Biomedical subjects

F Peschl

Publications and source records attributed to F Peschl.

9 recordsLinked to original sources

PubMed1997

The pulmonary homograft as aortic valve substitute: 7 years' follow up.

OBJECTIVE: The advantages of the aortic valve homograft high resistance to infective endocarditis, low risk of thromboembolism, low gradient and excellent long term results are well known. Trying to extend these advantages to a greater number of patients, we used pulmonary homografts as aortic valve substitute, based on the experimental evidence, that they can withstand the higher stress in systemic circulation. METHODS: From September 1988 to August 1994 175 patients (103 men, 72 women, mean age 61.75 +/- 12.92 years) underwent aortic valve replacement with a cryopreserved pulmonary homograft. All valves were taken from our own homograft bank. They were inserted freehand intraaortically, 162 in subcoronary position, 13 as intraaortic cylinder. All patients were followed clinically and by colorflow Doppler echocardiography in 3-12 month intervals. RESULTS: Patients, 8, died perioperatively (4.57%). None of the deaths was valve related. Patients, 2, had to be reoperated during the perioperative period due to severe valvular incompetence 165 patients were followed up to a period of 7.5 years (mean interval 3.83 +/- 1.45 years). Patients, 30, died, 13 deaths (7.42%) must be regarded as valve related. Patients, 22, (12.52%) had to be reoperated due to severe graft incompetence. Patients, 9 (5.14%), acquired prosthetic endocarditis. CONCLUSION: Due to our results, high rate of valve related deaths, high rate of graft failure and high rate of prosthetic endocarditis, we must state that the pulmonary homograft did not fulfil our expectations and presently we can not recommend it as an aortic valve substitute.

Aortic Valve↗

PubMed1995

Aortic valve replacement with cryopreserved pulmonary allografts: five years' follow-up.

Excellent clinical results with pulmonary autografts and experimental evidence that pulmonary valves can withstand the higher stress in the systemic circulation led us to use the cryopreserved pulmonary allograft for aortic valve replacement. From September 1988 until March 1993, 126 consecutive patients (61 +/- 10 years; 74 men and 52 women) underwent aortic valve replacement with a cryopreserved pulmonary allograft. All allografts were inserted freehand in the subcoronary position. There were four in-hospital deaths (3.2%), and 1 patient had severe valvular incompetence immediately postoperatively, requiring reoperation after 4 weeks. One hundred twenty-one patients were followed up in 3- to 6-month intervals for 25.3 +/- 16.3 months (range, 6 to 66 months), and valve performance was assessed routinely by means of color-flow Doppler echocardiography. Nine patients (7.1%) died during follow-up. Two patients died of multiple septic emboli during bacterial endocarditis, and 1 patient died of a massive stroke. The other 6 patients died of myocardial infarction (4), respiratory insufficiency due to chronic obstructive lung disease (1), and carcinoma (1). Ninety-four patients (78%) had absent or trivial aortic valve regurgitation. Valvular incompetence class II was present in 3 patients (2.5%), whereas 5 others (4%) demonstrated class II to III. Severe aortic regurgitation (class III or IV) could be detected in 10 patients (8.3%). All underwent reoperation and replacement of the valve with a prosthetic device. Bacterial endocarditis caused graft incompetence in 3 patients, valve degeneration was detected in another 3, and technical mistakes at valve implantation caused valve failure in the other 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMed1995

[Heart surgery in the elderly].

The number of octogenarian patients undergoing an open heart procedure in our unit is the fastest increasing group of patients. Between June 1985 and July 1994 112 octogenarians (mean age 81.7 years, 60 males, 52 females) underwent cardiac operations. The postoperative course was uneventful in 90 patients (80.4%). The perioperative mortality rate was 8.9% (10 patients). Mortality was lowest in the group receiving aortic valve replacement, with one death out of 30 patients (3.3%). The cause of death was left- or biventricular heart failure in more than half of the fatalities. Postoperative complications included: AV-block III (n = 1), postoperative bleeding (n = 2), unstable sternum (n = 3), acute cholecystitis (n = 1), low cardiac output syndrome (n = 1), stroke (n = 1), pneumothorax (n = 2) and urinary tract infections (n = 1). We consider open heart procedures in octogenarians, despite a mortality rate of 8.9%, as justified. According to the severity and course of clinical symptoms and the type of surgery required, selection of patients for operation should be decided on at an early stage of the disease. Not only life expectancy increases, but there is also a significant increase in life quality for these patients.

