Biomedical subjects

A J Razzouk

Publications and source records attributed to A J Razzouk.

60 records · Page 4Linked to original sources

PubMedDate not supplied

Cardiac transplantation for infants with hypoplastic left-heart syndrome.

OBJECTIVE: To determine whether cardiac transplantation improves the natural history of infants with hypoplastic left-heart syndrome and to examine differences in outcome as a function of the pretransplant period. DESIGN: Retrospective cohort study. Historical, clinical, and laboratory data were collected during the pretransplant period, the in-hospital period, and for up to 6 years following transplantation. Data were analyzed using the product-limit estimate and the log rank test. SETTING: A tertiary, acute care, university teaching hospital. PATIENTS: All 111 infants with hypoplastic left-heart syndrome who entered and completed a protocol leading to transplantation from November 19, 1985, to December 31, 1991. Infants who died while waiting for transplantation were included. INTERVENTION: Orthotopic cardiac allotransplantation. MAIN OUTCOME MEASURES: Pretransplant waiting mortality and its influence on posttransplant survival, operative (in-hospital or within 30 postoperative days in discharged patients) and intermediate-term mortality (5 years), and reoperation rates for cardiac surgery. RESULTS: Transplantation procedures were performed in 84 infants (76%; 95% confidence interval [CI], 66% to 83%) ranging in age from 3 hours to 151 days. Twenty-seven infants registered for transplantation died while awaiting a donor heart. Operative mortality was 13% (CI, 7% to 23%), and 69 patients were late survivors (62% [CI, 52% to 71%] of the study group and 82% [CI, 72% to 89%] of the transplant recipients). Overall 5-year actuarial survival was 61% (CI, 52% to 70%). Transplant recipients had a 5-year survival of 81% (CI, 71% to 88%). Freedom from reoperation was 89% (CI, 76% to 95%) at 5 years. CONCLUSIONS: Cardiac transplantation for hypoplastic left-heart syndrome has a significant positive impact on the natural history of this uniformly lethal lesion.

Cohort Studies↗

PubMedDate not supplied

Surgical intervention in children after heart transplantation.

One hundred sixty-eight children underwent heart transplantation from January 1989 to December 1992 at Loma Linda University Medical Center. Maintenance immunosuppression consisted of cyclosporine and azathioprine. Perioperatively, 19 patients required peritoneal dialysis, with a 42% hospital mortality rate. During a follow-up period ranging from 3 months to 4 years, major surgical procedures were performed on 72 patients (43%). Cardiovascular and thoracic interventions included balloon angioplasty of aortic coarctation (10 patients, 2 of whom later required surgical repair), permanent pacemaker placement (n = 4), extracorporeal membrane oxygenation (n = 4), right pulmonary artery banding (n = 1), retransplantation (n = 2), repair of pulmonary venous obstruction (three patients, one of whom underwent two more reoperations), thrombectomy of the abdominal aorta (n = 1), delayed sternotomy closure (n = 10), plication of the diaphragm (n = 5), tracheostomy (n = 2), and repair of lung herniation (n = 1). The overall procedural mortality rate for this group was 12.3%. There was one death associated with operations performed for conditions unrelated to the cardiac disease: hernia repair (n = 3), gastrointestinal procedures (n = 6), percutaneous gastrostomy (n = 5), and miscellaneous (n = 15). Risk factors affecting patient survival were the need for dialysis and the number (two or more) of pretransplant or posttransplant surgical procedures. Children with transplanted hearts can tolerate surgical intervention for treatment of complications or other untreated problems at an acceptable risk.

Adolescent↗

PubMedDate not supplied

Methotrexate as rescue/adjunctive immunotherapy in infant and adult heart transplantation.

Methotrexate may be a useful adjunct to more conventional immunosuppression in heart transplantation, but experience is limited. We report our findings in 18 patients aged 19 days to 64 years, who were treated with methotrexate. Five patients were less than 1 year of age; 11 patients were over 16 years of age. Indications could be divided in two groups. Seven patients were treated with methotrexate as rescue therapy for unresolving acute grade 3 rejection or for early recurrence after one rejection episode that had been treated with steroids and antilymphocyte serum. All infants were treated with methotrexate for life-threatening rejection. Methotrexate was given as an adjunct to conventional treatment in six patients for mild rejection, which occurred while steroids were being decreased or in patients with relative contraindications to high-dose steroids. One grade 3b rejection could not be reversed with methotrexate and led to the patient's death 3 months later. One grade 1b rejection only temporarily improved and was actually reversed with high-dose steroids after 4 months. All other rejections were rapidly reversed with the use of methotrexate. Tolerance of methotrexate has been very good with transient leukopenia in four patients, with ulcerative stomatitis in one patient, and with transient elevation of liver enzymes in two patients. We conclude that methotrexate is a valuable rescue/adjunctive immunotherapeutic agent that is capable of altering heart rejection with considerable safety and efficacy.

