Biomedical subjects

Sandra Eifert

Publications and source records attributed to Sandra Eifert.

7 recordsLinked to original sources

PubMed2005

Hemodynamic and vascular effects of ventricular sourcing by stent-based ventricle to coronary artery bypass in patients with multivessel disease undergoing coronary artery bypass surgery.

BACKGROUND: The hemodynamic and vascular effects of ventricular sourcing by a stent-based (VSTENT, Percardia) left ventricle-to-coronary artery bypass were studied in a patient subgroup of the European multicenter ADVANTAGE study (ADjunctive treatment with the VCAB/VSTENT myocardial implANT system in coronary Artery bypass Graft patiEnts). METHODS AND RESULTS: Twelve patients who underwent VSTENT implantation in addition to coronary artery bypass surgery were studied up to 12 months after the procedure. The VSTENT was implanted distal to a hemodynamically relevant coronary artery stenosis. Coronary flow velocity was assessed at rest and during dobutamine stress. Intraoperative VSTENT implantation was successful in 11 of 12 patients. Early postoperative angiograms showed patent VSTENT in 8 of 11 patients, with predominantly systolic flow distal to the VSTENT. Coronary flow velocity reserve induced by dobutamine stress was 1.7+/-0.1 (P=0.006). VSTENT patency at 2- to 6-month follow-up was present in 5 of 11 patients, with concomitant VSTENT stenosis in 4 of those 5. In all patients, coronary flow velocity increased 3- to 4-fold proximal to the VSTENT, which was associated with a moderate degree of arterial remodeling. Except for target vessel reintervention (n=5), no other major adverse events were observed in 11 of 12 patients. One patient died on the second postoperative day, though the cause was probably not related to the VSTENT implantation. CONCLUSIONS: VSTENT implantation seems to be safe in the mid-term follow-up and leads to a predominantly systolic coronary flow pattern in the vessel supplied by the VSTENT, with a flow reserve similar or close to that seen with conventional bypass. VSTENT patency rate, however, was unacceptably low at 3- to 6-month follow-up and needs to be improved.

Aged↗

PubMed2005

Early clinical results with a magnetic connector for distal coronary artery anastomoses.

PURPOSE: The main goals in the development of an anastomotic device are to reduce the invasiveness of the procedure and to improve graft patency. We analyze our preliminary clinical experience with the Ventrica magnetic vascular positioner (MVP) series 6000 system. DESCRIPTION: Eighteen distal anastomoses were performed in 11 patients using the MVP. EVALUATION: The target artery for MVP was left anterior descending in 9 patients, a marginal branch in 4, the first diagonal branch in 3, and the right coronary artery in 2. Graft material was the left internal thoracic artery in 9 patients, saphenous vein in 6, the right internal thoracic artery in 2, and the radial artery in 1 case. Fifteen anastomoses were performed in an end-to-side and 3 in a side-to-side fashion. Predischarge angiography was performed in 10 of 11 patients. There was a patent MVP anastomosis in all patients. CONCLUSIONS: Distal anastomoses using the MVP were performed successfully in all patients. The procedure is simple. Short-term patency is excellent. Further randomized trials are necessary to determine long-term safety and patency.

Adult↗

PubMed2005

First clinical experience with the HEARTSTRING, a device for proximal anastomoses in coronary surgery.

