Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK.

Objective: To review the UK neonatal extracorporeal membrane oxygenation (ECMO) service and identify predictors of outcome.

Design: Retrospective review of the national cohort.

Patients And Interventions: 718 neonates received ECMO for respiratory failure between 1993 and 2005.

Intracardiac impedance monitors hemodynamic deterioration in a chronic heart failure pig model.

Introduction: A large number of heart failure (HF) patients benefit from cardiac resynchronization therapy. Measurements of intrathoracic impedance (ITZ) by implantable devices correlate with intrathoracic fluid content and are used for monitoring lung edema formation in HF patients. However, intrathoracic fluid is only an indirect parameter of cardiac function.

Long-term follow-up after mitral valve replacement in childhood: poor event-free survival in the young child.

Objective: In children, mechanical mitral valve replacement may be the only option if the failing mitral valve cannot be repaired. Mandatory anticoagulation and the fixed size prosthesis are of concern in the growing child, but long-term follow-up results are lacking.

Methods: Single centre, extended retrospective study of 54 patients who underwent first mitral valve replacement between June 1982 and December 1997.

Variations in the technique of slide tracheoplasty to repair complex forms of long-segment congenital tracheal stenoses.

Slide tracheoplasty has become the preferred technique for repair of long-segment congenital tracheal stenosis with complete tracheal rings. Complex morphological subtypes require technical modifications, which we present as follows.

Tirofiban (Aggrastat) protects platelets and decreases platelet-granulocyte binding in an extracorporeal circulation model.

Objectives: Extracorporeal circulation (ECC) induces platelet activation and inflammation with potentially life-threatening organ dysfunction. Short-acting GP IIb/IIIa inhibitors like tirofiban and eptifibatide protect platelets during ECC without increasing bleeding complications and may reduce inflammation. This study investigates anti-thrombotic and anti-inflammatory effects of different platelet inhibitors.

Glycoprotein IIb/IIIa inhibition reduces prothrombotic events under conditions of deep hypothermic circulatory arrest.

Deep Hypothermic Circulatory Arrest (DHCA) is employed during thoracic aortic and congenital heart surgery, and can induce postoperative neurological damage probably caused by microthrombembolism. Hypothermia has been reported to induce platelet activation and aggregation. The platelet activation marker P-selectin mediates binding of platelets to leukocytes.

Hypothermia-induced platelet aggregation: no effect of aprotinin (trasylol) but inhibition by eptifibatide (integrilin).

Objectives: The serine-protease inhibitor aprotinin protects platelet function during cardiopulmonary bypass. However, its safety and efficacy during deep hypothermic circulatory arrest (DHCA) is controversial, and aprotinin is suspected to cause thrombosis especially during hypothermia. The platelet GP IIb/IIIa inhibitor eptifibatide has been assumed to preserve platelet function during cardiopulmonary bypass without increasing bleeding complications.

Extracorporeal circulation without external clamping and cannulation of the aorta: transventricular placement of a new multifunctional aortic cannula.

Background: Stroke is a devastating outcome of coronary artery bypass grafting (CABG). An atherosclerotic ascending aorta is a major risk factor for plaque detachment during cannulation and external clamping in patients undergoing CABG while on extracorporeal circulation (ECC). To avoid external cannulation and clamping we developed and tested a new multifunctional cannula in a pig model.

Forty years of clinical aprotinin use: a review of 124 hypersensitivity reactions.

Since its clinical introduction, the anaphylactic potential of aprotinin has been a major concern. World wide, its use is expanding so there is an increased chance that patients have reexposure from various sources. The risk of anaphylaxis is approximately 2.

Excision of the coronary orifices in arterial switch operation: "O" like obstructive and "U" like unobstructive?

Background: Stenoses of the neo-pulmonary artery (NPA) may complicate follow-up of the arterial switch operation (ASO). It is unknown whether the type of patch covering the coronary excision defects ("O"- or "U"-shaped) might influence this complication.

