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Biomedical subjects

K Hekmat

Publications and source records attributed to K Hekmat.

At least 19 recordsLinked to original sources
PubMed2006

Cardiac surgery in Germany during 2005: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery.

All cardiac surgical procedures performed in 79 German cardiac surgical units throughout the year 2005 are presented in this report, based on a voluntary registry, which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2005, a total of 98 860 cardiac surgical procedures (ICD and pacemaker procedures excluded) were collected in this registry. More than 8.4 % of the patients were older than 80 years, compared to 7.8 % in 2004. Hospital mortality in 54 126 isolated CABG procedures (9.7 % off-pump) was 2.9 %, while a mortality of 4.5 % was observed in 19 203 isolated valve procedures. This registry is an important tool of the German Society for Thoracic and Cardiovascular Surgery to ensure a continuous and voluntary quality assurance and illustrate the development of cardiac surgery in Germany.

Adolescent↗
PubMed2005

[Is measuring by portable heart rate monitors (sport watches) dependable in patients with an implanted pacemaker?].

BACKGROUND AND OBJECTIVE: Regular physical exercise is advantageous for physical fitness and endurance. The intensity of exercising can be controlled by portable heart rate monitors. The aim of the study was to investigate if wearable monitors work properly in pacemaker patients. PATIENTS AND METHODS: In 30 patients with an implanted single or dual chamber pacemaker made by five different manufacturers their heart rate was determined simultaneously by surface ECG and Holter ECG, and was compared with the heart rates derived from portable heart rate monitors (Polar A1) at rest, during 6 minutes in-house walk, and while exercising at 25, 50, and 75 watts in a bicycle exercise test. The tests were done with pacing set at uni- as well as bipolar stimulation mode. RESULTS: At rest in two of 30 patients (6,6 %) paced in unipolar mode the portable heart rate monitors counted double. Under exercise conditions the portable monitors counted double in six of 26 patients (23 %) while being stimulated in unipolar mode. In bipolar stimulation mode, the portable heart rate monitors were working properly in all patients under all conditions. CONCLUSIONS: Patients with an implanted bipolar pacing system can control their physical exercising safely and accurately by means of portable heart rate monitors. Pacemaker patients who are planning regular physical exercising should be provided with an implanted bipolar pacemaker system.

Adult↗
PubMed2005

Risk stratification models fail to predict hospital costs of cardiac surgery patients.

BACKGROUND: The aim of this prospective study was to determine if commonly used risk stratification models can predict total hospital costs in cardiac surgical patients. METHODS: Between October 1st and December 31st 2003, all consecutive adult patients undergoing cardiac surgery on CPB at our institution were classified using seven risk stratification scoring systems: EuroSCORE, Cleveland, Parsonnet, Ontario, French, Pons, and CABDEAL. Total hospital costs for each patient were calculated on a daily basis including preoperative diagnostic tests, operating room costs, disposable materials, drugs, blood components, costs for personnel, and hospital fixed-costs. Linear regression analysis was used to determine the correlation between costs and the seven risk stratifications models as well as length of stay (LOS) on ICU. The Spearman correlation coefficient was calculated from the regression line, and an analysis of residuals was performed to determine the quality of the regression. RESULTS: A total of 252 patients were operated for CABG (n=175), valve (n=39), CABG plus valve (n=21), thoracic aorta (n=13) and miscellaneous (2 myxoma, 1 ASD, 1 pulmonary embolism). Mean age of the patients was 66.0+/-11.4 years, 29.4% were female. LOS on ICU was 3.3+/-6.3 days and the 30-day mortality rate was 6.7%. Spearman correlation between the seven risk stratification models and hospital costs was below r=0.32 (p=0.0001), but was r=0.94 (p=0.0001) between ICU LOS and costs. CONCLUSIONS: Total hospital costs can be identified by length of ICU stay. None of the common risk stratification models accurately predicted total hospital costs in cardiac surgical patients.

Aged↗
PubMed2005

VDD-pacemaker in children--a long-term therapy?

