Jochen Cremer — Page 2

PubMedDate not supplied

Percutaneous valve replacement: significance of different delivery systems in vitro and in vivo.

BACKGROUND AND PURPOSE: Percutaneous heart valve replacement is an exciting growing field in cardiovascular medicine yet still with some major problems. Only sophisticated improvement of the instruments could make it a real alternative to conventional surgery. Therefore, the aim of this study was to evaluate different delivery devices for percutaneous heart valve replacement in vitro and in vivo. METHODS: A catheter prototype designed by our group, and two commercially available devices for the delivery of esophageal stents and aortic endoprostheses, were tested. After in vitro experiments, an ovine animal model of transfemoral pulmonary valve implantation was established using biological valved self-expanding stents. Only the delivery device for aortic endografts (Medtronic, Talent, Santa Rosa, CA, USA) allowed fast in vitro procedures without material fatigue. This device was chosen for the in vivo tests. RESULTS: Technical success was achieved in 9 of 10 animals (90%). One animal died after perforation of the ventricular wall. Orthotopic pulmonary placement was performed in 6 animals and intentional supravalvular valved stent placement in 3 animals. CONCLUSIONS: An adequate in vitro model for this evolving field of interventional heart valve replacement is presented. Furthermore, the present study pinpoints the key characteristics that are mandatory for a delivery system in percutaneous pulmonary valve implantation. With regard to the delivery device's ductility observed during this "venous" study, an approach to transfemoral aortic valve implantation seems feasible.

Angiography↗

PubMedDate not supplied

Coronary artery bypass surgery in diabetic patients.

BACKGROUND: Cardiovascular disease is a major cause of morbidity and mortality in patients with diabetes. This study examines the impact of diabetes on mortality and morbidity following coronary artery bypass surgery. METHODS: We retrospectively analyzed 590 consecutive patients after coronary artery bypass grafting in 1998. Reoperations and combined procedures were excluded. A total of 137 diabetic (23.2%) and 453 nondiabetic patients were evaluated. Among the diabetics, 53 were treated with insulin and 84 were non-insulin-dependent. Diabetics suffered more frequently from hypertension, peripheral vascular disease, and more often had an increased body mass index (BMI). RESULTS: There was no significant difference in mortality and major complications among insulin-dependent diabetics, non-insulin-dependent diabetics, and nondiabetic patients. Diabetics suffered more often from superficial sternal wound infection and had a higher incidence of superficial wound infections at the vein harvest site. CONCLUSION: The present study suggests that diabetes increases the risk of superficial wound infections after coronary artery bypass grafting. But diabetics do not necessarily have an increased risk of major complications and mortality.

Age Distribution↗