Adolescent↗

PubMedDate not supplied

Prolonged preservation of human pediatric hearts for transplantation: correlation of ischemic time and subsequent function.

Ninety-one infants and children, aged 0 days to 12 years, who received 93 hearts from donors aged 2 days to 24 years between November 1985 and September 1990 were retrospectively studied. Forty-three children were less than 1 month of age; 31 children were between 1 month and 6 months of age, and 19 children were between 6 months and 12 years of age. The donor heart ischemic time ranged from 51 minutes to 8 hours 17 minutes (mean, 4 hours 2 minutes). Fifty-one hearts had an ischemic time of less than 4 hours (group 1), and 42 hearts, more than 4 hours (group 2). No significant difference was noted in the age of donor or recipient or in donor/recipient weight ratio. No correlation was found between ischemic time and number of primary graft failures between groups. Inotropic support was required for 3.9 +/- 3.3 and 5.2 +/- 3.7 days for group 1 versus group 2 (not significant). Ventilator status was the same between the groups. A significant decrease of posterior wall movement in diastole (p < 0.01) occurred among patients of group 2 at 1 week after transplantation, but no difference was found between groups at 2 weeks, 1 month, and 3 months after operation. Posterior wall movement of group 2 heart grafts recovered completely by week 2. No difference was noted in the fractional shortening between the groups; but in both groups, fractional shortening significantly increased from week 1 to week 2. We conclude that ischemic times up to nearly 8 1/2 hours are well tolerated by donor hearts used in pediatric transplantation.

Age Factors↗

PubMedDate not supplied

Utilization of pediatric donors salvaged by cardiopulmonary resuscitation.

The efficacy of using infant donors with an extended cardiopulmonary resuscitation (CPR) history was investigated. Eight heart transplantations with donors who had no or minimal (less than 10 minutes) history of CPR (group A) and seven heart transplantations with donors with extended CPR history (35 to 125 minutes; mean, 59 minutes; group B) were compared for peak myosin levels after transplantation, and systolic and diastolic cardiac function in the first week after transplantation. All donor hearts had normal hemodynamics in the early postoperative period. No significant differences were found between the groups with regard to age of donors, age of recipients, donor heart ischemic time, and cardiac function in the first week after transplantation. In group B, peak myosin levels were 1.4, 4.6, 7.0, 11.3, 14.8, 20.2, and 21.3 ng/ml. These values were significantly (p < 0.05) higher than those in group A but represented only minimal myocardial damage when compared with the values in previous myocardial infarction studies. Although donors with a history of protracted CPR had higher efflux of myosin light chains perioperatively, hemodynamic recovery suggests that use of pediatric donor heart grafts after prolonged CPR is safe and efficacious.

Age Factors↗

PubMedDate not supplied

Silver modification of polyethylene terephthalate textiles for antimicrobial protection.

The safety and in vitro effectiveness of applying silver to polyethylene terephthalate fabric mechanical heart valve (MHV) sewing cuffs for the prevention of prosthetic valve endocarditis (PVE) were evaluated. PVE is an infrequent but grave complication of cardiac surgery associated with mortality rates potentially exceeding 50%. A poor response to antibiotic therapy is partly responsible for the high mortality rates. Silver is a well known antimicrobial agent with broad effectiveness. Preliminary in vitro microbial challenge studies of the coated fabric using the New York State 63 bacteriostatic test and Dow Corning Shake Flask test showed a > or = 97% reduction for most organisms tested. Sheep mitral valve replacement studies suggest comparable tissue ingrowth of uncoated and coated fabric with a more organized, thinner pannus formed on silver coated fabric. Low levels of silver were present in the serum at all time periods. These results indicate MHVs with silver coated cuffs may provide additional protection against PVE.

Animals↗