AIMS: Transvenous AV-synchronous pacing in children started with the invention of smaller sized VDD leads and miniaturization of pacemakers. Whether or not this is a favourable long-term therapy was retrospectively investigated by us based on data from our records. METHODS: From May 1977 to July 2001 we implanted pacemakers in 104 children younger than 15 years of age. In 55 patients transvenous leads were implanted. Twelve of these (21.8 %) received a VDD pacemaker for hemodynamic reasons. RESULTS: Ages ranged from 11 months to 14.5 years (mean 7.7 +/- 4.3 y). Sizes of the children ranged from 67 to 141 cm (mean 105.9 +/- 15.5 cm) and body weight ranged from 5.3 to 62.0 kg (mean 22.5 +/- 9.8 kg). The mean follow-up period was 47.5 +/- 15.1 months. In 86.3 % of the time during follow-up pacemakers of which we obtained data were working in the VDD mode. Five of the twelve VDD patients (41.7 %) had to be reoperated because of severe traction on the leads. In all five patients the VDD systems were explanted and the patients changed to dual chamber pacemakers. The period of time between implantation and VDD lead explantation ranged from 24 to 74 months (48.6 +/- 18.5). CONCLUSIONS: VDD pacemakers can be implanted safely even in children with a low complication rate perioperatively. 41.7 % of our VDD patients had to be reoperated within the surveillance time because of severe lead tension due to thoracic growth. In our experience VDD pacemakers in smaller children seem to be a temporary solution to bridge AV-synchrony from a young age to DDD pacing in young adulthood.

Child↗
PubMed2004

Interference by cellular phones with permanent implanted pacemakers: an update.

AIMS: The aim of this study was to test pacemakers with feedthru filters for interference with a digital cellular telephone. METHODS: The study comprised 100 patients having their first pacemaker implantation between January 2001 and May 2003. A GSM-standard cellular phone was tested in the standby, dialing and operating mode against 23 single-chamber and 77 dual-chamber pacemakers. Continuous surface electrocardiograms, intracardiac electrograms, and marker channels were recorded when calls were made by a land phone to the cellular phone. RESULTS: In 2 patients we observed pacing inhibition with the cellular phone positioned directly above the pacemaker pocket. The unipolar and bipolar ventricular sensitivity setting was 0.25 mV in one dual-chamber pacemaker, and when we changed the sensitivity to 0.50 mV and higher no interference could be detected. The second inhibition occurred in a single-chamber pacemaker with unipolar and bipolar ventricular sensitivity setting of 0.5 mV, where a sensitivity change to 1.0 mV eliminated the interference. CONCLUSION: Anticipating a correct setting of ventricular sensitivity, currently available pacemakers equipped with feedthru filters do not show any interference with cellular phones. Since interference was only observed with sensitivity settings below 0.50 mV, we recommend that permanent programming of ventricular sensitivity should be set at 2.0 mV and higher.

Adolescent↗
PubMed2004

Impact of tranexamic acid vs. aprotinin on blood loss and transfusion requirements after cardiopulmonary bypass: a prospective, randomised, double-blind trial.

INTRODUCTION: Aprotinin (AP) reduces blood loss and transfusions after cardiopulmonary bypass (CPB), but may sensitise patients and is expensive. Tranexamic acid (TA) has less side-effects, but data regarding its efficacy are controversial. The aim of our prospective, randomised, double-blind study was to compare the impact of AP vs. TA on drainage blood loss and transfusion requirements in patients undergoing first time CABG on CPB. MATERIALS AND METHODS: One hundred and twenty adult patients were randomised to receive either high-dose AP according to Hammersmith or a total of 2 g TA. Perioperative blood products were transfused in a standardised fashion. Blood loss was measured up to 24 h. Demographic and clinical patient data were collected until hospital discharge. RESULTS: The data from 118 patients (TA: n = 58, AP: n = 60) who completed the study according to protocol were analysed. Blood loss at 24 h postoperation in TA patients was significantly higher (896 +/- 354 ml) as compared to AP patients (756 +/- 347 ml; p = 0.03). TA patients received 1.5 +/- 1.5 units of red blood cells (AP: 1.5 +/- 1.7, p = 1.0), 1.3 +/- 2.0 units of fresh frozen plasma (AP: 1.0 +/- 2.0, p = 0.38) and 0.5 +/- 1.4 units of platelets (AP: 0.2 +/- 0.7, p = 0.15). Clinical data, including perioperative myocardial infarction rate, acute renal failure, mechanical ventilation, hospital stay and mortality, were not significantly different between either group. CONCLUSION: Our data show a difference in blood loss between TA and high-dose AP. Although statistically significant, it has little clinical relevance, because perioperative transfusion requirements were similar for both groups. Thus, TA appears to be a cost-effective alternative to AP in primary CABG patients.

