PubMed Health⌕ Search

Biomedical subjects

J Lavee

Publications and source records attributed to J Lavee.

At least 19 recordsLinked to original sources
PubMed2002

[Dynamic cardiomyoplasty].

The high prevalence of end-stage heart failure and its influence on the quality of life, force the medical community to seek effective therapeutic modalities. Heart transplantation is the accepted therapy for such patients, nevertheless, a significant percentage of patients do not reach transplantation due to the shortage of donors. Therefore, the establishment of surgical alternatives is very important. Dynamic cardiomyoplasty is accepted as an alternative to heart transplantation. In this technique skeletal muscle is wrapped around the heart and stimulated synchronously with the heart itself. We describe the present status of this procedure.

Cardiomyoplasty↗
PubMed2001

Hypotensive reactions associated with transfusion of bedside leukocyte-reduction filtered blood products in heart transplanted patients.

Severe hypotensive reactions that occur during transfusions of blood products to non-transplanted patients were recently linked to the use of bedside leukocyte-reduction filters, sometimes in association with angiotensin-converting enzyme (ACE) inhibitor treatment. We present the first report of such reactions in patients who underwent orthotopic heart transplantation. Fourteen (47%) of the 30 transfused patients experienced severe hypotensive reaction during filtered transfusion of at least 1 unit of blood product, with a total of 24 episodes. Eleven (79%) of these patients were treated pre-operatively with ACE inhibitors.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

[Massive pulmonary embolism--summary of experiences with 13 patients].

Pulmonary embolism is a common event in hospitalized patients. In some cases it presents with hemodynamic collapse, indicating massive obliteration of the pulmonary vasculature and has a very grim prognosis; 2/3 of such patients die within 2 hours of onset of symptoms. We describe our experience in 13 patients with massive pulmonary embolism. An aggressive diagnostic and therapeutic approach, utilizing sophisticated imaging techniques, thrombolytic therapy and surgery, led to the survival of 8 of the patients. Our experience supports an aggressive approach in these seriously ill patients.

Adult↗
PubMed1996

Prediction of mortality in patients awaiting cardiac transplantation: increased risk of sudden death in ischemic compared to idiopathic dilated cardiomyopathy.

A major problem in cardiac transplantation is the death of candidates due to the increasing shortage of donors and the consequent longer waiting periods. To determine whether clinical markers for death could be identified in these patients, 168 adult candidates with heart failure (NYHA class III and IV) listed between August 1987 and December 1989 were analyzed. There were 104 patients with ischemic cardiomyopathy (ISCM) and 64 with idiopathic dilated cardiomyopathy (IDCM). Transplantation was performed in 93 patients (55%). Actuarial 1 year survival was 61% in the ISCM group and 78% in the IDCM group (P = NS). Freedom from sudden death at one year was significantly lower in the ISCM group (73%) than in the IDCM group (96%) (P < 0.01). The rate of patients who did not die from terminal myocardial failure was 83% in the ISCM group and 81% in the IDCM group (P = NS). There were no significant differences between the two groups in right atrial, pulmonary artery, and pulmonary wedge pressures, transpulmonic pressure gradient, pulmonary vascular resistance, cardiac index, and ejection fraction. We conclude that candidates for cardiac transplantation with ISCM are at higher risk for sudden death during the first year on the waiting list than patients with IDCM. These results warrant consideration of aggressive arrhythmia control measures, including an automatic implantable defibrillator, to "bridge" these high risk patients to transplantation.

Actuarial Analysis↗
PubMed1995

Aprotinin improves hemostasis after cardiopulmonary bypass better than single-donor platelet concentrate.

Platelet transfusion and aprotinin administration improve platelet function and clinical hemostasis after extracorporeal circulation. To compare two methods of improving postoperative hemostasis, we preoperatively randomized 40 patients undergoing various open heart procedures into two groups. Group A included 20 patients who, immediately after bypass, received single-donor plateletpheresis concentrates collected from ABO-compatible donors (Baxter Autopheresis-C System). They were compared with 20 patients who received high-dose aprotinin (6 x 10(6) KIU) before and during cardiopulmonary bypass (group B). Group A patients showed significantly higher platelet count after single-donor plateletpheresis concentrate transfusion (157 +/- 36 x 10(9)/L compared with 118 +/- 42 x 10(9)/L (p < 0.05). However, platelet aggregation on extracellular matrix was better in group B (3.4 +/- 0.7 versus 2.8 +/- 0.9; p < 0.05). Total 24-hour blood loss and exposure to homologous blood products were significantly less in group B (396 +/- 125 mL and 1.1 +/- 1.6 units compared with 617 +/- 233 mL and 5.4 +/- 3.4 units; p < 0.01). Despite higher platelet count in patients after single-donor plateletpheresis concentrates transfusion, hemostasis in patients receiving aprotinin is better due to improved platelet function.