PURPOSE: The HEARTSTRING is a device designed to enable the creation of a clampless hand-sewn proximal anastomosis. DESCRIPTION: Seventy-six patients who underwent myocardial revascularization had 113 proximal anastomoses created by the HEARTSTRING. Fifty-five procedures were performed on cardiopulmonary bypass and 21, off pump. EVALUATION: Of 114 intended proximal anastomoses, 113 (99.1%) were successfully performed using the HEARTSTRING. The conduits anastomosed proximal with support of the HEARTSTRING were in 92 cases saphenous veins and in 21 cases radial arteries. Mean time to perform a HEARTSTRING-supported anastomosis was 6.6 +/- 1.2 minutes. One patient (1.3%) died postoperatively; the death was not device related. In 1 additional patient (1.3%), a stroke most likely due to air embolism occurred. Forty-nine patients (64.5%) underwent a predischarge coronary angiography (n = 20) or a contrast multislice computed tomography (n = 29). Of 76 grafts with a HEARTSTRING-supported proximal anastomosis, 74 (97.4%) were patent in these 49 patients. CONCLUSIONS: Our initial clinical experience with the HEARTSTRING demonstrates safety, reliability, and ease of use. Side clamping of the ascending aorta can be avoided, potentially decreasing the incidence of neurologic complications.

Aged↗

PubMed2005

First clinical experience with the VSTENT: a device for direct left ventricle-to-coronary artery bypass.

BACKGROUND: Stent-based left ventricle-to-coronary artery stent (VSTENT) is a newly developed, alternative surgical revascularization procedure (VCAB). We present here our initial experience using this technique. METHODS: Twelve patients (10 male and 2 female, mean age 61 +/- 13 years) underwent a VCAB concomitant to coronary artery bypass surgery. Myocardial revascularization was performed on-pump with arrested heart in 4 patients, on-pump with beating heart in 6 patients, and off-pump in 2 patients. Average number of coronary anastomoses per patient was 2.4 +/- 0.8. In all cases left internal thoracic artery-to-left anterior descending was used. In each patient only one VSTENT was implanted. Target artery for the VCAB was a diagonal branch in 5 patients, an intermediate branch in one patient and a marginal branch in 6 patients. Mean time for the VCAB was 23 +/- 5 minutes (17 to 30 minutes). RESULTS: An immediate procedural success was observed in 11 of 12 cases. In one case VCAB was not successful and conventional aortocoronary bypass was performed. One patient died on the second postoperative day due to a systemic inflammatory response syndrome. Autopsy demonstrated a patent VSTENT. Angiography was performed in 10 patients 2 to 16 days (9 +/- 5 days) postoperatively showing a patent VSTENT in 8 patients. CONCLUSIONS: The VCAB was feasible and potentially safe in the short-term postoperative follow-up, particularly with increasing experience after the first patients. Though the VSTENT is a promising tool for myocardial revascularization, long-term safety, patency, and performance of the device needs to be determined.

Adult↗

PubMed2004

Bipolar irrigated radiofrequency ablation of the posterior-inferior left atrium and coronary sinus is feasible and safe.

BACKGROUND: Success of surgical therapy for atrial fibrillation (AF) mainly depends on creating a complete set of transmural atrial lesions. The established Cox procedures may be simplified by dropping lesions, but not without the risk of impaired results. We aimed to create a complete set of lesions using bipolar irrigated radiofrequency including ablation of the posterior-inferior left atrium (LA) and coronary sinus. Feasibility and safety were investigated. METHODS: Six patients (mean age 63 +/- 14 years) with continuous AF (duration 15 +/- 8 months) underwent elective heart surgery for isolated mitral valve procedures (n = 4), in combination with myocardial revascularization (n = 1) or isolated bypass surgery (n = 1). Ablation of AF was performed using bipolar irrigated radiofrequency to create a modified Cox minimaze pattern. RESULTS: No major intraoperative or postoperative complication occurred. Two patients left the operating room in sinus rhythm and 4 in junctional rhythm with atrioventricular pacing. AF ablation required 20 +/- 5 minutes. CONCLUSIONS: Bipolar irrigated radiofrequency ablation including ablation of the posterior-inferior LA and coronary sinus is feasible and can be performed safety. Long-term studies in large patient cohorts are necessary to show efficiency of this method.

Absorptiometry, Photon↗

PubMed2003

Microthrombectomy reduces postsclerotherapy pigmentation: multicenter randomized trial.

