Clinical evaluation of the eSVS Mesh: First-in-Man trial outcomes.

In coronary artery bypass graft surgery, saphenous vein graft (SVG) patency is much lower than that of the internal mammary artery (IMA). To address this problem, an external support device, the eSVS Mesh was developed. A prospective randomized First-in-Man feasibility trial was conducted in 90 patients after institutional ethics committee approval at seven international centers.

Computerized tomographic angiography in patients having eSVS Mesh(R) supported coronary saphenous vein grafts: intermediate term results.

Background: The Saphenous Vein (SVG) is used in over 80% of coronary artery bypass procedures (CABG) and SVG patency is the Achilles heel of CABG. To address this issue, the eSVS Mesh(R), an external Nitinol knitted mesh, fitted like a sleeve over the vein graft preventing over expansion in the high pressure arterial system, has been introduced to improve disease management. Patency data is limited.

Influence of prosthesis type on long-term survival after re-replacement of aortic valve prosthesis.

Background: The purpose of this study is to examine the influence of the prosthesis type on early mortality and long-term survival after re-replacement of aortic valve prosthesis, especially in patients over 60 years old.

Methods: Late outcome of 223 patients who underwent a reoperation on the aortic valve and received a mechanical (mechanical group) or biological (biological group) heart valve prosthesis at a single institution were analyzed for survival and major valve-related complications, including structural valve deterioration, thromboembolism, hemorrhage, further reoperation, and valve-related mortality.

Results: Preoperative New York Heart Association class IV (P = 0.

Aortic root and ascending aortic replacement.

The Ross procedure is occasionally favoured in young adults, with the implantation of a mechanical conduit remaining a competing option when simultaneous replacement of the ascending aorta is indicated. Eighteen patients with replacement of the ascending aorta, in addition to the Ross procedure (Ross), and 20 patients with a mechanical composite graft (composite) were compared retrospectively. The Short Form Health Survey (SF36) was used to assess quality of life (QoL).

Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin.

In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30+/-11.2 months, 390 patients were assessed with Wald test-corrected chi(2) analysis to identify preoperative factors which correlate with a higher incidence of post-MIDCABG MI, PCI, CABG and mortality from cardiac causes.

Consequences of incomplete repair of acute type A aortic dissection.

During emergency repair of acute Stanford type A aortic dissections, surgical compromises in the form of incomplete arch replacement are made due to the unstable condition of the patient and safety issues of the performing team. We report a case of delayed reoperation after previous incomplete surgery for acute type A aortic dissection in a young patient with Marfan's syndrome. He presented again with repetitive chest pain five years after initial surgical treatment.

Preliminary experience with the mini-extracorporeal circulation system (Medtronic resting heart system).

A compact cardiopulmonary bypass (CPB) utilized by closed circuit system with minimized priming volume can be a solution to reduce adverse effects of CPB, and the Resting Heart System (RHS; Medtronic, Inc, Minneapolis, MN, USA) is the newest one on the market. We performed CABG with RHS in 10 patients, and report here our preliminary experiences with RHS in comparison with conventional CPB. Twenty patients who underwent isolated CABG were randomized into two groups; RHS group (n=10) with the use of RHS and Conventional group (n=10) with the use of a conventional CPB.

Long term angiographic monitoring reveals safety and efficacy of the Converge end-to-side anastomotic coupler.

Sutureless anastomotic systems promise to minimize surgical trauma during revascularization procedures. We evaluate graft patency following end-to-side coupling with the Converge device. Fifteen of 35 enrolled patients of a two-center, non-randomized clinical study underwent 2-year angiography and clinical follow up, after sutureless anastomotic coupling of one of the grafts, using the Converge system.

MRI-based safety evaluation of the ventrica magnetic coronary anastomotic system.

The Ventrica Magnetic Vascular Positioner system is a novel automatic anastomotic coupling device for distal coronary artery anastomosis. There is concern that enormous magnetic fields may negatively affect graft anastomosis or coronary artery blood flow, or that they may lead to disconnection of the magnetic ports. Forty-five domestic swine (26.

Iatrogenic type A dissection after attempted stenting of a descending aortic aneurysm.

This case demonstrates an iatrogenic acute retrograde type A dissection of the aortic arch and ascending aorta during elective endovascular stenting of a proximal descending aortic aneurysm. This devastating complication necessitated emergent surgery with unfavorable postoperative outcome. Other than the known causes, the described retrograde type A dissection resulted from guidewire manipulation and iatrogenic creation of a false lumen, which was erroneously dilated and stented.

Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients.

Objective: Extracorporeal membrane oxygenation (ECMO) has been used as initial, biventricular circulatory support for patients with severe postcardiotomy cardiogenic shock (PCS). Due to its aggressiveness and limited weaning quote, concerns have been raised about maintenance of ECMO support regarding duration. However, it is frequently hazardous for physicians to make an individualized decision, whether and when discontinuation of ECMO support should be considered.

Short moderate hypothermic circulatory arrest without any adjunctive cerebral protection for surgical repair of the ascending aorta extending into the proximal aortic arch: is it safe?

Introduction: We have been using only moderate hypothermic circulatory arrest (HCA) for patients with ascending aortic aneurysms extending into the proximal aortic arch if the distal anastomoses seem to be simple and easy. The aim of this study is to evaluate the early and midterm results of the use of moderate HCA without any adjunctive cerebral protection in such patients.

Methods: Between October 2000 and March 2005, 23 patients with an age range of 39 to 77 years (mean, 59.

Glycine application and right heart function in a porcine heart transplantation model.

Glycine reduces ischemia-reperfusion injury after experimental liver transplantation. We hypothesized that glycine might also protect right heart function in an isovolumic cardiac transplantation model. In six domestic donor pigs 150 ml of a 300 mmol L-glycine solution were administered intravenously.

Anastomotic obstruction after magnetic vascular coupling after minimally invasive direct coronary artery bypass grafting.

We report a 61-year-old man who required reoperation 8 months after minimally invasive direct coronary artery bypass grafting after magnetic vascular coupling due to a symptomatic subtotal obstruction at the anastomotic site. It was also determined that the patient had been noncompliant in following the prescribed postoperative antiplatelet therapy.

Cerebral microembolization during antegrade selective cerebral perfusion.

Background: This study quantified the number of intraoperative microemboli in patients undergoing aortic arch surgery using selective cerebral perfusion (SCP) in comparison with those in patients undergoing ascending aortic replacement without circulatory arrest and SCP.

Methods: A transcranial Doppler monitoring of the medial cerebral artery was performed in 15 patients undergoing proximal arch replacement with SCP (SCP group) and 15 patients undergoing replacement of the ascending aorta (control group).

Results: There was no significant difference in the high-intensity transient signal counts between the SCP group and the control group at any phase.

Allopurinol/uricase and ibuprofen enhance engraftment of cardiomyocyte-enriched human embryonic stem cells and improve cardiac function following myocardial injury.

Objective: A major limitation of stem cell transfer is early donor-cell death. Here, we seek to enhance myocardial repair following injury through transplantation of cardiomyocyte-enriched human embryonic stem cells (hESC) and recipient treatment with cytoprotective (allopurinol+uricase) and anti-inflammatory (ibuprofen) agents.

Methods: We injected 10(6) (15% hESC-derived cardiomyocytes) green fluorescent protein (GFP+) hESC in the infarcted area following left anterior descending artery (LAD)-ligation in SCID-beige mice.

Long-term physical activity and neurologic function after harvesting of the radial artery as T-graft or free graft in coronary revascularization.

Background: Radial artery grafts in coronary revascularization are frequently used, either as a T-graft or as a free radial graft such as a saphenous venous graft. Besides the neurologic function of the hand after radial artery harvesting, which is questioned especially in the long-term perspective, no data on patients' lifestyle are available in this special cohort. Therefore we focused on both the patients' neurologic function as well as level of physical activity, along with their body mass index and smoking habits in this prospective, long-term study.

First clinical results with a 30 degrees end-to-side coronary anastomosis coupler.

Objective: The purpose of this study is to evaluate the safety and efficacy of a novel 30 degrees end-to-side coronary anastomotic coupler (Converge Medical, Inc., Sunnyvale, CA) that facilitates a non-penetrating, sutureless vein graft to coronary artery anastomosis.

Material And Methods: The Coupler utilizes a set of concentric mating frames approximating adjacent vessel tissue allowing for biological healing of the anastomosis.

Severe right heart failure after heart transplantation. A single-center experience.

We reviewed our heart transplantation recipient population, using hard criteria defining severe right heart failure (RHF), and analyzed possible risk factors for outcome after RHF. Between 1983 and 1998 621 cardiac transplantations were performed at our institution. RHF was defined by the necessity to implant an assist device or echocardiographically confirmed right ventricular ballooning with concomitant end organ failure.