Antifibrinolytic Agents↗
PubMed2004

The effect of preoperative antiplatelet therapy in coronary artery surgery: blood transfusion requirements for patients on cardiopulmonary bypass.

INTRODUCTION: Bleeding after heart operations remains a common complication and contributes to morbidity and death. Recent studies have suggested that antiplatelet therapy (APT) may not increase homologous blood requirements in coronary bypass surgery. The purpose of this study was to examine the influence of APT therapy on haemorrhage and transfusion requirements in patients undergoing coronary artery bypass (CABG) on cardiopulmonary bypass (CPB). MATERIALS AND METHODS: Records from 290 consecutive patients who underwent CABG with CPB were retrospectively reviewed, including 145 patients who received APT within 5 days prior to surgery and 145 control patients (CON). Blood loss was measured up to 24 h. Demographic and clinical patient data were collected until hospital discharge. RESULTS: Both groups were well matched with respect to demographic and intra-operative data. There was significantly (p < 0.0005) more mediastinal tube drainage at 24 h in the APT group (1123 mL +/- 537 mL) compared to CON patients (874 mL +/- 351 mL). In addition, the APT group received significantly more units of blood (APT: 2.6 +/- 2.5 vs CON: 1.6 +/- 1.8; p < 0.0005), platelet units (APT: 1.2 +/- 1.8 vs CON: 0.2 +/- 0.8; p < 0.0005), and fresh frozen plasma units (APT: 2.0 +/- 2.2 vs CON: 1.3 +/- 2.0; p = 0.01). CONCLUSION: This study suggests consideration should be given to delaying elective CABG for patients who have received APT treatment until APT is discontinued for at least 5 days.

Blood Loss, Surgical↗
PubMed2002

Cardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery.

OBJECTIVE: Surface-modifying additives (SMA) have been suggested for improving cardiopulmonary bypass (CPB) circuit biocompatibility, potentially minimizing inflammatory complications and bleeding associated with CPB. The purpose of this prospective, randomized clinical study was to compare a novel copolymer surface-modified CPB circuit (SMARXT; COBE Cardiovascular) against the unmodified circuit. METHODS: We randomized 122 patients with isolated coronary artery disease subjected to first-time surgery on CPB into either the SMA (n = 62) or the control group (n = 60). Exclusion criteria included renal insufficiency, liver disease, coagulopathy, anticoagulation therapy < 6 days preop, carotid artery stenosis > 70 %, and a history of stroke. We collected perioperative clinical data including drainage blood loss, transfusion requirements, duration of mechanical ventilation, and ICU stay. Platelet function was determined pre- and post-CPB. RESULTS: SMA patients received 3.2 +/- 0.9 (SD) grafts during 48 +/- 16 min of aortic cross clamp and 91 +/- 30 min CPB (Control: 3.0 +/- 0.9 grafts; p = 0.33, 46 +/- 14 min AXC; p = 0.36, and 84 +/- 23 min CPB; p = 0.14). In the SMA group, 23 patients (37 %) received red blood-cell transfusions, 9 patients (15 %) fresh frozen plasma, and 3 patients (5 %) received platelets (control: n = 27 [46 %], p = 0.44; n = 10 [17 %], p = 0.91; and n=4 [7 %], p = 0.71, respectively). Platelet count on CPB fell to the same level in both groups. In SMA patients, platelet function decreased from 94.2 +/- 24.9 % pre-CPB to 79.5 +/- 32.8 % post-CPB (p = 0.043) (control: from 87.7 +/- 25.6 % to 69.4 +/- 34.7 %; p = 0.001). Postoperative drainage blood loss, mechanical ventilation duration, and ICU stay were similar in both groups (p > 0.3). One patient of the control group was excluded due to surgical bleeding, and one SMA patient died. CONCLUSIONS: Our results show that the surface-modified CPB circuit decreased neither blood loss nor transfusions despite slightly better platelet function preservation compared to the unmodified circuit. This type of CPB circuit surface modification does not appear to improve clinical outcome in low-risk coronary artery surgery patients.

Aged↗
PubMed2002

Impact of hematocrit value after coronary artery surgery on perioperative myocardial infarction rate.

