ischemia but increased during reperfusion. CONCLUSIONS: ENOS activation during ischemia occurs through phosphorylation at Ser1177 mediated by Akt/PKB. ERK1/2 does not seem to be involved in myocardial eNOS regulation especially not via phosphorylation at eNOS (Thr495).


Assuntos
Ponte Cardiopulmonar , Parada Cardíaca Induzida , Miocárdio/enzimologia , Óxido Nítrico Sintase Tipo III/metabolismo , Animais , Ativação Enzimática , Feminino , Ventrículos do Coração/enzimologia , Imuno-Histoquímica , Masculino , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Modelos Animais , Contração Miocárdica , Fosforilação , Proteínas Proto-Oncogênicas c-akt/metabolismo , Serina , Suínos , Treonina , Fatores de Tempo , Função Ventricular Esquerda
15.
Acta Radiol ; 50(6): 624-8, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19452338

RESUMO

Endovascular aneurysm repair (EVAR) is a well-established alternative to open surgery. The presented case underwent endovascular therapy of an abdominal aortic aneurysm (AAA) with the anatomical prerequisite of a horseshoe kidney. We describe the technique used, including the embolization of aortic side branches, to avoid endoleaks, and the management of thrombotic complications during follow-up.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Rim/anormalidades , Complicações Pós-Operatórias/tratamento farmacológico , Stents , Terapia Trombolítica/métodos , Trombose Venosa/complicações , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/etiologia , Prótese Vascular , Implante de Prótese Vascular , Embolização Terapêutica , Seguimentos , Humanos , Masculino , Falha de Prótese , Artéria Renal/diagnóstico por imagem , Retratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Trombose Venosa/tratamento farmacológico
17.
J Thorac Cardiovasc Surg ; 131(6): 1323-30, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16733165

RESUMO

BACKGROUND: Endovascular application of pulmonary heart valves has been recently introduced clinically. A tissue-engineering approach was pursued to overcome the current limitations of bovine jugular vein valves (degeneration and limited longevity). However, deployment of the delicate tissue-engineered valves resulted in severe tissue damage. Therefore the objective of this study was to prevent tissue damage during the folding and deployment maneuver. MATERIAL AND METHODS: Porcine pulmonary heart valves, small intestinal submucosa, and ovine carotid arteries were obtained from a slaughterhouse. After dissection and antimicrobial incubation, the valves were trimmed (removal of sinus and most of the muscular ring) to fit into the deployment catheter. The inside (in-stent group, n = 6) or outside (out-stent group, n = 6) of a nitinol stent was covered by an acellular small intestinal submucosa, and the valves were sutured into the stent. The valves were folded, tested for placement in the deployment catheter, and decellularized enzymatically. Myofibroblasts were obtained from carotid artery segments and seeded onto the scaffolds. The seeded constructs were placed in a dynamic bioreactor system and cultured for 16 consecutive days. After endothelial cell seeding, the constructs were folded, deployed, and processed for histology and surface electron microscopy. RESULTS: The valves opened and closed competently throughout the entire dynamic culture. Surface electron microscopy revealed an almost completely preserved tissue in the in-stent group. Stents covered with small intestinal submucosa on the outside, however, showed severe damage. CONCLUSION: This study demonstrates that small intestinal submucosa covering of the inside of a pulmonary valved stent can prevent stent strut-related tissue damage.


Assuntos
Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Valva Pulmonar/cirurgia , Engenharia Tecidual , Animais , Células Cultivadas , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Stents
19.
Thorac Cardiovasc Surg ; 54(1): 39-41, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16485187