OBJECTIVE: Postsclerotherapy pigmentation occurs in nearly 30% of patients. Hemosiderin, from degradation of the venous thrombus, is the possible cause. The hypothesis that early removal of the thrombus may eliminate or decrease the incidence of pigmentation has not been proved or documented. The objective of this study was to investigate the effects of early microthrombectomy on incidence of postsclerotherapy pigmentation. MATERIAL AND METHODS: This multicenter, randomized, controlled study involved 101 patients with varicose veins (100 women, 1 man; mean age, 46 years [range, 25-68 years]). Patients were divided into two groups, with veins 1 mm or less in diameter (group 1, n = 50) or veins 3 mm or less in diameter (group 2, n = 51). Group 1 was treated with Sotradecol (STD) 0.25%, and group 2 with STD 0.50%. In each patient, an area of varicosities was selected and divided into halves. One half was randomized to microthrombectomy and the other half served as control. Microthrombectomy was performed 1 to 3 weeks after treatment in the randomized half. Standard photographs were obtained before and 16 weeks after treatment, and were evaluated by three independent reviewers who were blinded to treatment assignments. Each reviewer received an identical set of pretreatment and posttreatment 10 x 15-cm color photographs of the study area, and completed a scoring sheet. Average of the scores was used to evaluate primary (pigmentation) and secondary (overall clinical improvement) end points. The paired t test and chi-square test were used for statistical analysis. RESULTS: In group 1, microthrombectomized areas had statistically significant less pigmentation (P =.0047) and better overall clinical improvement scores (P =.0002) compared with the control side. In group 2 there was no significant difference between the two areas, but patients reported significant relief of pain and inflammation associated with postsclerotherapy thrombophlebitis. CONCLUSION: In veins 1 mm or smaller, microthrombectomy reduced pigmentation and improved overall clinical results. In veins 3 mm or smaller, statistical significance was not achieved, but thrombectomy resulted in faster resolution of the postsclerotherapy pain and inflammation. On the basis of these results, microthrombectomy after sclerotherapy is recommended.

Adult↗

PubMed2003

Midterm results of beating heart surgery in 1-vessel disease: minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with full sternotomy.

BACKGROUND: Off-pump cardiac surgery is becoming an established method of surgical revascularization. However, performing anastomoses on a beating heart can be challenging, especially through small incisions. We compared our midterm results in patients with 1 vessel disease using full sternotomy (OPCAB) or a left anterior minithoracotomy (MIDCAB). METHODS: At our institution between December 1996 and December 1998, 102 patients (OPCAB, n = 45, MIDCAB, n = 57); age, 61 +/- 11 years; 69% men with 1-vessel disease of the left anterior descending coronary artery (LAD) underwent off-pump myocardial revascularization through the left internal thoracic artery (LITA). In the OPCAB group 17 (37.8%) of the patients received an additional vein graft to a diagonal branch. OPCAB was generally preferred in obese or high-risk patients or patients with a long LITA-LAD distance (>7 cm) on an electron beam computed tomography of the chest. RESULTS: Operative mortality was 0. Time of surgery (169 +/- 48 versus 197 +/- 45 minutes) and coronary artery occlusion time (19 +/- 7 versus 23 +/- 6 minutes) were significantly lower (P = .004 and P = .009) in the OPCAB group. MIDCAB surgery was related to a higher incidence of occluded (4 versus 0; P = .039) or stenosed (7 versus 2; P = .06) anastomoses and necessity for immediate reintervention (9 versus 0; P = .023). During a mean follow-up period of 5.2 years, MIDCAB patients (6 MIDCAB patients versus 1 OPCAB patient) tended to need more coronary interventions and develop more recurrent angina (23 MIDCAB versus 12 OPCAB patients). Two OPCAB patients died during the follow-up period. CONCLUSIONS: Our initial experience in beating heart surgery demonstrated that MIDCAB is technically more challenging than OPCAB. MIDCAB procedures should therefore be performed by experienced surgeons on selected patients. Midterm results after OPCAB procedures tend to a lower rate of adverse cardiac events.

Analysis of Variance↗