BACKGROUND: The optimal hematocrit (HCT) value after coronary artery bypass grafting on cardiopulmonary bypass (CPB) has not yet been established. The purpose of our retrospective study was to investigate the association between HCr at the time of entry into the ICU and perioperative Ml rate. METHODS: We reviewed the charts of 500 consecutive coronary artery surgery patients with respect to biometric data, operative procedure, aprotinin or tranexamic acid use, perioperative drainage blood loss and transfusion requirements, perioperative Ml, ICU stay and hospital mortality. Perioperative Ml was defined as new Q-wave on ECG and CK-MB 250U/I. Patients were categorized into three groups depending on their HCr value at the time of entry into the ICU: low (HCTcu 27%): medium (HCr,cu 28% to 32%); high(HCTrcu > or =33%). RESULTS: Age, gender distribution, preoperative LV function, and previous Ml rate were similar between the three groups. Low HCT patients (n -133) received 3.1 +/- 1.0 (Mean + SD) grafts during 55 +/- 19 minutes aortic cross clamp time, 98 +/- 31 minutes on CPB (medium HCT: n = 257; 3.2 +/- 1.0 grafts, 51 +/- 20 min cross clamp time, 93 +/- 30 min CPB; p - 0.45 vs. low HCT; high HCT: n = 110: 3.3 +/- 1:0 grafts; 53 +/- 20 min cross clamp time; 104 +/- 38 min CPB; p = 0.02 vs. medium HCT). The perioperative Ml rate was 3.8% in the low, 4.3% in the medium, and 6.4% in the high-HCr group (p =0.59 ). Intraoperative red blood cell and fresh frozen plasma transfusions were similar between the groups. In the low-HCa group, 53.4% of the patients received aprotinin during the procedure (medium HCa: 65.4%; high HCT: 77.3%; p<0.001). Drainage blood loss during the first 24 hours on ICU was 834 +/- 453 ml in the low, 757 +/- 485 ml in the medium (p -0.44 vs. low), and 640 +/- 353 ml in the high-HCr group (p = 0.003 vs. low). Postoperative red blood cell and fresh frozen plasma transfusions were highest in the low-HCa group(p<0.001). ICU stay was similar between the groups. Hospital mortality was 0.75% in the low, 1.9% in the medium, and 4.5%in the high-HCa group (p = 0.12). CONCLUSIONS: In this retrospective analysis of 500 consecutive coronary artery surgery patients, we did not find any association between perioperative Ml rate and HCr value on entry into the ICU. These results do not support the recent suggestion that low HCT at the time of entry into the ICU protects against perioperative Ml.

Aged↗
PubMed2000

Activation of myocardial constitutive nitric oxide synthase during coronary artery surgery.

OBJECTIVE: The role of nitric oxide (NO) in myocardial ischemia/reperfusion is controversial. While some studies have shown cardioprotective effects of NO, others suggested that increased myocardial NO release secondary to ischemia may contribute to reperfusion injury. However, the impact of cardioplegia-induced myocardial ischemia/reperfusion on the activity of the NO-producing enzyme constitutive NO-synthase (cNOS or NOS-III) has not been investigated. METHODS: Twenty elective CABG patients were randomized to receive myocardial protection using either intermittent cold blood cardioplegia with 'hot-shot' (CBC; n=10) or continuous warm blood enriched with the ultra-fast-acting beta-blocker esmolol (WBE; n=10). We collected transmural LV biopsies prior to cardiopulmonary bypass (CPB), at the end of the cross-clamp period, and at the end of CPB. Specimen were subjected to immunocytochemical staining against myocardial NOS-III and cGMP using polyclonal antibodies. NOS-III activity was determined using TV-densitometry (gray units) and cGMP content using a semiquantitative score. Global myocardial metabolism was assessed by arterio-coronary sinus lactate concentration difference (a-csD(LAC)). For LV function determination we measured the fractional area of contraction (FAC) using TEE. RESULTS: In CBC hearts a-csD(LAC) was significantly decreased following cross-clamp removal as compared to pre-CPB indicating global ischemia during cross-clamp. In contrast, a-csD(LAC) was unchanged in WBE hearts indicating absence of relevant ischemia in this group. In CBC hearts NOS-III activity did not change from pre-CPB (35.6+/-11.1 U) to the end of the cross-clamp period (38. 0+/-8.1 U; P=0.2), but increased significantly to 48.5+/-12.1 U at the end of CPB following initial warm blood reperfusion (P=0.026). In WBE hearts NOS-III activity remained unchanged throughout (29. 2+/-10.8, 35.1+/-11.8, and 32.2+/-14.7 U, respectively; 0.3). At the end of CPB, nine CBC hearts, but only one WBE heart showed increased cGMP content (P=0.002). Compared to pre-CPB, FAC in the CBC group was 109+/-25% following weaning off CPB (P=0.26), but was slightly decreased to 87+/-22% at 4 h post-CPB (P=0.03). In the WBE group FAC remained unchanged compared to pre-CPB throughout (103+/-21 and 96+/-37%, respectively; 0.5). CONCLUSIONS: Our data show that global myocardial ischemia and reperfusion induced by CBC is associated with myocardial NOS-III activation and increased cGMP content suggesting increased NO release. In contrast, avoidance of ischemia by use of WBE prevented NOS-III and c-GMP increase. As LV function was decreased at 4 h post-CPB in the CBC group, these data suggest that increased NO release secondary to NOS-III activation may have contributed to ischemia-reperfusion injury as has been shown experimentally.