RESUMO

OBJECTIVE: Standard extracorporeal circulation (ECC) remains the staple procedure for cardiac surgeons. Despite modern membrane oxygenators and arterial filters micro bubbles are regularly detected in the arterial line. We investigated whether initial deairing of the venous drainage during connection can reduce the quantity and size of micro bubbles on the arterial side. METHODS: 12 patients underwent isolated coronary artery revascularization with conventional ECC using a two-stage venous catheter and an open, passive venous return into a reservoir. In 6 patients (Control) the venous catheter was routinely connected to the venous line, thereby accepting moderate incorporation of air. In another 6 patients (deaired) the catheter was connected avoiding any visible air entrapment. A bubble counter was used to detect the number and size of any micro bubbles in the arterial line of the ECC. The total number of bubbles as well as the number of bubbles of different sizes was assessed directly after initiation of ECC and during the first 60 sec. RESULTS: All patients had an uneventful surgery with a normal postoperative course. In the Control group a considerable number of bubbles of all sizes occurred initially and after 60 sec. In contrast, very few bubbles were detected in the deaired group. CONCLUSION: Incorporated venous air inevitably reaches the arterial side of the ECC. As deairing of the venous line is a simple and effective manoeuvre to significantly reduce the amount of micro bubbles on the arterial side, we recommend and perform routine deairing in all our patients.


Assuntos
Doença da Artéria Coronariana/cirurgia , Drenagem , Embolia Aérea/prevenção & controle , Circulação Extracorpórea/instrumentação , Microbolhas/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ponte Cardiopulmonar/instrumentação , Estudos de Casos e Controles , Cateteres de Demora , Circulação Cerebrovascular , Doença da Artéria Coronariana/fisiopatologia , Embolia Aérea/etiologia , Embolia Aérea/fisiopatologia , Desenho de Equipamento , Segurança de Equipamentos , Circulação Extracorpórea/efeitos adversos , Filtração/instrumentação , Humanos , Oxigenadores de Membrana , Tamanho da Partícula , Circulação Pulmonar , Veias Pulmonares/cirurgia , Resultado do Tratamento
20.
Artigo em Alemão | MEDLINE | ID: mdl-15714399

RESUMO

OBJECTIVE: Does the electrocardiographic method for central venous catheter positioning distinguish between a correct intravasal and a malpositioned extravasal position? METHODS: 24 cardiac surgical patients were enrolled in this prospective observational study. In 18 patients the left, in another 6 patients the right internal jugular vein was cannulated. Using a J-wire within a triple-lumen catheter the amplitude of the P-wave was measured at 3 different intravasal sites: Intra-1: (intravasal baseline electrocardiogram), i. e. 10 cm marking of the catheter on skin level; Intra-2: clear rise of the P-wave amplitude upon further insertion of the catheter; Intra-3: maximum P-wave amplitude. At this position the control of the catheter tip was achieved by means of transoesophageal echocardiography (TOE). Intraoperatively, another J-wire within a triple-lumen catheter was placed by the heart surgeon on 3 extravasal sites and the ECG was recorded: Extra-1: extravasal at the left innominate vein above the pericardial reflection; Extra-2: extravasal on the superior vena cava below the pericardial reflection; Extra-A: extravasal on ascending aorta below the pericardial reflection. The catheter was suture fixed with its tip in position Intra-3. Post surgery a chest radiograph was taken. RESULTS: All catheter tips were visualised at the basis of the Crista terminals (border between right atrium and superior vena cava) by TOE control. The rise of the P wave amplitude at Intra-2, Extra-2 and Extra-A was highly significant compared to the base line at Intra-1 (Intra-1/Intra-2, Intra-1/Extra-2, Intra-1/Extra-A: p in each case < 0.001). The P wave amplitudes of the corresponding intra- and extravasal positions of the left innominate vein (Intra-1/Extra-1, n = 18, p = 0.096)) as well as those of the superior vena cava (Intra-2/Extra-2, n = 24, p = 0.859) did not differ. CONCLUSION: The electrocardiographic method can not differentiate between intra- and extravasal position of a central venous catheter, and thus, presumably fails to identify malpositioning as a result of vascular perforation.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Eletrocardiografia , Erros Médicos , Idoso , Procedimentos Cirúrgicos Cardíacos , Cateterismo Venoso Central/métodos , Cateterismo Periférico , Ecocardiografia Transesofagiana , Feminino , Humanos , Veias Jugulares , Masculino , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos Prospectivos
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