Eight years' experience with bridging to cardiac transplantation.

Although bridging to cardiac transplantation has become a therapeutic option for transplant candidates whose condition deteriorates while they are awaiting a donor heart, short-term efficacy has not been proved and long-term survival has not been reported. We retrospectively reviewed data on 44 patients who had circulatory assist devices placed as a bridge to transplantation between May 1985 and April 1993. The 35 male and nine female patients ranged in age from 12 to 65 years (mean 43.

Circulatory assist devices in congestive heart failure.

This article discusses the use of mechanical circulatory assist devices to support patients who have developed heart failure that has become refractory to more conventional treatment. Included is a description of the various devices available, the respective advantages and disadvantages of each, and a general discussion of the indications for mechanical circulatory support.

Specific ablation of human immunodeficiency virus Tat-expressing cells by conditionally toxic retroviruses.

The identification of human immunodeficiency virus (HIV) as the etiologic agent of AIDS has led to the proposal of novel intervention strategies to block HIV infection and viral replication or eliminate HIV-infected cells. We have produced recombinant retroviruses for a molecular ablation system, whereby a toxin gene can be delivered to hematopoietic cells for the specific elimination of HIV Tat-expressing cells. For this cell-specific ablation, we have coupled the conditional toxin herpes simplex virus type 1 thymidine kinase (tk) gene to the HIV-2 promoter and Tat responsive region (TAR) in order that transcriptional activity be under the absolute control of HIV and simian immunodeficiency virus Tat trans-activator proteins.

Vascular complications from intraaortic balloons: risk analysis.

Purpose: The purpose of this study was to assess the incidence of and predictors for vascular complications in patients who required perioperative intraaortic balloon pump (IABP) support.

Methods: Data from 580 patients collected with a retrospective review were statistically analyzed with 25 perioperative parameters, and significant variables were evaluated with multivariate analysis. These data were also statistically compared with data from a 1983 study from our institution.

Working heart model of heterotopic heart-lung transplantation in rats.

A technique for a working heart model of heterotopic heart-lung transplantation is described. The donor aorta and left pulmonary artery are anastomosed to the recipient's abdominal aorta in an end-to-side fashion. Arterial blood from the recipient's abdominal aorta enters the donor left heart via the donor left lung and is ejected into the donor ascending aorta by the transplanted left ventricle.

Reinfusion potassium blood cardioplegia versus cold blood reinfusion alone in elective revascularization.

The purpose of this study was to determine if the addition of potassium to reinfusion cold blood cardioplegia (CBC) offers an advantage over cold blood alone. Forty patients matched for age, left ventricular function, extent of coronary disease and number of vessels bypassed were prospectively randomized. Each patient received an initial dose of CBC (10 cc/kg) with potassium.

CD4 cell surface downregulation in HIV-1 Nef transgenic mice is a consequence of intracellular sequestration.

The Nef gene product is a regulatory protein of HIV whose biological function is poorly understood. Nef has been thought to have a negative effect on viral replication in vitro but has been shown in studies with SIV to be necessary in the establishment of viraemia in vivo. In vitro studies in various human cell lines have shown that Nef downregulates the expression of cell surface CD4 and thus could have effects on the immune response.

Studies of HIV-2 promoter activity and cell specific ablation.

We have a developed a retroviral mediated molecular ablation method to specifically eliminate HIV Tat-expressing cells. This approach utilizes the Tat-inducible HIV-2 promoter and a conditional toxin gene. The Herpes Simplex Virus thymidine kinase gene product is toxic to mammalian cells only after treatment with Ganciclovir (GCV) or other nucleoside analogues.

Microvascular augmentation of the blood supply of the contralateral side of the free transverse rectus abdominis musculocutaneous flap.

The free transverse rectus abdominis musculocutaneous (TRAM) flap is a recognized, reliable method of breast reconstruction after mastectomy. However, blood supply to the contralateral side of both the free and pedicled TRAM flap, especially in zone four, is often precarious. In patients with previous midline abdominal scars or with significant rectus divarication, both zones three and four are at risk of necrosis.

Bridging to cardiac transplantation with mechanical circulatory support.

During the last decade, it has been clearly demonstrated that mechanical assist devices are capable of supporting patients in the interim before cardiac transplantation. The use of these devices prior to transplantation has provided an important window of opportunity to evaluate critically the devices and their potential for adaptation to permanent systems. The overall survival rates in the bridge-to-transplant patient population have improved.

Vascular rejection in heart transplant recipients.

