Biomedical subjects

M Heilbron

Publications and source records attributed to M Heilbron.

4 recordsLinked to original sources

PubMed1998

Wallgraft endoprosthesis: initial canine evaluation.

This study evaluated the in vivo deployment and the healing characteristics of a self-expanding endoluminal graft [Wallgraft (WG) Endoprosthesis] in a canine (n = 22) aorta. The WG consisted of a 10 or 12 mm x 7.5 cm Wallstents (Schneider, Inc.) covered with polyethylene terephthalate (Dacron) graft material. Twenty-two WGs were deployed using fluoroscopic guidance. Devices were oversized approximately 10 per cent. Intravascular ultrasound (IVUS) was repeated, and balloon expansion along the length of the WG was performed to assure maximum expansion. WGs were evaluated with IVUS, angiography, and histology at 14 (n = 4), 30 (n = 4), 90 (n = 4), 180 (n = 5), and 365 (n = 5) days. Predeployment aortic diameters were 9.9 +/- 1 mm. Mid-WG diameters were 9.0 +/- 0.8 mm before balloon dilation and 9.2 +/- 0.5 mm after dilation with 8- (n = 1), 10- (n = 16), and 12- (n = 5) mm balloons. Twenty-two of 23 devices were deployed accurately with good apposition and aortic flow after deployment. On explant, all of the covered grafts were widely patent on IVUS and angiogram. Four explants demonstrated gaps (due to WG taper) between the proximal or distal ends of the graft on IVUS. The device length (9.1 + 0.5 cm) did not change significantly after deployment. Histologically at 6 months and 1 year the lumens were cell-lined. Scanning electron micrography demonstrated endothelial-like cells. This study demonstrates the ability of a WG to be accurately deployed and maintain excellent patency. Balloon expansion after deployment did not significantly increase the diameter. Clinical evaluation of this device is in progress.

Animals↗

PubMed1997

Deployment and healing of an ePTFE encapsulated stent endograft in the canine aorta.

This study evaluated deployment mechanics and long-term healing of an endoluminally placed stent/graft in normal canine aortas. The endoluminal graft (ELG) consisted of a 8.5 cm segment of expanded polytetrafluoroethylene (ePTFE) graft material (Impra, Inc., Tempe, AZ) encapsulating a series of six Palmaz P-128 stents (Johnson & Johnson Interventional Incorporated, New Brunswick, NJ) along the length of the graft. The prostheses were deployed via the femoral artery using a 14Fr delivery system that contained a balloon catheter to expand the ELG in the infrarenal aorta. Twenty-one prostheses were deployed and evaluated at 1 week (n = 3), 1 month (n = 3), 3 months (n = 3), 6 months (n = 9), and 1 year (n = 3). Dimensions of the infrarenal aorta were determined with intravascular ultrasound (IVUS) and angiography prior to deployment of devices. Real-time fluoroscopy and IVUS were used to monitor device deployment with both imaging modalities repeated following implantation. Gross inspection and microscopic evaluation was performed on the explanted specimens following in vivo evaluation by CT scan, IVUS, and angiography prior to retrieval of the specimens. The prostheses were easily deployed from the femoral access site. Oversizing of the deployment balloon compared to the aortic diameter was necessary to accommodate the 10% device recoil observed following balloon deflation, however, all devices were seated against the aortic wall as evidenced by IVUS. At explant, all devices ware widely patent with limited luminal thrombosis observed in four specimens (19%). Devices were well-incorporated by cellular ingrowth into the ePTFE with the formation of neointima. No device migration or postdeployment recoil was observed. ePTFE graft material between stents protruded slightly into the vessel lumen accounting for a 10% luminal reduction. Fully supported ELG's consisting of balloon expandable stents encapsulated in ePTFE are easily deployed using a low-profile delivery system. Specimens demonstrated uniform long-term patency and healing up to 1 year in a canine aortic model. Those preliminary findings support further study of this fully supported prosthesis in the treatment of arterial disease.

Angioplasty, Balloon↗

PubMed1997

A review of the literature: transmyocardial laser revascularization.

BACKGROUND AND OBJECTIVE: Transmyocardial laser revascularization is an investigational procedure that improves chronic angina that is not amenable to other forms of therapy. The theorized mechanism is an increased supply of oxygenated blood to the myocardium via the creation of left ventricular transmural channels. The objective of this review is to facilitate an understanding of the current work published in the literature on the subject of transmyocardial laser revascularization. METHODS: Using Melvyl Medline, all pertinent literature associated with transmyocardial laser revascularization was sought and reviewed. CONCLUSION: The research in transmyocardial laser revascularization is growing. The results of the current work in animals is conflicting with some showing a benefit from this procedure and others that refute its effectiveness. This may be the outcome of differing methodology, which has yet to be evaluated. Although the results of human trials are positive, the overall effectiveness in comparison with the conventional forms of therapy has not been addressed. It is, therefore, a procedure worthy of continued study.

Angina Pectoris↗

PubMed1997

Modular bifurcation endoprosthesis for treatment of abdominal aortic aneurysms.

OBJECTIVE: The authors analyzed a single group's experience treating abdominal aortic aneurysms (AAAs) with a new self-expanding, modular, bifurcated device. SUMMARY BACKGROUND DATA: Successful exclusion of AAAs by prototype devices has led to several controlled clinical trials evaluating prostheses designed and manufactured specifically for this application. METHODS: Sixteen patients (15 males, 1 female) of American Society of Anesthesiologists grade 2 through 4 and average age of 72 years had AAAs (average 57-mm diameter) treated as part of a phase I Food and Drug Administration-approved trial. RESULTS: All patients were treated successfully with no surgical conversions. No endoleaks or aneurysm enlargement was noted either predischarge by contrast computed tomography or on follow-up at 1 month by duplex ultrasound examination. At 6 months, 12 of 13 patients who were observed for this interval had no endoleaks, whereas one patient (patient 3) showed a small area of extravasation that appeared to arise from the device in an area that was traumatized at the time of deployment. One procedure-related mortality (6%) occurred in a patient who died of septic complications secondary to a gangrenous gallbladder diagnosed 1 day after the procedure. There were no device-related mortalities. Complications included two iliac artery dissections, two groin wound infections, and two transient elevations of serum creatinine. Other significant variables including median procedure length (5 hours), intensive care unit stay (1 day), hospitalization postprocedure (4.5 days), and blood loss (1100 mL) all decreased as the study progressed. Blood replacement in all but three patients was accomplished by autotransfusion or banked-autologous blood replacement. At 6-month follow-up in 13 patients, the maximum diameter of the aneurysm decreased by an average of 5.6 mm (range, 0-15 mm), and the maximal cross-sectional area decreased an average of 20.3% (range, 0-72%). CONCLUSIONS: This study suggests that endovascular prosthesis exclusion of AAAs using a self-expanding modular device may be effective in many patients who are otherwise surgical candidates for repair if further clinical studies confirm these observations.

Aged↗