Aprotinin↗
PubMed1995

Percutaneous balloon pericardiostomy for treatment of cardiac tamponade.

Percutaneous balloon pericardiostomy was performed in eight severely ill patients with malignancy (seven patients) and chronic renal failure (one patient). To investigate the feasibility of balloon pericardiostomy as a bedside procedure, echocardiography was used in addition to fluoroscopy in monitoring the procedure. The pericardium was entered from the standard subxiphoid site. An 18 to 25 mm, 3 or 4 cm long, balloon catheter, introduced over a stiff guidewire was inflated across the parietal pericardium. Creation of a pericardial opening was obtained in each of the eight patients. Bleeding from the needle entry site was the only complication observed in one patient. The balloon catheter could be localized by echocardiography only in 2/8 cases. Two patients died, 3 and 14 days after the procedure, from the primary disease; six patients were still alive at follow-up ranging from 32 to 342 days. No recurrence of cardiac tamponade was observed in any patient. Percutaneous balloon pericardiostomy is efficacious and safe in relieving pericardial tamponade and preventing its recurrence in severely ill patients. Fluoroscopy is needed to monitor the procedure. The value of echocardiography is limited for follow-up controls of pericardial effusion.

Adult↗
PubMed1995

Irradiation of fresh whole blood for prevention of transfusion-associated graft-versus-host disease does not impair platelet function and clinical hemostasis after open heart surgery.

Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8-10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVHD) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy,12 patients) after CPB. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope and graded from 1 to 4 (from poor to excellent aggregation), was similar in both groups preoperatively [3.3 +/- 0.9 (FWB) and 3.5 +/- 0.5 (Ir FWB)], and at the end of CPB [1.8 +/- 1.2 (FWB) and 1.9 +/- 0.9 (IrFWB)]. Platelet aggregation was similar after transfusion of FWB (3.0 +/- 1.0) and after IrFWB (3.2 +/- 0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560 +/- 420 and 523 +/- 236 ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient's next of kin.

Aged↗
PubMed1993

Platelet protection by low-dose aprotinin in cardiopulmonary bypass: electron microscopic study.

To evaluate the effect of low-dose aprotinin during cardiopulmonary bypass on platelet function and clinical hemostasis, 30 patients undergoing various cardiopulmonary bypass procedures employing bubble oxygenators were randomized to receive either low-dose aprotinin (2 x 10(6) KIU in the cardiopulmonary bypass priming solution, 15 patients [group A]) or placebo (15 patients [group B]). Blood samples were collected before and after cardiopulmonary bypass to assess platelet count and aggregation on extracellular matrix, which was studied by a scanning electron microscope. On a scale of 1 to 4 preoperative mean platelet aggregation grades were similar in both groups (3.8 +/- 0.5 and 3.5 +/- 0.5 for groups A and B, respectively). Postoperatively, platelet aggregation on extracellular matrix decreased slightly in group A (2.8 +/- 1.3; p < 0.01) and significantly in group B (1.3 +/- 0.5; p < 0.001). Eleven of the 15 patients in group A remained in aggregation grade 3 or 4 compared with none of the group B patients. Platelet count was similar in both groups preoperatively and postoperatively. Total 24-hour postoperative bleeding and blood requirement were lower in the aprotinin group (487 +/- 121 mL and 2.3 +/- 1.0 units) than in the placebo group (752 +/- 404 mL and 6.8 +/- 5.1 units; p < 0.01). These results show that the use of low-dose aprotinin during cardiopulmonary bypass provides improved postoperative hemostasis, which might be related to the protection of the platelet aggregating capacity.

Aged↗
PubMed1993

Successful outcome of a left ventricular free wall rupture in a community hospital: case report.