Adrenergic beta-Antagonists↗
PubMed2000

Myocardial protection with high-dose beta-blockade in acute myocardial ischemia.

OBJECTIVE: The risk of postoperative cardiac dysfunction is markedly increased by emergency coronary artery bypass grafting in the presence of acute myocardial ischemia. High dose beta-blockade during continuous coronary perfusion has been suggested as an alternative to conventional cardioplegia and this technique has been applied successfully in high risk patients for coronary artery bypass grafting (CABG) surgery. This study compared high dose beta-blockade with esmolol to continuous warm blood cardioplegia in a clinically oriented model of acute left ventricular (LV) ischemia and reperfusion. METHODS: Twelve dogs were subjected to 60 min of regional LV ischemia by left anterior descending branch (LAD) ligation. Cardiopulmonary bypass (CPB) and aortic crossclamp were applied after 45 min of ischemia. Thereafter, high dose beta-blockade during continuous coronary perfusion (ESMO, n = 6) or antegrade continuous warm blood cardioplegia (WBC, n = 6) were maintained for 60 min. Myocardial water content (measured from endomyocardial biopsies using a microgravimetric technique), global LV function (preload recruitable stroke work: PRSW), and regional LV function (echocardiographic wall motion score) were determined at baseline and after weaning from CPB. RESULTS: During aortic crossclamp interstitial edema formation was significantly higher in the WBC group with an average water gain of 2.2 +/- 0.49 vs. 0.76 +/- 0.12% in the ESMO group. Thereafter, edema resolved in both groups, but myocardial water gain remained significantly higher in the WBC group at 60 and 120 min post CPB (0.98 +/- 0.19 and 1.13 +/- 0.32% vs. 0.07 +/- 0.25 and 0.04 +/- 0.08%). Global LV function was significantly higher in the ESMO group at 60 and 120 min post CPB (PRSW 103 +/- 6 and 94.7 +/- 4.6% of baseline vs. 85.3 +/- 4.9 and 74.7 +/- 7.6% of baseline). However, regional LV function showed no significant difference between groups. CONCLUSIONS: High-dose beta-blockade during continuous coronary perfusion may allow the surgeon to utilize the advantages of warm heart surgery, while avoiding the interstitial edema formation and temporary cardiac dysfunction associated with continuous warm blood cardioplegia. In high risk patients such as patients with unstable angina or after failed PTCA, high-dose beta-blockade may be an applicable alternative to cardioplegic arrest.

Acute Disease↗
PubMed1999

Myocardial beta-blockade as an alternative to cardioplegic arrest during coronary artery surgery.

