Validation of biomarkers for loin meat quality (M. longissimus) of pigs.

The aim of this study was to validate previously reported associations between microarray gene expression levels and pork quality traits using real-time PCR. Meat samples and meat quality data from 100 pigs were collected from a different pig breed to the one tested by microarray (Large White versus Pietrain) and a different country of origin (Denmark versus Germany). Ten genes (CARP, MB, CSRP3, TNNC1, VAPB, TNNI1, HSPB1, TNNT1, TIMP-1, RAD-like) were chosen from the original microarray study on the basis of the association between gene expression levels and the meat quality traits meat %, back fat, pH24, drip loss %, colour a*, colour b*, colour L*, WB-SF, SFA, MUFA, PUFA. Real-time PCR detection methods were developed for validation of all ten genes, confirming association with drip loss (two of two genes), ultimate pH (three of four genes), a* (redness) (two of six genes) and L*(lightness) (two of four genes). Furthermore, several new correlations for MUFA and PUFA were established due to additional meat quality trait information on fatty acid composition not available for the microarray study. Regression studies showed that the maximum explanation of the phenotypic variance of the meat quality traits was 50% for the ultimate pH trait using these ten genes only. Additional studies showed that the gene expression of several of the genes was correlated with each other. We conclude that the genes initially selected from the microarray study were robust, explaining variances of the genes for the meat quality traits.

Ascending-to-descending bypass for simultaneous surgery of aortic coarctation with other cardiac pathologies.

BACKGROUND: The appropriate approach for aortic coarctation associated with other cardiac diseases necessitating surgery is still controversial. The aim of this study was to evaluate the results after simultaneous surgery performed via median sternotomy and consisting of extra-anatomical ascending-to-descending aortic bypass and various other cardiac procedures. METHODS: Between January 1999 and February 2009, 13 consecutive patients with aortic coarctation coexistent with other cardiac diseases necessitating surgery underwent simultaneous surgery via median sternotomy. An extra-anatomical ascending-to-descending aortic bypass for coarctation repair was performed in all patients accompanied by various cardiac procedures (5 aortic root and valve replacement; 2 aortic valve replacement; 2 coronary artery bypass grafting; 2 mitral valve repair; 1 aortic valve replacement and coronary artery bypass grafting; 1 mitral and tricuspid valve repair). There were 3 women and 10 men with a mean age of 52 years (range 25-69). Two patients had recurrent or residual coarctation 37 and 46 years after previous surgical repair, respectively. RESULTS: Early mortality was 0 and there was only 1 late death during the follow-up of up to 11 years. New York Heart Association (NYHA) functional class improved on average from 2.4 to 1.2. At the last follow-up, blood pressure measured at the upper and lower extremities showed no gradient in any patient, indicating a durable function of the extra-anatomical bypass. Only 3 patients were on reduced antihypertensive therapy; 8 patients were on the same medication and 1 patient required increased medication therapy compared with the medication prior to surgery. CONCLUSIONS: Ascending-to-descending bypass can be performed via median sternotomy simultaneously with various cardiac procedures without considerable extension of the procedure. The operative and long-term results are excellent, and this approach can be recommended as the procedure of choice in patients with aortic coarctation and additional cardiac diseases necessitating surgery.

Foreign material reaction to BioGlue® as a possible cause of cardiac tamponade.

We describe the case of a 65-year-old female patient who underwent aortic valve reconstruction for aortic valve stenosis. During the operation, repair of a left ventricular laceration produced by a left ventricular vent was necessary. BioGlue® (CryoLife, Atlanta, GA, USA) and pledgeted sutures were used for repair. Pericardial effusion with signs of cardiac tamponade developed five months later. The patient was treated successfully by the removal of all foreign material and part of the BioGlue®. Microbiological findings were sterile. Histology showed a chronic granulomatous inflammatory response suggesting a foreign material reaction to BioGlue® as the cause of the effusion. Though all visible material was removed, the risk of pericardial effusion still persists as part of the BioGlue® remained within the ventricular wall.

