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Biomedical subjects

D Latter

Publications and source records attributed to D Latter.

12 recordsLinked to original sources
PubMed1999

The Canadian Study of Cardiac Transplantation. Atherosclerosis. Investigators of the CASCADE Study.

OBJECTIVES: To describe risk factors associated with the development of transplantation coronary artery disease (TCAD). DESIGN: A retrospective study of the Canadian experience. PATIENTS: Seven hundred and nineteen patients with follow-up of at least 12 months following transplantation and a minimum of one coronary angiogram were analyzed. RESULTS: Two hundred and fourteen patients (30%) developed angiographic evidence of TCAD during an average follow-up of 50+/-25 months. Actuarial freedom rate from TCAD averaged 60%, and survival averaged 85% five years following transplantation. Abnormal coronary angiograms increased from 11% to 40% between the first and the fifth year following transplantation. The Cox multivariate final model showed that recipients of donor hearts of 50 years and older (RR 4.35, 95% CI 2.32 to 8.15), patients with two or more episodes of acute rejection (RR 1.56, 95% CI 1.11 to 2.21) and patients with a diagnosis of ischemic cardiomyopathy before transplantation (RR 1.38, 95% CI 1.03 to 1.84) were at higher risk of TCAD. The same risk factors also had a significant effect on survival, although patients who were administered a hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor during follow-up had a higher survival rate (95% versus 85%, P=0.01) five years following heart transplantation. CONCLUSIONS: Recipients of hearts from older donors, patients with an ischemic heart disease before transplantation and those with several episodes of acute rejection are at increased risk for TCAD. Patients who are administered an HMG-CoA reductase inhibitor during follow-up have a higher survival rate five years following transplantation.

Adult↗
PubMed1998

Predictors of early mortality after heart transplantation: the Canadian transplant experience from 1981 to 1992. The CASCADE Investigators. Canadian Study of Cardiac Transplant Atherosclerosis Determinants.

OBJECTIVE: To determine risk factors for early death following transplantation in the Canadian heart transplant experience. METHODS: A retrospective multicentre study of the Canadian experience in heart transplantation was performed to evaluate the role of risk factors of early death within 30 days following transplantation. Eight hundred and thirty-three patients older than 15 years underwent cardiac transplantation between 1981 and 1992 in 10 centres across Canada. The association between risk factors and early mortality was analyzed with a multivariate logistic model to examine simultaneously the effect of all risk factors. RESULTS: Seventy-eight patients (9%) died during the first month following transplantation. Recipient age (P = 0.549), sex (P = 0.554) and body mass (P = 0.313) had no effect. Baseline pulmonary vascular resistance (P < 0.001) and systolic pulmonary pressure (P = 0.021) before transplantation were related to early death. Older donors (P = 0.027) were associated with a higher rate of early death but there was no relation with donor sex (P = 0.597), body mass (P = 0.413), blood group (P = 0.227) and ischemic time (P = 0.309). Patients with pulmonary vascular resistance of 6 or greater (Wood units) and donors older than 50 years had relative risks of early death five and two times, respectively, those of patients without these risk factors. CONCLUSION: Patient survival averaged 91% one month following transplantation in the Canadian experience between 1981 and 1992. The two predictors most strongly correlated with early death were elevated pulmonary vascular resistance at baseline and older donors.

Adolescent↗
PubMed1997

Temperature during cardiopulmonary bypass for coronary artery operations does not influence postoperative cognitive function: a prospective, randomized trial.

OBJECTIVE: The objective was to examine the effect of temperature (28 degrees vs 36 degrees C) during cardiopulmonary bypass on postoperative cognitive functions in a prospective, double-blind, and randomized manner. METHODS: Sixty-two patients scheduled for coronary operations were randomized to warm or cold cardiopulmonary bypass. Preoperative and postoperative (7 days) neuropsychologic evaluations were performed by an observer unaware of cardiopulmonary bypass temperature. RESULTS: Fifty-four patients completed the study (cold bypass, n = 24; warm bypass, n = 30). Significant (p < 0.01) postoperative deterioration for tests of psychomotor coordination and verbal memory was noted in both warm and cold groups, but no differences were observed between groups. CONCLUSION: Temperature during cardiopulmonary bypass for coronary operations does not influence postoperative cognitive function.

Adult↗
PubMed1995

An integrated approach to the surgical management of heart failure.

Many among the large and increasing number of patients suffering from heart failure can benefit from surgical interventions. The indications, efficacy and limitations of various surgical procedures currently available are reviewed, and an integrated approach to offer surgical therapy optimal for the particular patients is proposed.

Canada↗
PubMed1994

Is the incidence of cytomegalovirus disease following heart transplantation decreased by prophylactic ganciclovir and CMV-hyperimmunglobulin?