Antibody medicated (vascular) rejection has recently been described in heart transplantation. We report our experience with vascular rejection in a series of 62 patients who did not receive perioperative lymphocyte antibody therapy. Sixty-five rejections were reported, of which 58 (89%) were pure cellular; five (8%) had both cellular and vascular components, and two (3%) had only vascular rejection.

Accumulation of the beta amyloid precursor protein at sites of ischemic injury in rat brain.

We used various antibodies to the beta amyloid precursor protein (APP) of Alzheimer's disease to study changes in the cellular distribution of APP in experimental ischemic brain injury. In contrast to sham operated controls, rats with repeated reversible occlusions of one middle cerebral artery showed striking APP reactivity in astrocytic processes in perifocal regions and white matter tracts. Dystrophic axons and neurons with accumulated APP were also evident in the ipsilateral neocortex and hippocampus.

Circulatory support in infants and children.

Although the last decade has brought dramatic improvement in patient selection and postoperative management of adults and children undergoing advanced mechanical circulatory support, technological advances have been largely limited to the adult population. Intraaortic balloon pumps are technically feasible, but their efficacy has been questioned and their use has been limited in children. Over the last decade, extracorporeal membrane oxygenation has become the most commonly used method of mechanical circulatory support in children who have severe cardiac failure after cardiac operations.

Intraaortic balloon pumping in patients requiring cardiac operations. Risk analysis and long-term follow-up.

The intraaortic balloon pump is usually the first mechanical device inserted for perioperative cardiac failure; however, little current information is available regarding short- and long-term effectiveness. From January 1983 through November 1990, 6856 adult patients underwent cardiac surgical procedures, 580 of whom (8.5%) had an intraaortic balloon inserted preoperatively (107 patients), intraoperatively (419 patients), or postoperatively (54 patients).

Replacement of paracorporeal ventricular assist devices.

In this communication we describe a technique to change paracorporeal ventricular assist devices after the development of mechanical complications. This procedure is technically simple and in our experience does not require a sternotomy or cardiopulmonary bypass. Paracorporeal ventricular assist devices can be safely changed allowing continued support and survival.

Conservative versus surgical management of chylothorax.

Chylothorax is a potentially life-threatening disorder that has profound respiratory, nutritional, and immunologic consequences. Treatment for this problem is controversial, and the results have been variable. From 1985 to 1990, 29 patients (16 males, 13 females; mean age: 20.

Hemangiopericytoma of the hand: a literature review and case study.

We present a case of hemangiopericytoma of the hand. We also attempt to differentiate hemangiopericytoma from glomus tumor with a summary of the history and a comprehensive review of the literature demonstrating the malignant character of the neoplasm, and we offer some guidelines for treatment.

Extracorporeal membrane oxygenation in children after cardiac surgery.

Background: From August 1982 to May 1991, 65 children (32 boys), 1 day to 14 years old, received extracorporeal membrane oxygenation (ECMO) 0-50 hours after cardiac surgery. Forty-four (67.7%) were weaned, with 23 (35.

Prolonged extracorporeal support for nonneonatal respiratory failure.

Extracorporeal membrane oxygenation (ECMO) is effective for newborns with pulmonary failure unresponsive to conventional therapy. However, ECMO for the older child and adult has been controversial and not widely utilized. Over 4 years, 24 patients (aged 4 months to 16 years; 11 boys, 13 girls) underwent venoarterial ECMO (duration, 7 to 19 days) for respiratory failure.

Dog mastocytoma cells produce transforming growth factor beta 1.

Transforming growth factor-beta (TGF beta) promotes deposition of extracellular matrix and is associated with fibrotic conditions both in experimental animals and in humans. Although a role for mast cells has been suspected in the pathogenesis of fibrosis, no potent mediator capable of stimulating fibroblast growth or extracellular matrix deposition has been identified in mast cell supernatants. We report here the constitutive production of TGF beta 1 by four dog mastocytoma cell lines.

Aortic valve replacement. Aortic root versus coronary sinus perfusion with blood cardioplegic solution.

The role of retrograde coronary sinus cardioplegia in patients undergoing aortic valve replacement for aortic stenosis alone or in combination with myocardial revascularization has not been fully defined. Sixty-three patients undergoing elective aortic valve replacement received cold potassium blood cardioplegic solution via either the aortic root (36 patients) or the coronary sinus (27 patients). The patients were similar with respect to age, degree of aortic stenosis, ventricular function, severity of coronary artery disease, crossclamp time, completeness of revascularization, and mean volume and temperature of the infusion solution.