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  • 1
    Digitale Medien
    Digitale Medien
    Oxypurinol Protects Normothermic Ischemic Hearts (1990)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 5 (1990), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Abstract Rabbit hearts were mounted on a Langendorff apparatus and after measurement of baseline hemodynamic function exposed to 30 minutes normothermic arrest. Hearts were reperfused at 37°C with buffer solution containing oxypurinol in different concentration: group II (0.01 mM), group III (0.1 mM), group IV (1 mM). Group I did not receive active drug and served as control. Each group consisted of eight hearts. After reperfusion, hemodynamic function was again measured and compared to baseline. Groups III and IV showed significantly less deterioration (p 〈 0.05) than the control, while group II was better than the control, but in general differences were nonsignificant. We conclude that oxypurinol ameliorates ischemic cardiac damage following normothermic cardiac arrest. The beneficial effect of oxypurinol is most likely due to the drug's scavenging effect of oxygen-free radicals.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.1990.tb00765.x
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  • 2
    Digitale Medien
    Digitale Medien
    Limited Access Left Thoracotomy for Reoperative Coronary Artery Disease: On or Off Pump (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 15 (2000), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Abstract  Between 1971 and 1988 left thoracotomy was performed on pump for selected reoperations. Since 1993, 92 patients were operated on with a limited approach and an increased number of cases were done off pump (70 patients). The purpose of this paper is to describe the transition of our operative techniques from on pump to off pump for reoperative coronary patients. From 1995 to 1999, 22 patients (Group 1) were operated on pump and 70 patients (Group II) off pump; 86 of 92 (93.5%) had reoperations. The demographic data were similar in these two groups regarding age, gender, ejection fraction, and total number of grafts performed. In this study 92 patients had a crude mortality of 4.3%. Limited access thoractomy provides safer reoperation than previously (1971–1988) with an improved on or off pump (4.5% vs. 4.3%) mortality, compared to the on pump mortality of 10% between 1971–1988. Off-pump operations are performed with increasing frequency and with the same risk and less postoperative complications.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.2000.tb01292.x
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  • 3
    Digitale Medien
    Digitale Medien
    Partial Left Ventriculectomy in Patients with Dilated Failing Ventricle (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 13 (1998), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Abstract Background: While partial left ventriculectomy (PLV) improves left ventricular energetic efficiency, concomitant reduction in mitral regurgitation may improve ventricular function. Methods: Two hundred ninety-five patients undergoing lateral ventricular wall excision between the papillary muscles (lateral PLV) and 101 patients with an additional excision of papillary muscles and mitral valve replacement (extended PLV) were compared with 65 patients undergoing excision of anterior wall or ventricular aneurysm (anterior PLV). Results: All patients had reduced functional capacity, New York Heart Association (NYHA) Class 111 to IV (3.62 ± 0.49). Etiologies were cardiomyopathy (37.3%), coronary artery disease (32.3%), valvular disease (19.7%), Chagas' disease (7.8%), and others (2.8%). Patients undergoing lateral and extended PLV had cardiomyopathy as the primary cause of heart failure, while a majority of anterior PLV patients had ischemic disease. Associated procedures included mitral valvuloplasty or replacement (lateral PLV 67%, extended PLV 100%, anterior PLV 40%) and tricuspid annuloplasty (67%, 76%, 28%, respectively.) In each group after surgery, end-systolic dimension decreased more than end-diastolic dimension despite reduced mitral regurgitation. Although extended PLV resulted in greater volume reduction and less mitral regurgitation, these patients had delayed recovery and poor survival. Patients with valvular disease had the most advanced myocardial hypertrophy with the best survival, while those with Chagas' disease had more severe myocarditis, interstitial fibrosis, and the poorest survival. Conclusion: Lateral PLV improved hemodynamics and functional capacity as much as aneurysmectomy by reducing ventricular volume and mitral regurgitation. Inclusion and exclusion criteria have to be sought to make PLV safer and more effective.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.1998.tb01094.x
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  • 4
    Digitale Medien
    Digitale Medien
