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Biomedical subjects

A Laske

Publications and source records attributed to A Laske.

79 records · Page 5Linked to original sources
PubMed1990

[Long-term follow-up after heart transplantation].

Actuarial survival rate two years after heart transplant in our patients is 90%. The most patients report excellent quality of life (NYHA I) and present definitely improved work load capacity as well as normal cardiac hemodynamic assessment two years after transplant. The major problems in the long follow-up of heart transplant recipients are accelerated coronary disease (graft atherosclerosis), arterial hypertension and renal function impairement.

Cause of Death↗
PubMed1989

[Results of the initial 50 heart transplantations in Zurich].

During the first 40 months of the new Heart Transplantation Program (September 1985 until December 1988) a total of a 160 patients were evaluated for transplantation at the University Hospital in Zurich. 50 patients eventually came to heart transplantation, while one patient underwent a heart-lung transplant. In the same period 9 patients accepted for transplantation died on the waiting list before transplantation. All 50 hearts were transplanted orthotopically. Follow-up treatment, immunosuppression and diagnostics for rejection are described. There was no operative mortality in this group. Two patients died early and three died late. For the first consecutive 50 heart transplant patients, showing a total of 732 patient months, actuarial survival was calculated at 90.1% at one and two years, and at 79.5% at three years. "Enlarged Heart Transplantation Program" describes some of the secondary activities spurred by the new Heart Transplantation Program.

Actuarial Analysis↗
PubMed1989

[Ventricular septal defect following myocardial infarct].

Surgery was performed for postinfarction ventricular septal defect (VSD) in 25 consecutive patients (14 men, 11 women; mean age 68 +/- 8 years). 9 patients were preoperatively in cardiogenic shock and required mechanical circulatory support by intra-aortic balloon pump (IABP) before surgery, whereas 11 acute patients underwent surgery without use of the IABP beforehand. The following procedures were performed: VSD patch closure in 25/25 patients, resection of infarct in 15/25, and patch enlargement of the left ventricle in 3/25. The overall 30-day mortality was 6/25 (24%). However, mortality was higher (4/9 [44%]) in the group with IABP support versus the group of acute patients without it (2/11 [18%]: p less than 0.05). In patients with significant postinfarction VSD, surgical closure appears to be mandatory.

Aged↗
PubMed1989

[Blood replacement in heart transplantation].

Transfusion of blood and blood products in orthotopic heart transplantations were analysed in a series of 31 consecutive patients operated upon between September 1985 and December 1987. Mean age of the 29 men and 2 women was 41 +/- 12 years (range: 15-63). All patients had to be assigned to NYHA functional class IV before operation and their mean left ventricular fraction was 20%. The etiologies of cardiac disease leading to transplantation in this series were: cardiomyopathy in 19/31 patients (61%), ischemic heart disease in 7/31 (23%), valvular disease in 2/31 (6%), life threatening arrythmias in 2/31 (6%) and primary cardiac tumor in 1/31 (3%). Previous cardiac surgery had been performed in 6/31 patients (19%). Full anticoagulation with coumarines was observed in 24/31 patients (77%) at the time of surgery when mean PT was 33 +/- 12% and mean hematocrit was 40 +/- 4%. Mean blood products transfusion requirements in patients receiving an orthotopic heart transplant were 24.2 +/- 14.7 units (range 7-67 units) during the entire hospital stay. These figures are even higher if compiled in function of the number of donors of the transfused blood products: 29.2 +/- 22.4 (range 7-105). The following mean number of blood and blood components was perfused per patient: Red cells (hematocrit 50 +/- 10%) 4.4 +/- 3.9, concentrated red cells (hematocrit 70 + 10%) 5.9 +/- 4.3, fresh frozen plasma 7.4 +/- 3.3, platelets 3.9 +/- 4.1, and others (factor 8, 9 etc) 0.6 +/- 1.6. In-hospital mortality was 1/31 patients (3%) and actuarial survival is 27/31 (87%) at 33 months of follow-up (mean 17 +/- 7 months). However, 7/27 survivors (26%) had to be treated for cytomegaly acquired during or after the heart transplantation. Therefore transfusion of cytomegaly free blood products has to be recommended.

Adult↗
PubMedDate not supplied

Echocardiographic evaluation of left ventricular wall motion before and after heart transplantation.

Forty transplanted hearts were retrospectively investigated before, immediately after, and 15 +/- 12 months after heart transplantation by two-dimensional echocardiography for the presence and course of left ventricular myocardial wall motion abnormalities. Fourteen heart donors who were brain dead because of subarachnoid hemorrhage formed group 1 (mean age, 35 years); 21 heart donors who were brain dead because of head injury formed group 2 (mean age, 29 years), and five heart donors who were brain dead because of head injury with an additional chest trauma formed group 3 (mean age, 28 years). Myocardial wall motion was examined in six different myocardial segments (inferior, septal, anterior, posterior, posterolateral, apical) and was quantitatively assessed by a modified score index system (score index 0 = normal wall motion; score index 1 = diffuse hypokinesia). Overall, 27 of the 40 heart donors showed mild to severe (9 of the 40) wall motion abnormalities, which improved shortly after heart transplantation (score index: 0.36 vs 0.18, p < 0.01), and remained improved 15 months after heart transplantation (score index: 0.15). Among the different study groups, a significant improvement occurred in the myocardial wall motion score index on a short-term and long-term basis in all the groups, except for group 2, regarding the long-term follow-up. This study concluded that brain-dead, potential heart donors often reveal mild-to-severe left ventricular wall motion abnormalities, which are readily detected and semiquantitated by two-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Prophylactic cytolytic therapy in heart transplantation: monoclonal versus polyclonal antibody therapy.

The value of immunoprophylaxis with monoclonal anti-CD3 antibodies (OKT3) was evaluated in 44 consecutive, nonrandomized heart transplant patients. The control group (n = 22) was treated with polyclonal rabbit antithymocyte globulin (RATG) for 5 days. The study group (n = 22) was treated with OKT3 for 14 days. All patients had identical perioperative immunosuppressive therapy and similar maintenance therapy, with cyclosporine, azathioprine, and low-dose prednisone (starting prednisone: OKT3 group immediately, RATG group 3 weeks [n = 11] or greater than 3 months [n = 11] after transplantation). The mean histologic rejection grade (Texas classification) in the RATG and the OKT3 groups was 2.5 +/- 1.9 and 0.6 +/- 0.8 (p less than 0.005) after 1 week and 4.3 +/- 1.6 and 2.0 +/- 1.5 (p less than 0.001) after 2 weeks, but there was no difference in the first year. The linearized rejection rate (rejections per 100 patient days) was higher in the RATG group in the first 2 weeks (2.6 vs 0, p less than 0.05 respectively, 7.8 vs 0.7, p less than 0.001) and higher in the OKT3 group in the second month (1.4 vs 2.8, p less than 0.01). In the RATG group the rejection rate fell continuously, to 0.1 at the end of the first year, whereas in the OKT3 group it remained 0.4 (NS). The cumulative first-year incidence was similar for persistent rejections (RATG 0.38 +/- 0.29 vs OKT3 0.48 +/- 1.13, NS) and insignificantly higher for severe rejections in the OKT3 group (RATG 0.21 +/- 0.32 vs OKT3 0.49 +/- 1.10). Rejection-related mortality in the first year was 0% (RATG) and 9% (OKT3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