Rupture of the myocardium in the setting of acute myocardial infarction has a universally grim prognosis. The time that elapses between diagnosis and definitive therapy is the most critical determinant of the patient's outcome when death is not instantaneous. Survivors of this catastrophic event have not been frequently reported. We present a case of free wall left ventricular rupture in a patient with an acute myocardial infarction hospitalized in the Cardiac Care Unit of a small community hospital. The patient was successfully transferred to the referral institution for surgery. Rapid diagnosis, primary bedside therapy, and utilization of new surgical techniques helped obtain a good outcome.

Aged↗
PubMed1992

Platelet protection by aprotinin in cardiopulmonary bypass: electron microscopic study.

To evaluate the functional integrity of platelets in patients administered the proteinase inhibitor aprotinin during cardiopulmonary bypass, 20 patients undergoing a complicated and prolonged open heart operation were studied. They were randomized to receive either a high dose of aprotinin (total dose, 6 to 7 x 10(6) KIU) before and during cardiopulmonary bypass (10 patients) or a placebo (10 patients). Blood samples were collected preoperatively, at the termination of bypass, and 90 minutes thereafter to assess platelet count and aggregation on extracellular matrix, which was studied by scanning electron microscopy. On a scale of 1 to 4, mean preoperative platelet aggregation grades were similar in both groups (3.5 +/- 0.5). Postoperatively, at the termination of cardiopulmonary bypass and 90 minutes thereafter, all 10 patients treated with aprotinin revealed normal, unchanged platelet aggregation (grade, 3.5 +/- 0.5), whereas all placebo-treated patients showed severely disturbed aggregation (grade, 1.4 +/- 0.5) (p less than 0.001). The platelet count was similar in both groups before and after operation (preoperatively, 182 +/- 75 x 10(9)/L and 146 +/- 30 x 10(9)/L, and postoperatively, 87 +/- 13 x 10(9)/L and 80 +/- 27 x 10(9)/L for the aprotinin and placebo groups, respectively). Total 24-hour postoperative bleeding and blood requirement were significantly lower in the aprotinin group (371 +/- 84 mL and 2 +/- 0.7 units, respectively) compared with the placebo group (608 +/- 28 mL and 3.4 +/- 1.3 units, respectively) (p less than 0.01). These results demonstrate that improved postoperative hemostasis is directly related to the complete preservation of platelet function achieved by the protective properties of aprotinin.

Adult↗
PubMed1992

Aprotinin prevents cardiopulmonary bypass-induced platelet dysfunction. A scanning electron microscope study.

BACKGROUND: Administration of aprotinin during extracorporeal circulation reduces blood loss and improves platelet function. METHODS AND RESULTS: To evaluate the protective effect of aprotinin on platelets, 50 patients undergoing cardiopulmonary bypass were randomized before surgery to one of three groups. Seventeen patients (group A) received continuous high-dose aprotinin (7 x 10(6) KIU) during cardiopulmonary bypass, 17 (group B) received a single bolus of aprotinin in the pump prime (2 x 10(6) KIU), and 16 (group C) received placebo. Scanning electron microscopy was used to evaluate platelet aggregation on extracellular matrix. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Immediately after cardiopulmonary bypass, 16 patients in group A (94%) reached preoperative aggregation grade (mean grade, 3.4 +/- 0.7) compared with nine of 17 in group B (52%) (mean grade, 2.9 +/- 1.2), and none in group C (0%) (mean grade, 1.4 +/- 0.5; p < 0.001). Postoperative platelet count did not differ significantly among the three groups. After surgery, group A bled less than groups B and C (395 +/- 120 versus 488 +/- 135 and 780 +/- 408 ml, respectively; p < 0.01). Patients in the aprotinin groups received fewer red blood cell units (0.9 +/- 1.2 and 1.9 +/- 1.2 versus 3.4 +/- 1.9, respectively; p < 0.01) and were exposed to less homologous blood products (1.3 +/- 1.7 and 2.1 +/- 1.1 versus 6.1 +/- 5, respectively; p < 0.001). CONCLUSIONS: By preserving platelet function, aprotinin improves postoperative hemostasis in all patients who receive high dose and in most who receive low dose.

Aprotinin↗