Methods: Echocardiographically and invasively measured NPA pressure-gradients were evaluated retrospectively in 95 children after ASO.

Emergency donor heart protection: application of the port access catheter technique using a pig heart transplantation model.

Background: Organ shortage limits the number of transplantations, and donor deterioration may precede and often prevent conventional organ preservation. This study evaluates in situ perfusion as a bedside method for cardiac allograft procurement in a large animal model.

Methods: Thirty Landrace pigs (42 +/- 7 kg) were studied.

Sodium-hydrogen inhibitor cariporide (HOE 642) improves in situ protection of hearts from non-heart-beating donors.

Background: Reperfusion injury is a vital problem in non-heart-beating donor (NHBD) organs. The sodium-hydrogen inhibitor cariporide is thought to improve cellular integrity after ischemia and reperfusion. Recently, we demonstrated the possibility of preserving hearts with in situ perfusion after circulatory death.

Assessment of peripheral arterial occlusive disease: comparison of multislice-CT angiography (MS-CTA) and intraarterial digital subtraction angiography (IA-DSA).

Purpose: The aim of the study was to assess the arterial vascular system of the lower extremities in patients with peripheral arterial occlusive disease using Multislice-CT angiography (MS-CTA) and to compare the results with the standard of reference, intraarterial digital subtraction angiography (IA-DSA).

Materials And Methods: MS-CTA and IA-DSA of the lower extremities were carried out on 23 patients with peripheral arterial occlusive disease (Fontain Stage IIb: 18, III: 3, IV: 2). MS-CTA comprised a 4 x 2.

Isolated coronary artery rupture after blunt chest trauma.

After blunt chest trauma, a patient with chronic coronary heart disease sustained an isolated rupture of the right coronary artery. All findings suggested a heart contusion complicated by a non-compromising pericardial effusion and aggravated by anticoagulation with phenprocoumon. After right-ventricular failure occurred, emergency coronary revascularization could not prevent a fatal outcome.

[Angina pectoris as initial clinical manifestation of ruptured abdominal aortic aneurysm with aortocaval fistula].

Case Report: A 75-year-old patient was hospitalized for angina pectoris and tachycardia. Neither ECG nor laboratory examinations were diagnostic for myocardial infarction. Because of an abdominal thrill and a history of an aortic aneurysm a thoracic and abdominal CT scan was performed.

An immediate, allergic skin reaction to aprotinin after reexposure to fibrin sealant.

Background: The safety of fibrin tissue adhesives has been a concern since they entered wide clinical application. Most commercially available kits contain the proteolytic inhibitor, aprotinin, to stabilize the fibrin clot. A bovine protein, this substance has an allergenic potency.

The significance of preformed aprotinin-specific antibodies in cardiosurgical patients.

Unlabelled: Acute hypersensitivity reactions are serious complications of reexposure to aprotinin. Previous contact via infusions or fibrin tissue adhesives can induce specific antibodies. In this study, we aimed to elucidate the preoperative prevalence of aprotinin-specific antibodies in patients scheduled for cardiac operations.

Aprotinin in fibrin tissue adhesives induces specific antibody response and increases antibody response of high-dose intravenous application.

Background: In cardiac operations, aprotinin therapy is used either locally as a component of commercially available fibrin tissue adhesives, intravenously, or combined. Our aim was to examine the formation of aprotinin-specific antibodies with regard to the application mode.

Methods: Sera of 150 patients who had undergone cardiac operations and were receiving aprotinin therapy for the first time were sampled before the operation and at medians of 3.

Fibrin sealant, aprotinin, and immune response in children undergoing operations for congenital heart disease.

Objective: Most commercially available fibrin sealants contain aprotinin in doses of 1500 kallikrein inactivator units per milliliter. They are used in many operative disciplines. An elevated risk of hypersensitivity reactions exists at reexposure to aprotinin.