Use of a carotid artery for arterial cannulation: side-related differences.

BACKGROUND: Cannulation of arch arteries (innominate, axillary or carotid) for arterial return during cardiopulmonary bypass is increasingly being used; however, the flow and pressure profile in the cannulated arteries remains unclear. The aim of this study was to evaluate the flow and pressure characteristics of arterial inflow through a carotid artery, especially with regard to operative and technical aspects, clinical outcomes, and side-related differences. METHODS: Between January 2005 and April 2008, 200 consecutive patients underwent elective aortic arch surgery at our facility. One hundred patients were assigned to undergo cannulation of the left and another 100 to undergo cannulation of the right carotid artery. Both groups were similar in terms of age, sex, and type of surgery. In all patients, arterial return was through a side-graft anastomosed to the carotid artery. The arterial line was also used for unilateral cerebral perfusion for brain protection during mild hypothermic circulatory arrest. The flow and pressure profiles in the arterial line and in the carotid artery were evaluated with regard to cardiopulmonary bypass flow rate and side of cannulation. RESULTS: No complications related to the cannulation of a carotid artery were observed. The arterial return was adequate in all patients, regardless of the side being cannulated. Because of low resistance (mean pressure<50 mmHg) in the carotid artery proximal to the inflow side-graft, the flow toward the aortic arch averaged 87+/-2% (range 84.4-92%) of the total flow volume (4.6+/-0.5 L/min), without a significant difference between the sides. However, the perfusion pressure in the arterial line was significantly higher when the left carotid artery was cannulated (216+/-30 mmHg vs. 205+/-30 mmHg; P=0.013). There was also a significant difference in the pressure in the distal carotid arteries, which, compared to the systolic blood pressure prior to cardiopulmonary bypass, increased by 30+/-24 mmHg on the left and decreased by 16+/-21 mmHg on the right (P<0.001). CONCLUSIONS: Both common carotid arteries are suitable for arterial cannulation; however, left-sided cannulation is associated with an increase in the pressure profile. Therefore, if vascular pathology does not dictate cannulation of the left carotid artery, the right carotid artery should be considered the site of choice.

The expression of genes PKM2 and CAST in the muscle tissue of pigs differentiated by glycolytic potential and drip loss, with reference to the genetic group.

The present studies aimed at an analysis of the expression level of genes PKM2 and CAST in Longissimus lumborum [LL] muscle tissue of pigs differing as regards the glycolytic potential [GP] and drip loss [DL] from the LL muscle, with reference to the genetic group. The studies covered a total of 65 pigs: 20 purebred Landrace [L], 22 crossbreeds of Landrace with the Yorkshire [L x Y] and 23 three-breed crosses (Landrace x Yorkshire) x Duroc [(L x Y) x D]. In the case of gene PKM2 one may observe in (L x Y) x D crossbreds, compared to L x Y crossbreds, an increased expression, closely related with the increase in dry matter content, including intramuscular fat, as well as a more favourable progress of glycolytic and energy metabolism during the early time post mortem (pH(45) and R(1)). Compared with Landrace animals, the lower expression of the CAST gene observed in (L x Y) x D pigs is manifested by a marked improvement of meat quality (R(1) pH(45) pH(24), pH(48)), arising from the rate of glycolytic and energy metabolism, typical for normal meat, that in effect results in its higher culinary and technological value.

Contained rupture of the aorta in acute Stanford type A aortic dissection causing right ventricular wall dissection.

We describe a rare case of an acute aortic type A dissection after previous aortic valve replacement and coronary artery revascularization complicated by a contained rupture and right ventricular wall dissection. Although preoperatively echocardiography and CT scan described a pericardial hematoma, intraoperatively no intrapericardial hematoma was found; instead an extended right ventricular wall dissection caused by a large thrombus formation within the right ventricular muscle layers was demonstrated. After replacement of the ascending aorta and removal of the thrombus as the sole treatment for right ventricular wall dissection, the two dissected layers of the right ventricular wall were contracting synchronously again.

Surgical repair of the aortic coarctation combined with complete replacement of the ascending aorta and aortic arch.