Aged↗

PubMed1994

[Use of autologous femoral vein in superior vena cava thrombosis. Case report and review of the literature].

We report on a 52-year old male patient who underwent implantation of an insulin pump because he had diabetes and in whom superior vena cava syndrome developed as a long-term complication. After unsuccessful lysis therapy superficial femoral vein was implanted to form a bypass from the internal jugular vein to the right atrium. The postoperative course was uneventful from the aspects of both the bypass and the leg after explantation of the superficial femoral vein. The bypass is still patent 7 months after the operation, and the patient has no symptoms. Autogenous superficial femoral vein can be used successfully in the reconstruction of large venous vessels. It should be the graft of choice for young patients with benign diseases. We compare our result and those obtained with different substitutes described in the literature that have been used for reconstruction in superior vena cava syndrome.

Femoral Vein↗

PubMed1994

The octogenarians--a new challenge in cardiac surgery?

The per- and early postoperative outcomes of 75 consecutive octogenarians (38 male, 37 female, mean age 81.7 years) who underwent open heart surgery were analysed to identify independent variables of risk factors influencing morbidity and mortality. There were 48 coronary bypasses. 20 valve replacements, and 7 combined procedures. Multivariate analysis revealed that functional class (New York Heart Association), operative procedure, aortic cross clamp time, total bypass time, and age are independent predictors for morbidity and mortality (p < 0.05). There were 6 postoperative deaths (8%). Postoperative complications included haemorrhage (2), stroke (1), unstable sternum (2), acute cholecystitis (1), pneumothorax (2), and urinary tract infection. It is concluded that octogenarians may benefit from open heart surgery at an acceptable risk.

Aged↗

PubMed1994

Perioperative infusion of nifedipine and metoprolol provides antiischemic and antiarrhythmic protection in patients undergoing elective aortocoronary by-pass surgery.

A randomised study was performed on 70 patients undergoing elective coronary by-pass procedure to examine whether the combined, perioperative, 24-hour infusion of nifedipine and metoprolol reduces the incidence of perioperative myocardial ischemia and arrhythmias. The control group received nifedipine only. Repeated assessments of serum enzyme levels and 12-lead-ECG together with a 3-channel Holter monitoring over 48h were used to classify perioperative myocardial ischemia and supraventricular and ventricular arrhythmias. The two groups did not differ with respect to their demographic data, extracorporeal circulation, aortic cross-clamping time, or number of distal anastomosis. No perioperative myocardial infarction in either group was detected. However, a significantly lower incidence of transient ischemic event was observed in the NM group as compared transient ischemic events was observed in the NM group as compared to the N group. In addition, there was a tendency towards lower CK-MB-level and peak-values of CK- and CK-MB-enzymes in the NM group. With regard to perioperative dysrhythmias, there was a significantly lower incidence of sinus tachycardia and atrial flutter/fibrillation in the NM group as compared to the N group. In addition, postoperative heart rate was lower in the NM group starting from the 6th hour after opening the aortic cross-clamp. In conclusion, the combined perioperative infusion of nifedipine and metoprolol is superior in preventing perioperative myocardial ischemia and decreasing the incidence of supraventricular arrhythmias as compared to a single-drug regimen with nifedipine.

Arrhythmias, Cardiac↗

PubMed1993

Combined perioperative infusion of nifedipine and metoprolol provides antiischemic and antiarrhythmic protection in patients undergoing elective aortocoronary bypass surgery.