    Improved Left Ventricular Contraction and Energetics in a Patient with Chagas' Disease Undergoing Partial Left Ventriculectomy (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: A 43-year-old patient with heart failure, precluded from heart transplantation or dynamic cardiomyoplasty because of Chagas' disease cardiomyopathy, mitral regurgitation, and ventricular mural thrombi, underwent mitral valvuloplasty and partial left ventriculectomy (PLV) between the papillary muscles. Intraoperative pressure-volume relationship analyses suggested improvement in left ventricular contraction, energetics, isovolumic relaxation, and mitral valve competency. These improvements allowed prompt, short-term recovery despite unchanged myocardial pathology, which suggests that a surgical approach can after anatomic-geometric factors and achieve clinical improvement in a dilated failing ventricle.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00480.x
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  • 5
    Digitale Medien
    Digitale Medien
    Left Ventricular Volume Reduction Surgery: The 4th International Registry Report 2004 (2005)
    350 Main Street , Malden , MA 02148-5020 , USA and 9600 Garsington Road , Oxford OX4 2XG , England . : Blackwell Science Inc
    Journal of cardiac surgery 20 (2005), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Abstract  Background and Methods: An international registry of left ventricular volume reduction (LVVR) procedures, including partial left ventriculectomy, has been expanded, updated, and refined to include 568 cases voluntarily reported from 52 hospitals in 12 countries. Results: Gender, age, ventricular dimension, ethnology, myocardial mass, presence or absence of mitral regurgitation, as well as transplant indication, had little effect on event-free survival, which was defined as either absence of death or ventricular failure requiring mechanical assist or transplantation. Poor preoperative patient condition such as New York Heart Association classification IV, depressed contractility and decompensation requiring an emergency procedure were associated with reduced event-free survival. Other risk factors included an early surgery date, lack of experience, dilated cardiomyopathy as the underlying pathology and extended myocardial resection. Performance of LVVR reached a peak by 1998, but was largely abandoned by 2001, except in Asia, where experienced institutes continue to perform it in patients in better condition with preserved myocardial contractility. Conclusion: Avoidance of risk factors appears to have contributed to the recent survival improvement and may help stratify patients for LVVR. While performance has been decreasing, the concept has been extended to other LVVR and less invasive procedures, which are now under clinical trials.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.2005.00149.x
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  • 6
    Digitale Medien
    Digitale Medien
    Partial Left Ventriculectomy for Patients with Ischemic Cardiomyopathy (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background: Partial left ventriculectomy (PLV) has been performed in patients with dilated cardiomyopathy (DCM), but improved myocardial energetics may make PLV useful also for ischemic cardiomyopathy (ICM) unamenablis to conventional treatment. Methods: Of 262 patients undergoing PLV, 94 patients with ICM as the underlying pathology were analyzed and compared with 168 patients with DCM. Results: ICM patients were older (57.3 years vs 50.9 years, p = 0.0001) and heavier (69.7 kg vs 65.9 kg, p = 0.039) than those with DCM, but ventricular end-diastolic and end-systolic dimensions were similar with comparably depressed fractional shortening (16% vs 15%, p = 0.294) and equally severe functional limitation [New York Heart Association (NYHA) Class 3.7 vs 3.6, p = 0.734]. A majority of patients in both groups underwent lateral PLV (76% vs 74%, p = 0.883) with myocardium excised between papillary muscles and simultaneous mitral valvuloplasty (41% vs 74%, p 〈 0.0001). Because ICM patients required coronary artery bypass grafting (CABG) more frequently (79% vs 0.6%, p 〈 0.0001), operation was more extensive in terms of bypass time (74 minutes vs 47 minutes, p 〈 0.0001), percentage requiring cardiac arrest (43% vs 19%, p 〈 0.0001), and arrest duration (34 minutes vs 28 minutes, p = 0.280), but all had similar resection and postoperative ventricular dimensions. Nonetheless, ICM patients required shorter intensive care unit (ICU) time (4.4 days vs 5.9 days, p = 0.048) and similar postoperative hospital stays, resulting in similar hospital survival rates (69% vs 71%, p = 0.778) and functional capacity in long-term follow-up. Conclusions: Results suggest that PLV can be performed in patients with ICM with comparable risks and benefits as in DCM. Relative efficacy of CABG and mitral repair as compared to volume reduction remains to be studied.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00500.x