We present a 63-year-old patient with aortic valve stenosis, ascending aorta aneurysm, aortic coarctation as well as atherosclerotic, elongated, and stenosed aortic arch. Surgical treatment consisted of a complete ascending aorta replacement with a valved composite graft and complete replacement of the aortic arch including the isthmus, and was performed simultaneously through median sternotomy.

Modified technique of chordal replacement for mitral valve repair.

The appropriate length of the artificial chordae is crucial for the proper functioning of the mitral valve after chordal replacement. In the technique described here, the artificial chordae are assembled during surgery and their lengths fixed according to the individual anatomy; they are then first attached to the margin of the prolapsed leaflet and subsequently to the papillary muscle. This ensures that the ultimate length of the artificial chordae is determined during fixation at the papillary muscle and not during knotting at leaflet level.

Reevaluation of ethylene oxide hemolysis and irritation potential.

The in vitro hemolytic and in vivo mucosal irritation potential of ethylene oxide (EO) was investigated with standard procedures used to determine the biocompatibility of medical devices. Test solutions containing EO at concentrations of 25, 50, 100, 250, 500, 1,250, 2,500, 5,000, or 10,000 microg/mL were prepared in saline to simulate a worst-case aqueous extraction of standard medical devices containing 125, 250, 500, 1,250, 2,500, 6,250, 12,500, 25,000, or 50,000 microg/g of EO, respectively. Concentrations of EO up to 500 microg/mL were not hemolytic ( < 5% hemolysis after a 4-h exposure), whereas > or =1250 microg/mL of EO resulted in significant hemolysis. Hamster cheek pouches exposed to cotton pellets saturated with EO at concentrations of up to 2500 microg/mL for 4 h with a recovery period of 14 days were without effects attributable to EO. However, at > or =5000 microg/mL of EO, significant histomorphological alterations of the buccal mucosa were observed and attributed to EO exposure. It was concluded that solutions of EO of up to 500 microg/mL representing an aqueous extract of a general medical device containing at least 2500 microg/g of EO residue do not result in significant hemolysis and irritation.

Stentless valved composite graft for replacement of the aortic valve and ascending aorta.

BACKGROUND: Conduits with biological valves are rarely used for aortic root replacement because of technical problems when degeneration of the valve prosthesis requires reoperation. A composite graft as described could likely avoid this problem. MATERIAL AND METHODS: Between November 1998 and November 1999, 28 consecutive patients underwent replacement of the ascending aorta and aortic valve with a stentless valved composite graft. The indication for surgery was aneurysm of the ascending aorta (26 patients) and aortic dissection (2 patients). The composite graft was assembled during surgery using a stentless porcine aortic bioprosthesis (Toronto SPV) and a woven polyester collagen-coated vascular prosthesis (InterGard). RESULTS: There was no hospital mortality. Echocardiographic evaluation before discharge showed excellent hemodynamics with a mean transvalvular gradient of 8.5 mmHg (standard deviation I3.0 mmHg) and no regurgitation across the valve. Within a follow-up period of up to one year there was one late death because of a cerebral hemorrhage under anticoagulation. CONCLUSIONS: The valved composite graft described offers the excellent hemodynamic performance of a stentless biological valve and is expected to avoid major technical difficulties should later replacement of the biological prosthesis due to structural failure become necessary, because only the valve cusps need to be resected, leaving the tube graft untouched.

Aortic root replacement versus aortic valve replacement: a case-match study.