The authors' recent experimental work has demonstrated that myocardial protection using continuous coronary perfusion with warm beta-blocker-enriched blood avoids myocardial ischaemia and minimizes myocardial oedema formation, thus completely preserving left ventricle function. The purpose of this clinical study was to compare this alternative technique in terms of structural and functional myocardial protection with the routinely used crystalloid Bretschneider cardioplegia. Sixty coronary artery surgery patients were randomized to receive either crystalloid cardioplegia or continuous coronary perfusion with warm blood enriched with the ultra-short acting beta-blocker esmolol. Cardiac function was evaluated using transoesophageal echocardiography (fractional area of contraction) and cardiac metabolism using arterial-coronary sinus lactate concentration difference (a - csD(LAC)). From left ventricular biopsies, the authors determined myocardial oedema, heat-shock-protein-70, intercellular-adhesion-molecule and actin pattern. Patients with crystalloid cardioplegia received 3.6 +/- 0.8 grafts during 64 +/- 20 min cross-clamp time (beta-blocker: 3.5 +/- 0.9 grafts during 68 +/- 22 min; NS). Following cross-clamp removal crystalloid cardioplegia hearts released significant lactate amounts (a- csD(LAC)) - 1.0 +/- 0.6 versus - 0.1 +/- 0.2 mmol/litre in beta-blocker hearts; P < 0.05). In crystalloid cardioplegia hearts, myocardial water content increased from 82.1 +/- 2.1% pre-cardiopulmonary bypass to 83.2 +/- 1.7% at the end of cardiopulmonary bypass (P < 0.05); in beta-blocker hearts myocardial water content remained unchanged (pre-cardiopulmonary bypass: 82.3 +/- 1.9%; end of cardiopulmonary bypass: 82.4 +/- 1.7%; NS). At the end of cardiopulmonary bypass, left ventricular biopsies of beta-blocker hearts showed less structural damage as determined by heat shock protein-70, intercellular adhesion molecule-I and deranged actin cross-striation pattern as compared with crystalloid cardioplegia hearts (P < 0.05). The post-cardiopulmonary bypass fractional area of contraction was similar in both groups (beta-blocker: 65 +/- 14%; crystalloid cardioplegia: 62 +/- 16%); however, beta-blocker patients required less inotropic stimulation (dopamine: beta-blocker: 2.9 +/- 2.5 versus crystalloid cardioplegia: 5.0 +/- 2.3 microg/kg per min; P < 0.05). The data suggest that continuous coronary perfusion with warm esmolol-enriched blood results in better myocardial protection compared with crystalloid cardioplegia. It is concluded that the concept of beta-blocker-induced cardiac surgical conditions may be a useful alternative for myocardial protection during coronary artery surgery.

Adrenergic beta-Antagonists↗
PubMed1998

Emergency coronary artery surgery after failed PTCA: myocardial protection with continuous coronary perfusion of beta-blocker-enriched blood.

BACKGROUND: Myocardial protection during cardiac surgery in patients with acute ischemia after failed PTCA remains a challenge. Our recent experimental work demonstrated that continuous coronary perfusion with warm beta-blocker-(Esmolol) enriched blood may be a useful alternative to current cardioplegia techniques, especially for compromised hearts. This technique was applied in our last 12 patients after failed PTCA (beta-B). The purpose of this retrospective study was to compare this alternative myocardial protection technique with our standard technique of cold crystalloid cardioplegia (CP). METHODS: Between January 1994 and January 1998 fifty-five patients (beta-B: n = 12; CP: n = 43) underwent emergency coronary artery bypass grafting within 24 hours after failed PTCA. The mean age in beta-B patients was 62+/-9 (SD) years, and 33% were female (CP: 59+/-9 years, 42% female, p = NS). In beta-B patients 67% had myocardial infarction (MI) prior to coronary angioplasty, 67% had an ejection fraction (EF) >55%, and coronary vessel involvement (VI) was 2.1+/-0.7. CP patients had the following findings: MI rate 42%, EF >55% in 84%, VI was 2.2+/-0.6; p = NS. Operation commenced within 25-980 min after failed PTCA. Beta-B patients received 2.7+/-0.8 grafts during 45+/-20 min continuous coronary perfusion with Esmolol enriched blood, whereas CP patients had 3.0+/-1.1 grafts in 42+/-17 min cross-clamp time, p = NS. RESULTS: The total hospital stay was significantly (p = 0.004) shorter for beta-B patients (18+/-8 days) compared to CP patients (27+/-12 days). 30-days mortality rate was 9% in CP patients, whereas none of the beta-B patients died. Postoperative low cardiac output occurred in only one patient (8%) of the beta-B group and was treated with an intra-aortic balloon pump (IABP). Eight (19%) of the CP patients required an IABP and in five (12%) patients an additional ventricular assist device was necessary (LVAD: n = 4; RVAD: n = 1). The need for circulatory support with inotropes was significantly lower in beta-B patients. Cumulative postoperative dosage of dopamine and dobutamine was 34516+/-40400 microg/kg and 16221+/-26678 microg/kg respectively in CP patients. Beta-B patients required only 12457+/-14738 microg/kg (p = 0.02) dopamine and 5112+/-7381 microg/kg (p = 0.01) dobutamine. Perioperative myocardial infarction occurred in 53% of the CP patients and 17% of beta-B patients (p = 0.046). Total CKmax was significantly (p = 0.003) higher in CP patients (812+/-531 U/L) than in beta-B patients (457+/-265 U/L). Four CP patients (9%) had acute postoperative renal failure requiring hemofiltration, and 11 CP patients (26%) had acute postoperative pneumonia. In beta-B patients one patient (8%) suffered from postoperative pneumonia (p = NS) and no patient had renal failure (p = NS). CONCLUSION: These clinical results appear to confirm our experimental data and suggest that continuous coronary perfusion with warm esmolol-enriched blood is superior to crystalloid cardioplegia in terms of in-hospital complications and mortality, especially for compromised hearts after failed PTCA.

