Generating robust human valvular interstitial cell cultures: Protocol and considerations.

Research in heart valve biology is a growing field that has yet to elucidate the fundamentals of valve disease. Human valvular interstitial cells (hVICs) are the best option for studying the cellular mechanisms behind valvular pathologies. However, there is a wide range of isolation procedures for these cells published in the literature.

Fibroblast growth factor 2 inhibits myofibroblastic activation of valvular interstitial cells.

Heart valve disease is a growing problem worldwide. Though very common in older adults, the mechanisms behind the development of the disease aren't well understood, and at present the only therapeutic option is valve replacement. Valvular interstitial cells (VICs) may hold the answer.

Trends in computed tomography aortography and acute aortic syndrome in an emergency department within Aotearoa New Zealand.

Objective: Acute aortic syndrome (AAS) comprises a triad of life-threatening aortic conditions that are difficult to diagnose because of their non-specific clinical presentations. Contrast-enhanced computed tomography aortography (CTA) has a high sensitivity and specificity for these conditions. However, under- and over-investigation of patients with suspected AAS using CTA carries significant risk.

Models of immunogenicity in preclinical assessment of tissue engineered heart valves.

Tissue engineered heart valves may one day offer an exciting alternative to traditional valve prostheses. Methods of construction vary, from decellularised animal tissue to synthetic hydrogels, but the goal is the same: the creation of a 'living valve' populated with autologous cells that may persist indefinitely upon implantation. Previous failed attempts in humans have highlighted the difficulty in predicting how a novel heart valve will perform in vivo.

Clinical performance of decellularized heart valves versus standard tissue conduits: a systematic review and meta-analysis.

Background: Valve replacement surgery is the definitive management strategy for patients with severe valvular disease. However, valvular conduits currently in clinical use are associated with significant limitations. Tissue-engineered (decellularized) heart valves are alternative prostheses that have demonstrated promising early results.

Low-dose erythropoietin treatment is not associated with clinical benefits in severely anaemic Jehovah's Witnesses: a plea for a change.

Background: Jehovah's Witnesses who refuse blood transfusion have high mortality. Erythropoietin (EPO) has been used as an alternative to blood transfusion. The optimal dosing of EPO in anaemic Jehovah's Witnesses is unknown.

Normalized end-systolic volume and pre-load reserve predict ventricular dysfunction following surgery for aortic regurgitation independent of body size.

Pre-operative end-systolic volume (ESV) is predictive of outcome after surgery for severe aortic regurgitation. ESV is influenced by body size and reflects function and afterload, but not pre-load. Left ventricular (LV) chamber size and function were measured in 40 patients (ages 10 to 64 years) by echocardiography before and 7 months after operation and expressed as z-scores in addition to simple indexing.

Are two internal thoracic artery grafts as safe as one? Experience from Green Lane Hospital.

Aim: To compare short-term mortality and major morbidity between patients undergoing elective primary isolated CABG with bilateral internal thoracic artery (BITA) or single internal thoracic artery (SITA) grafts at Green Lane Hospital (Auckland, New Zealand).

Methods: We conducted a retrospective study of short-term outcomes in 5955 patients receiving SITA and 637 patients receiving BITA grafts between 1990 and 2004. Only patients undergoing elective primary isolated coronary artery surgery were included.

Chronic extra-aortic balloon counterpulsation: first-in-human pilot study in end-stage heart failure.

Background: Some patients continue to have significant heart failure symptoms despite optimal medical therapy.

Methods: We describe a first-in-human experience with an implantable non-blood-contacting extra-ascending aortic counterpulsation heart assist system (C-Pulse) in 5 end-stage heart failure patients, aged 54 to 73 years.

Results: All patients improved by 1 NYHA class and improvements in invasive hemodynamics were documented in 3 patients.

Consensus statement: minimal criteria for reporting the systemic inflammatory response to cardiopulmonary bypass.

The lack of established cause and effect between putative mediators of inflammation and adverse clinical outcomes has been responsible for many failed anti-inflammatory interventions in cardiopulmonary bypass (CPB). Candidate interventions that impress in preclinical trials by suppressing a given inflammation marker might fail at the clinical trial stage because the marker of interest is not linked causally to an adverse outcome. Alternatively, there exist examples in which pharmaceutical agents or other interventions improve clinical outcomes but for which we are uncertain of any antiinflammatory mechanism.

Cerebral protection by lidocaine during cardiac operations: a follow-up study.

Background: A previous study showed less postoperative neurocognitive impairment in open-chamber cardiac surgery patients given lidocaine for 48 hours after induction of anesthesia. In the present study, we aimed to test the benefit of a 12-hour infusion in a broader group of cardiac surgery patients, including those undergoing coronary artery bypass graft surgery.

Methods: This was a randomized, double-blind, intention-to-treat trial.

Extra-aortic implantable counterpulsation pump in chronic heart failure.

Extra-aortic counterpulsation for the management of chronic heart failure is a novel approach. We report the use of an extra-aortic implantable counterpulsation pump in the management of a 73-year-old patient with severe heart failure refractory to medical therapy. The implantable counterpulsation pump prolonged his life and greatly improved its quality.

Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery.

Background And Purpose: Improvements in cardiac surgery mortality and morbidity have focused interest on the neurological injury such as stroke and cognitive decline that may accompany an otherwise successful operation. We aimed to investigate (1) the rate of stroke, new ischemic change on MRI, and cognitive impairment after cardiac valve surgery; and (2) the controversial relationship between perioperative cerebral ischemia and cognitive decline.

Methods: Forty patients (26 men; mean [SD] age 62.

Extra-ascending aortic versus intra-descending aortic balloon counterpulsation-effect on coronary artery blood flow.

Background: Diastolic counterpulsation has been used to provide circulatory augmentation for chronic heart failure or for short-term cardiac support. Recently an extra-aortic balloon (EAB) counterpulsation device has been proposed.

Aim: To compare the circulatory effects of counterpulsation using the EAB or an intra-aortic balloon (IAB) in the acute pig model.

Extra-aortic balloon counterpulsation: an intraoperative feasibility study.

Background: Current methods of counterpulsation or ventricular assistance have significant vascular and limb complications. The aim of this study was to determine the safety and performance of a new method of non-blood-contacting counterpulsation using an inflatable cuff around the ascending aorta (extra-aortic balloon [EAB]).

Methods And Results: In 6 patients undergoing first time off-pump coronary bypass surgery via sternotomy, the EAB was secured around the ascending aorta and attached to a standard counterpulsation console.

Cardiopulmonary bypass in pregnancy: possible new role for the intra-aortic balloon pump.

Cardiopulmonary bypass (CPB) during pregnancy is associated with a maternal mortality similar to the nonpregnant population; however, fetal morbidity and mortality are high. Various strategies to improve fetal survival have been advocated. Alteration in uterine artery flow velocity has been reported during nonpulsatile CPB; however, roller pump-generated pulsatile flow for CPB remains controversial.

Staphylococcal post-sternotomy mediastinitis: five year audit.

Background: The reported rate of post-sternotomy mediastinitis is between 0.8 and 2.3%, with up to 79% of cases caused by staphylococci.

Asymmetric primary ringless repair of mitral valve endocarditis: a case report.

The case is presented of a patient with a large mitral valve vegetation. A technique of mitral valve repair involving ringless annuloplasty repair following bileaflet resection of the infected regions of the valve is described. No pledgets or prosthetic material were used in the repair.