Ganciclovir (DHPG) was used for the prophylaxis of CMV disease after heart transplantation (HTx) in 20 patients (aged 52 +/- 8 years old). DHPG was used during the first 2 weeks post HTx, and during antirejection therapy with OKT3 or thymoglobulin (ATG), at a dosage of 3 mg/kg q 12 h in the case of a CMV+ donor (D) and/or CMV+ recipient (R). CMV-hyperimmunglobulin (-Ig, 1 ml/kg per week for 6 weeks) was added in the case of a CMV+ donor. A historical control group included 18 HTx patients (aged 53 +/- 10 years old). We excluded the combination of CMV- donor and CMV- recipient. Both groups received the same immunosuppression with methylprednisolone (MP), azathioprine, ATG, and cyclosporine A. The global incidence of CMV disease was 15% (3/20 patients) in the study group and 11% (2/18 patients) in the control group. Similar results were observed in the D+/R- combination (study group 40%, 2/5 patients; control group, 25%, 2/8 patients) and in cases of R+ irrespective of D status (study group, 7%, 1/15 patients; control group 0%, 0/10 patients). No difference was observed in both groups with respect to the incidence of CMV disease after antirejection therapy either with MP or with OKT3/ATG. At 1 year post HTx, no difference was found in the incidence of acute rejection, coronary artery disease or other etiology of infection or mortality. All patients CMV disease responded to a 14-day course of DHPG (5 mg/kg q 12 h). No relapsing disease was observed, and no patient died from CMV. Our results suggested that at the doses and time-scale used, DHPG, with or without CMV-Ig did not reduce the incidence of CMV disease after HTx.

Adult↗
PubMed1989

Congenital abdominal aortic aneurysm.

The authors report the extremely rare occurrence of a congenital abdominal aortic aneurysm, 6 cm in diameter, found in a 1-month-old infant. Prenatal ultrasonography at 34 weeks' gestation had shown the aneurysm, which at that time was interpreted as a renal cyst. At operation, an 8-mm polytetrafluoroethylene tube graft was interposed between the infrarenal aorta and the bifurcation. Cardiopulmonary bypass facilitated operative management by permitting return of blood lost and by maintaining body temperature. In a review of the literature, the authors could not find any report of a neonatal aneurysm of this magnitude. Regrettably, the cause of this true aneurysm remains obscure.

Aorta, Abdominal↗
PubMedDate not supplied

Reinfusion of mediastinal blood in CABG patients: impact on homologous transfusions and rate of re-exploration.

BACKGROUND: Reinfusion of mediastinal shed blood after cardiac surgery has been used in some centers to reduce exposure to homologous blood transfusions. The method has not been widely applied mostly because some studies have failed to demonstrate a significant benefit. METHODS: A group of 675 consecutive patients undergoing first-time, isolated coronary artery bypass surgery (CABG) was studied. Prospective data was collected on the first 375 patients receiving autotransfusion (ATS) of mediastinal shed blood. The charts of 338 patients immediately preceding the institution of the ATS program at our institution (NO ATS group) were retrospectively reviewed. Transfusion of homologous blood products and rate of re-exploration for bleeding were closely monitored. RESULTS: The two groups were identical. The net blood loss was significantly less in the ATS group than in the NO ATS group (1013 +/- 431 cc vs 1371 +/- 631 cc, p < 0.0001). Rate of exploration for postoperative bleeding was 1.5% in the ATS group and 5.0% in the NO ATS group (p < 0.01). In the ATS group, 51.9% of patients were not exposed to any homologous blood product (vs 17.8% in the NO ATS group, p < 0.0001). The ATS patients received on the average 2.9 +/- 7.2 units of blood products versus 6.4 +/- 9.7 units in the NO ATS group (p < 0.0001). CONCLUSION: Reinfusion of mediastinal shed blood significantly reduces exposure to homologous blood transfusions and rate of reexploration. The ATS system reduces the number of re-explorations for coagulopathy-related postoperative hemorrhage.

Blood Loss, Surgical↗
PubMedDate not supplied

Size matching in lung transplantation.

Volume concordance between donor lungs and the chest cavities of transplant recipients has important perioperative and postoperative implications. Between December 1987 and August 1991, 90 patients underwent lung transplantation in the Joint Marseilles-Montreal Lung Transplantation Program: 51 patients had double lung transplants, 19 patients had single lung transplants, and 20 patients had heart-lung transplants. There were 18 children (age range, 7 to 17 years) and 72 adults (age range, 18 to 58 years). Size matching was based on measurement of the submammary thoracic perimeter. Patient age (+/- 2 years) was also taken into consideration in children. Airway anastomoses were bronchial except for all heart-lung transplant patients and two double lung transplant patients, who had tracheal anastomoses. Occasional differences between donor and receiver bronchial diameters in children (greater donor size twice and smaller donor size once) required bronchoplasty in three instances. Healing was normal in these three instances, and no bronchial stenoses were noted. Performance of separate sutures rather than continuous running sutures on the cartilaginous anterior portion facilitated correction of airway diameter inequalities in adults. Excess volume was noted in three patients during closure of the thorax. In one patient, donor and recipient thoracic perimeters were similar. In two patients, however, donor size was greater by more than 20%. This was corrected by pneumoreduction with a surgical stapler. Lung size was decreased by 10% to 40% with use of this technique. Thoracic closure was facilitated and hemodynamic instability was thus corrected. No functional abnormalities were noted after surgery once the differences in lung size were corrected.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Successful repair of recurrent coarctation after neonatal heart transplantation.

Neonatal orthotopic heart transplantation is an attractive primary surgical therapy for severe uncorrectable congenital heart defects such as variants of the hypoplastic left heart syndrome. Aortic arch reconstruction is frequently required to repair the hypoplastic aortic arch and the coarctation at the time of graft implantation. Residual coarctation of the aorta after neonatal heart transplantation for such a condition has satisfactorily been treated with percutaneous balloon dilatation. We describe the successful surgical repair of a recurrent coarctation of the aorta via a sternotomy in a 2-year-old patient who had previously undergone neonatal orthotopic heart transplantation. Postoperative periodic investigations have not shown any evidence of obstruction across the site of the primary end-to-end anastomosis.

Anastomosis, Surgical↗