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  • 7
    Digitale Medien
    Digitale Medien
    Reoperative Grafting of the LAD System Using the LAST Approach: Technical Detail (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 15 (2000), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Abstract  In patients in whom the left internal mammary artery (LIMA) has been previously utilized, reoperative grafting of the left anterior descending (LAD) or diagonal coronary arteries can be performed through a left anterior small thoracotomy (LAST) approach, utilizing the subclavian artery as inflow source. In such cases, however, the left upper lobe of the lung and the lingula may exert unwanted traction on the newly constructed coronary graft. Herein, we describe a detail of technique that eliminates this inconvenience.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.2000.tb01297.x
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  • 8
    Digitale Medien
    Digitale Medien
    Prevention of Bleeding in Aortic Root Surgery (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 14 (1999), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Bleeding after aortic root replacement with a valved conduit may be problematic and difficult to control. A few technical details that may facilitate hemostasis in aortic root surgery are described.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.1999.tb01016.x
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  • 9
    Digitale Medien
    Digitale Medien
    Myocardial Revascularization of the Beating Heart in High-Risk Patients (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 16 (2001), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Objective: Myocardial revascularization without cardiopulmonary bypass (CPB) has been proposed as an alternative technique in patients at high risk for conventional coronary artery bypass grafting (CABG). The purpose of this article is to evaluate the potential benefit of such an approach. Methods: We retrospectively evaluated the perioperative results of off-pump CABG (OPCAB) performed from January 1995 to December 1999. Patients were divided into three groups on the basis of their preoperative risk factors: age greater then 80 years, reoperative CABG, and left ventricular ejection fraction percentage (LVEF%) less than 40%. The three subgroups were compared with patients operated on-CPB (ONCAB) during the same period of time. A total of 172 octogenarians had ONCAB versus 97 OPCAB, 307 reoperations were ONCAB versus 274 OPCAB, and 514 patients with LVEF% less than 40% were operated ONCAB versus 220 OPCAB. Results: Preoperative comorbidities were homogeneously distributed in the OPCAB and ONCAB groups. More extensive coronary artery disease was found in the ONCAB groups. A trend for a lower number of perioperative complications was reported in the OPCAB groups. Freedom from overall complications was significantly higher (p 〈 0.005) in the OPCAB group. Actual mortality rates in the OPCAB and ONCAB groups were comparable (p = NS). Conclusions: CABG can be performed safely without CPB in patients with a high preoperative risk profile. Freedom from perioperative complications is markedly higher when the OPCAB approach is utilized.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.2001.tb00498.x
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  • 10
    Digitale Medien
    Digitale Medien
    Role of Coronary Graft Flow Measurement During Reoperations for Early Graft Failure After Off-Pump Coronary Revascularization (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 14 (1999), S. 0 
    Details
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Doppler-based techniques of coronary graft flow measurement are frequently used, especially during coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), to exclude graft dysfunction resulting from technical errors. Nevertheless, early graft failure in the immediate postoperative period continues to affect a small percentage of patients who may require emergent reoperation as a result of severe hemodynamic deterioration. In this setting, in which coronary angiography is infrequently an option, expeditious intraoperative assessment of previously constructed coronary grafts may be performed by using the Doppler-based technique Transit Time Flow Measurement (TTFM). As a result, the hemodynamic values obtained during reoperations may guide the operative strategy. In this study we report on eight patients who underwent “off-pump” CABG and necessitated early reintervention as a result of presumed graft dysfunction. In these patients, graft dysfunction was confirmed or excluded by using intraoperatively the TTFM technique, comparing newly obtained flow hemodynamic variables with those recorded as a baseline during primary operations.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8191.1999.tb01006.x
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