Biomedical subjects

Eric E Roselli

Publications and source records attributed to Eric E Roselli.

5 recordsLinked to original sources

PubMed2006

Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation for structural valve deterioration of allograft and pericardial prostheses.

OBJECTIVE: To compare explantation for structural valve deterioration in nonelderly patients after aortic valve replacement with stented bovine pericardial and cryopreserved allograft valves. METHODS: From 1981 to 1985, 478 patients received pericardial prostheses during premarket approval; from 1987 to 2000, 744 patients received cryopreserved allografts. Mean age of patients receiving allografts was 49 +/- 12 years, and that of those receiving pericardial prostheses was 65 +/- 11 years; pericardial valves were used in 138 patients younger than age 60. Mean follow-up was 15 +/- 5.1 years for pericardial valves (4674 patient-years of follow-up) and 5.6 +/- 3.1 years for allografts (3892 patient years of follow-up). Multivariable hazard function methodology, age-group stratification, and propensity matching were used to compare age-specific explantation for structural valve deterioration. RESULTS: Ninety-five pericardial valves and 46 allografts were explanted, and structural valve deterioration was the mechanism of failure in 74% and 59%, respectively. The risk of structural valve deterioration increased with younger age at implantation for both allografts (P = .07) and pericardial valves (P < .0001), with a similar magnitude of effect in patients age 50 years or younger (P = .5), 50 to 60 years (P = .7), and greater than 60 years (P = .9) and in propensity-matched pairs (P = .2). Thus, pericardial valves were as durable as allografts at all adult ages. CONCLUSIONS: Structural valve deterioration is the most frequent cause of valve-related reoperation after both pericardial and allograft aortic valve replacement and is similarly age dependent, suggesting that pericardial valves may be appropriate for nonelderly as well as older persons.

Adult↗

PubMed2006

Failure modes of the Carpentier-Edwards pericardial bioprosthesis in the aortic position.

BACKGROUND AND AIM OF THE STUDY: Modes of failure of the Perimount bioprostheses have not been characterized. Thus, the study aim was to classify their failure modes, to compare their rates of occurrence, and to relate these to patient age. METHODS: Between September 1981 and July 1985, a total of 478 patients received Carpentier-Edwards Perimount aortic valve prostheses as part of a premarket approval cohort. During yearly follow up over 19 years, 95 prostheses were explanted, 70 (74%) for reasons of structural valve deterioration (SVD). Preoperative diagnostic studies, echocardiograms, operative notes and pathology reports were reviewed to classify the primary modes of failure. Hazard function methodology established mode-specific occurrence rates and how these were modulated by patient age at implant. RESULTS: The pathophysiology of SVD was pure regurgitation in 23 cases, pure stenosis in 18, mixed in 20, and uncertain in nine. Primary modes of failure were calcification (n = 27; 39%), non-calcific degeneration (n = 21; 30%), fibrosis (n = 5; 7.1%), dehiscence (n = 4; 5.7%), a combination of these (n = 10; 14%), or unknown (n = 3; 4.3%). The failure rate for each mode accelerated with time, was highest and almost equal for calcification and degeneration, and was slower and almost equal for fibrosis and dehiscence. Except for dehiscence, failure modes were age-dependent (p < 0.05), and this was most prominent for degeneration and calcification. CONCLUSION: Perimount bioprostheses rarely fail from design-related causes; rather, they fail at almost equal rates from calcific and non-calcific degeneration, both of which occur late and are age-dependent. Further investigation into improved methods for fixation and anti-calcification in preparing these valves is warranted.

Adult↗

PubMed2005

Atrial fibrillation complicating lung cancer resection.

OBJECTIVE: To (1) characterize atrial fibrillation complicating lung cancer resection, (2) evaluate its temporal relationship to other postoperative complications, and (3) assess its economics. METHODS: From January 1998 to August 2002, 604 patients underwent anatomic lung cancer resection. Atrial fibrillation prevalence, onset, and temporal associations with other postoperative complications were determined. Propensity matching was used to assess economics. RESULTS: Atrial fibrillation occurred in 113 patients (19%), peaking on postoperative day 2. Older age, male gender, heart failure, clamshell incision, and right pneumonectomy were risk factors (P < .01). Although atrial fibrillation was solitary in 75 patients (66%), other postoperative complications occurred in 38. Respiratory and infectious complications were temporally linked with atrial fibrillation onset. In 91 propensity-matched pairs, patients developing atrial fibrillation had more other postoperative complications (30% vs. 9%, P < .0004), had longer postoperative stays (median 8 vs 5 days, P < .0001), incurred higher costs (cost ratio 1.8, 68% confidence limits 1.6-2.1), and had higher in-hospital mortality (8% vs 0%, P = .01). Even when atrial fibrillation was a solitary complication, hospital stay was longer (median 7 vs 5 days, P < .0001), and cost was higher (cost ratio 1.5, 68% confidence limits 1.2-1.6). CONCLUSION: Atrial fibrillation occurs in 1 in 5 patients after lung cancer resection, with peak onset on postoperative day 2. Risk factors are both patient and procedure related, and atrial fibrillation may herald other serious complications. Although often solitary, atrial fibrillation is associated with longer hospital stay and higher cost. It therefore requires prompt treatment and should stimulate investigation for other problems.

Aged↗

PubMed2005

Small intestinal submucosa intracardiac patch: an experimental study.

In this experimental study, small intestinal submucosa was implanted as an atrial prosthesis in calves. Echocardiography and histology showed this to be an impermeable prosthesis that develops a neointimal nonthrombogenic surface making it safe for repair of defects in a low-pressure system. Further study with small intestinal submucosa in an intracardiac position is warranted.

Animals↗

PubMed2004

Surgical advances in heart and lung transplantation.

The successes of thoracic transplantation have led to the expansion of indications and a subsequent growth in demand for a short supply of organs. In response to this disparity, the criteria for organ donation have been liberalized. Despite these difficult challenges, with advances in surgical techniques and perioperative care of both the donor and recipient, outcomes have continued to improve over time. This article focuses on the more recent surgical advances in donor selection and management, procurement and implantation, and the impact of these advances on patient outcome.

Heart Transplantation↗