A randomized study was performed on 70 patients undergoing elective coronary bypass surgery to examine whether the combined, perioperative, 24-hour infusion of the calcium-channel blocker nifedipine (10 micrograms/kg/h) and the beta 1-blocker metoprolol (12 micrograms/kg/h) reduces the incidence of perioperative myocardial ischemia and arrhythmias (group NM, n = 34). The control group received nifedipine only (n = 36). Repeated assessment of serum enzyme levels (CK, CK-MB) and 12-lead ECG, together with 3-channel Holter monitoring over 48 h were used to define perioperative myocardial ischemia (transient ischemic event, myocardial infarction) and supraventricular and ventricular arrhythmias. The two groups did not significantly differ with respect to preoperative anamnestic and surgical data. No perioperative myocardial infarction was detected in either group. However, a significantly lower incidence of transient ischemic events was observed in the NM group as compared to the nifedipine group (3% versus 11%; p < 0.05). In addition, there was a tendency towards lower CK-MB levels and peak-values of CK- and CK-MB in the NM group. With regard to perioperative dysrhythmias, there was a significantly lower incidence of sinus tachycardia (9%) and atrial flutter/fibrillation (6%) in the NM group as compared to the nifedipine group (33 and 27%, p < 0.05). In addition, postoperative heart rate was lower in the NM group starting from the 6th hour after opening of the aortic cross-clamp. In conclusion, the combined perioperative infusion of nifedipine and metoprolol is superior in preventing perioperative myocardial ischemia and decreasing the incidence of supraventricular arrhythmias as compared to a single-drug regimen with nifedipine.

Aged↗

PubMed1991

Nifedipine reduces the incidence of myocardial infarction and transient ischemia in patients undergoing coronary bypass grafting.

A randomized study was performed on 104 patients undergoing elective coronary artery bypass grafting to examine whether the infusion of nifedipine (n = 53) reduces the incidence of perioperative myocardial ischemia and necrosis in the early postoperative period. Continuous hemodynamic and three-channel Holter monitoring was performed for 24 hours and serial assessment of serum enzymes and 12-lead electrocardiography were performed for 36 hours postoperatively. Nifedipine (minimum dose, 10 micrograms/kg/hr for 24 hours) was applied from the onset of extracorporal circulation. The control group (n = 51) received nitroglycerin (minimum dose, 1 micrograms/kg/min for 24 hours). Using the combined analyses of electrocardiography and Holter recordings, myocardial ischemia was defined as being either a transient ischemic event (TIE), transient coronary spasm (TCS), or myocardial infarction (MI). The two groups did not differ with respect to preoperative New York Heart Association classification, age, history of myocardial infarction, extracorporal circulation and aortic cross-clamp time, number of distal anastomoses, or systemic and pulmonary hemodynamics. The incidence of perioperative myocardial ischemia was substantially lower in the nifedipine than in the nitroglycerin group [TIE: three of 53 patients (6%) versus nine of 50 patients (18%), p less than 0.001; MI: two of 53 patients (4%) versus six of 50 patients (12%), p less than 0.001; and TCS: none of 53 patients (0%) versus two of 50 patients (4%), p = NS].(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗

PubMed1990

Infusion of nifedipine after coronary artery bypass grafting decreases the incidence of early postoperative myocardial ischemia.

We performed a randomized study on patients undergoing elective coronary bypass grafting to examine whether postoperative infusion of nifedipine (n = 25) could reduce the incidence of isolated transient myocardial ischemia, myocardial infarction, or both. The control group (n = 25) received nitroglycerin. Hemodynamic and Holter monitoring and serial assessment of enzymatic and electrocardiographic changes were performed for all patients. Both groups showed comparable preoperative and operative data. The incidence of myocardial infarction was significantly lower in the nifedipine group (n = 1) as compared with the control group (n = 4), whereas the number of patients with isolated transient myocardial ischemia was similar in both groups (nifedipine, 3; control, 4). At the time of peak activity, levels of creatine kinase (350 +/- 129 versus 511 +/- 287 IU/mL), creatine kinase-MB (8.4 +/- 5.4 versus 17.1 +/- 11.0 IU/mL), and glutamate-oxaloacetate-transaminase (30.4 +/- 4.4 versus 41.0 +/- 7.9 IU/mL) were markedly lower in the nifedipine group (p less than 0.05). We conclude that infusion of nifedipine after elective coronary artery bypass grafting effectively decreases the incidence of myocardial infarction and the extent of myocardial necrosis during the early postoperative period.

Blood Pressure↗