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Biomedical subjects

Gilbert H L Tang

Publications and source records attributed to Gilbert H L Tang.

10 recordsLinked to original sources
PubMed2006

Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes.

BACKGROUND: The purpose of this study was to compare the long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. METHODS AND RESULTS: 702 patients underwent TV repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral valve surgery in 80% of patients, aortic valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow-up was 99% complete and was 5.9+/-4.9 (mean+/-SD) years long. Ring patients were younger (55+/-14 versus 59+/-14 years; P=0.001) and less likely to have coronary artery disease (10% versus 17%; P=0.02), more likely to be female (75% versus 65%; P=0.01) and having had previous cardiac surgery (56% versus 42%; P=0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P=0.03) and event-free survival (HR, 0.8; CI, 0.6 to 1.0; P=0.04). CONCLUSIONS: Placement of an annuloplasty ring in patients undergoing tricuspid valve repair is associated with improved survival and event-free survival.

Adult↗
PubMed2006

Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease.

BACKGROUND: Organic tricuspid valve (TV) disease is uncommon. Few studies have compared TV repair with replacement in these patients. The current study compared midterm outcomes of TV repair versus replacement in a large group of patients with organic tricuspid disease. METHODS: Two-hundred and fifty patients underwent surgery for organic TV disease at our institution from 1979 to 2003. Clinical and echocardiographic follow-up were obtained, were 99% complete, and were 5.2 +/- 4.1 years long (mean +/- standard deviation). RESULTS: One hundred and seventy-eight patients (71%) underwent TV repair and 72 (29%) received TV replacement (54 bioprosthetic, 18 mechanical). Repair patients were more likely to have hypertension, rheumatic pathology, or elective surgery. Concomitant procedures included mitral (50% of patients), aortic (26%), and coronary bypass (6%) operations. Perioperative and midterm mortality were higher in the replacement group (both p < 0.001). Cox regression analysis revealed TV replacement as an independent predictor of midterm mortality (hazard ratio: 5.1, 95% confidence interval: 2.9 to 9.1, p < 0.001) and decreased event-free survival (hazard ratio: 2.0, 95% confidence interval: 1.1 to 3.6, p = 0.02). Follow-up echocardiography revealed more moderate to severe tricuspid regurgitation in repair patients (38% vs 5%, p < 0.001), but no difference in New York Heart Association functional class or reoperation rates. CONCLUSIONS: Tricuspid valve repair is associated with better perioperative, midterm, and event-free survival than TV replacement in patients with organic tricuspid disease. Despite more tricuspid regurgitation in the repair group during follow-up, reoperation rates and functional class were similar. Repair should be performed whenever possible in patients with organic tricuspid disease.

Adult↗
PubMed2005

Current status of cellular therapy for ischemic heart disease.

Cellular therapy for acute myocardial infarction and ischemic cardiomyopathy has entered clinical trials across the globe. Early promising results have now provided the justification for larger randomized and blinded trials to address the efficacy of cellular therapy. A variety of fresh or cultured autologous cells have been delivered by catheter-guided endocardial, catheter-guided intracoronary, catheter-guided transvenous, and direct epicardial routes. This review will summarize the clinical data and highlight salient basic science data that support the ongoing efforts to identify the optimal cellular therapy both for acute myocardial infarction and chronic ischemic cardiomyopathy patients.

Bone Marrow Cells↗
PubMed2005

Aortic root replacement surgery: indications, techniques and outcomes.

Aortic root pathology is a common cause of aortic insufficiency. Aortic root aneurysm and aortic dissection, if left untreated, carry significant risk of mortality and morbidity. Surgical treatment involves replacement of the aortic valve, sinuses and ascending aorta. A number of prosthetic options have been developed including composite valve-synthetic graft, xenograft, homograft and pulmonary autograft. The current review describes the two main indications for aortic root replacement surgery, aortic dissection and root aneurysm, and discusses the various operative strategies and outcomes.

Aorta, Thoracic↗
PubMed2004

Prevention and management of deep sternal wound infection.

Deep sternal wound infection (DSWI) is an uncommon but serious complication of median sternotomy in cardiac surgery, associated with significant mortality and morbidity. We performed a retrospective review of 30,102 consecutive cardiac surgical patients operated on at our institution from 1990 to 2003 and found an incidence of DSWI of 0.77%. The in-hospital mortality rate was 6.9% for DSWI patients versus 2.8% for patients without DSWI (P = 0.0002). Multivariable predictors for development of DSWI were old age, diabetes, previous stroke or TIA, and congestive heart failure. The use of bilateral internal thoracic artery (BITA) grafts increased the risk of DSWI in patients undergoing coronary artery bypass surgery, particularly in those with congestive heart failure alone or with diabetes. Skeletonization of BITA grafts resulted in a lower risk of DSWI, comparable to nondiabetic patients (1.3% versus 1.6%, P = 0.8). Patients with DSWI were treated with either sternal debridement and primary closure or sternectomy with myocutaneous flap reconstruction, resulting in a 6-month freedom from adverse event rate of 76% in both groups.

Cardiac Surgical Procedures↗
PubMed2003

Cell transplantation to improve ventricular function in the failing heart.

Current therapies for congestive heart failure are limited in efficacy or in applicability. Cardiac cell transplantation offers a novel therapeutic approach to improve heart function. Although significant progress has been made over the past decade in the development of cell transplantation, only recently have investigators studied the changes in ventricular function following cell transplantation. This review article describes the latest research developments, evaluates recent studies of ventricular function after cell transplantation, and discusses the future directions of cell transplantation as a new therapy to 'repair broken hearts'.

Animals↗
PubMedDate not supplied

Thrombosis of mechanical mitral valve prosthesis.

Obstruction of mechanical valve prostheses is a rare but potentially lethal complication following valve replacement surgery. Identifying the etiology and differentiation between thrombus, pannus, and vegetation obstructing the valve prosthesis can pose a diagnostic challenge. We report a patient who had an acute cerebral hemorrhage, developed a progressive mass lesion obstructing his mechanical mitral valve, and discuss contemporary diagnostic and management strategies.

Cerebral Hemorrhage↗