Adrenergic beta-Antagonists↗
PubMed1997

Surgical repair of a large residual atrial septal defect after transcatheter closure.

Transcatheter closure of ostium secundum atrial septal defects is a less invasive method of repairing atrial septal defects in comparison with an open heart operation. In selected patients the transvenous closure of atrial septal defects may be an effective alternative. Defects with circumferential septal rims, secundum atrial defects, and patent foramen are the best candidates for this method. We report a case in which a large residual atrial septal defect after transvenous closure with a Sideris occluder device required surgical closure.

Cardiac Catheterization↗
PubMed1994

[Diabetic coma with deep hypothermia. Successful resuscitation with hemofiltration].

A 41-year-old woman with severe juvenile diabetes mellitus suffered from profound hypothermia after loss of thermoregulation in diabetic ketoacidosis. She was found unconscious, without measurable blood pressure; the electrocardiogram (ECG) showed bradycardia of 30 min and the rectal temperature was 23.7 degrees C. The patient received mechanical ventilation, fluid therapy, warmed gastric lavage, and, unfortunately, inotropic medication. She was transferred to a department of cardiac surgery in order to continue the therapy with cardiopulmonary bypass (CPB). On arrival, the patient had a rectal temperature of 27.3 degrees C, the ECG showed an absolute arrhythmia with a frequency of 70/min, and the blood pressure was 63/43 mmHg. We decided to use a rapidly available but not highly invasive venovenous hemofiltration technique for slowly rewarming the patient. Vascular access was achieved by percutaneous femoral vein cannulation with a Shaldon catheter. The hemofiltration system (Gambro AK-10, Gambro AB, Sweden) was instituted with a blood flow rate of 200 ml/min. The hemofiltration monitor controls the pumps for filtering and substituting fluid volumes and allows the infusion solutions to be heated up to 40 degrees C. Sinus rhythm resumed without antiarrhythmic medications at a temperature of 29.5 degrees C, and within 8 h the patient was rewarmed to 35.5 degrees C. After treatment of the adult respiratory distress syndrome caused by pneumonia, she was discharged from the intensive care unit to complete treatment with no evidence of any permanent organ damage. We conclude that hemofiltration may be the method of choice for rewarming deeply hypothermic patients when their circulation is preserved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Endoscopic re-establishment of urethral continuity after traumatic disruption of the membranous urethra.

We report 3 cases of complete traumatic disruption of the membranous urethra treated by transurethral section of the scar tissue with transvesical endoscopic guidance and digital rectal control. Postoperatively, the patients required an average of 3 subsequent urethrotomies. They remain well, continent and free of voiding symptoms for 28, 11 and 14 months after re-establishment of urethral continuity. We suggest that this treatment be considered as an alternative to conventional surgical repair, particularly in elderly and other high risk patients.

Adult↗
PubMed1980

Acclerated growth of testicular cancer after cytoreductive surgery.

Surgical removal of bulky metastases of non-seminomatous germ-cell testicular cancer has been advocated as an adjuvant to chemotherapy in patients whose disease probably is too extensive to be cured by chemotherapy or surgery alone. However, in 8 of our patients, cytoreductive surgery was followed by a sudden and dramatic exacerbation of the disease. In some cases, a marked rise in the serum levels of alpha-fetoprotein and human chorionic gonadotropin was the only evidence. The cause and prevalence of such exacerbations are unknown. Cytoreductive surgery in patients with advanced testicular tumor is accepted treatment and should be advocated, but it appears that in some cases such surgery may adversely alter the course of the malignancy. This must be considered in planning treatment for patients with advanced disease.

Adolescent↗