BACKGROUND: There is increasing evidence that patients with aortic valve disease and dilatation of the ascending aorta are at risk for later dissection or rupture of the aortic wall when the dilated ascending aorta is not replaced or reinforced at the time of aortic valve replacement. In order to find out whether the more complex surgical procedure of aortic root replacement carries a higher early or late postoperative risk than isolated aortic valve replacement, we conducted a matched-pair study with patients of both groups. METHODS: Between June 1993 and August 1998, 100 consecutive patients with aortic valve disease and ectasia/aneurysm of the ascending aorta underwent replacement of the aortic valve and the ascending aorta with a CarboSeal composite graft (CarboSeal; Sulzer Carbo-Medics Inc, Austin, TX). Identical bileaflet valve prostheses (CarboMedics; Sulzer CarboMedics Inc, Austin, TX) were implanted during the same time period in 928 patients for aortic valve disease. On the basis of various preoperative clinical variables 100 patients with aortic valve replacement were matched to the 100 patients with replacement of the aortic root. The duration of follow-up for both groups was similar with 37 + 17 months (range, 9 to 70) for the CarboSeal group and 38 + 14 months (range, 13 to 65) for the CarboMedics group. Survival and morbidity were calculated by Kaplan-Meier analysis and risk-adjusted mortality was evaluated by multivariate analysis in a Cox regression model. RESULTS: The early postoperative mortality of 1% in the CarboSeal group and 4% in the CarboMedics group was insignificantly different. Although the overall survival rate at 5 years was lower (60.7% vs 86.3%; p = 0.13) in the CarboSeal group, the freedom from cardiac mortality and valve-related morbidity was similar in the two groups. CONCLUSIONS: Replacement of the ascending aorta and aortic valve can be performed with similar operative risk, valve-related morbidity, and late cardiac mortality as isolated aortic valve replacement.

Intermediate-term results with 1,019 carbomedics aortic valves.

BACKGROUND: A retrospective study was conducted to evaluate the intermediate-term outcome in patients with the Carbomedics aortic valve prosthesis. METHODS: The study included 1,019 primary valve replacements between 1989 and 1997. Seventy-two percent of patients were men; mean (standard deviation) age was 61 (10) years. The preoperative New York Heart Association functional class was III or IV in 70% of patients. Follow-up at 9 years was 99.6% complete, comprising 2,730 patient-years (mean, 2.7 years). RESULTS: Patient survival, including operative deaths, was 80% at 7 years. The linearized death rate was 2.9%/year. Statistically significant risk factors for mortality were diabetes, pure valve insufficiency, advanced age at operation, and advanced preoperative functional class. Linearized rates were thrombosis, 0.1%/year; thromboembolism, 1.0%/year; hemorrhage, 1.7%/year; endocarditis, 0.1%/year; paravalvular leak, 0.1%/year; reoperation, 0.1%/year; and all events, 3.0%/year. The 7-year estimates of freedom from complications were thrombosis, 99%; thromboembolism, 93%; hemorrhage, 89%; endocarditis, 99%; paravalvular leak, 99.7%; reoperation, 99%; and all events, 82%. No structural valve failure was observed. CONCLUSIONS: The low incidence of valve-related complications favors the continued use of the Carbomedics valve in the aortic position.

Replacement of the aortic valve and ascending aorta with a valved stentless composite graft: technical considerations and early clinical results.

BACKGROUND: Replacement of the aortic valve and the ascending aorta with a conduit consisting of a mechanical valve and a Dacron tube has become a fairly common procedure. Commercially available conduits employing xenografts are rarely used for the same purpose, because if a reoperation becomes necessary due to degeneration of the valve prosthesis, usually the entire conduit must be replaced. A composite graft with a stentless valve, such as we describe in this article, avoids this problem, because in case of reoperation only the valve cusps need to be resected and the tube graft may be left in place. METHODS: Surgical technique of replacement of the aortic valve and the ascending aorta with a stentless composite graft and early results of the procedure are presented. RESULTS: Hemodynamics of the graft soon after surgery were excellent, with an average systolic gradient of 8 mm Hg and no regurgitation across the valve. There were two reoperations for bleeding in the early postoperative period. CONCLUSIONS: The stentless composite graft we describe provides excellent hemodynamics, has no need for anticoagulation, and is expected to offer a benefit in case of reoperation.

Replacement of the ascending aorta and aortic valve with a valved stentless composite graft.

A technique of total aortic root replacement with a stentless porcine composite graft is described. This graft is assembled during surgery using a woven polyester vascular prosthesis and a stentless aortic bioprosthesis.