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Biomedical subjects

T Drews

Publications and source records attributed to T Drews.

10 recordsLinked to original sources
PubMed2002

Oral surgical management of patients with mechanical circulatory support.

After the introduction of mechanical circulatory support (MCS) for treatment of patients with severe cardiogenic shock, the survival rate of these patients increased significantly. Temporary MCS may be applied over a period of several days up to months prior to heart transplantation (HTx). Oral surgical management of patients with MCS is seriously complicated by a combination of anticoagulant and antiaggregant medication. Moreover, contact of blood with artificial surfaces, i.e. polyurethane and silicone, may increase the risk of thromboembolic events and infections. A total of 32 patients with MCS (29 men and three women with a median age 48 years [range 27-60 years]) were examined for odontogenic foci, treatment needs and local and cardiovascular complications after oral surgical intervention. In 27 patients (84%) at least one potential focus was diagnosed. Following tooth extraction 4 out of 6 patients presented with local haemorrhage (n=3) and thromboembolic events (n=2). Generally MCS has to be considered a relative contraindication for elective oral surgical interventions.

Adult↗
PubMed2001

Revascularization of the occluded right coronary artery during left ventricular assist device implantation.

A 62-year-old man with end-stage ischemic cardiomyopathy and left ventricular function of 20% was evaluated for heart transplantation. Cardiac catheterization revealed proximal occlusion of the dominant right coronary artery (RCA) with collateral blood flow and significant stenosis in the distal part, but no significant re-occlusions of the stented left coronary artery and no significant stenosis of the left circumflex artery. When the patient became catecholamine dependent, Novacor left ventricular assist device (LVAD) implantation, as a bridge to transplantation, was considered and the patient operated upon. To avoid ischemic right heart failure after LVAD implantation, a concomitant re-vascularization of the distal RCA was performed. The post-operative course was uneventful. Five weeks later, a control angiogram showed the patent bypass graft. The distal stenosis of the RCA was treated successfully with dilation and stent implantation. The patient is presently in stable condition on LVAD and awaits transplantation as an outpatient.

Angioplasty, Balloon, Coronary↗
PubMed2001

Outpatients on biventricular assist devices.

As waiting times for transplants have lengthened, long-term mechanical circulatory support (MCS) has become more common in patients who present with severe cardiogenic shock leading to multiorgan failure. With these patients, we used the biventricular assist device (BVAD, Berlin Heart). In this report, we will describe our 4 years of experience with 11 patients on a BVAD who were discharged home while awaiting transplantation. The 11 patients underwent BVAD implantation from 1997 to 2000. These were 2 women and 9 men. The mean support time was 382 days (range: 156 - 567). The indication for BVAD was cardiomyopathy--six dilated, one restrictive and four ischemic. These patients were monitored for infections, thromboembolic events, bleeding complications, and psychological effects during the time they spent at home. Our experience shows that all of the patients could leave hospital following sufficient training for dressings and anticoagulation after recovering completely from secondary organ dysfunction. The mean time period the patients spent at home was 48 days (range: 3 - 182) days. Seven patients (63 %) had to be readmitted to the hospital--due to transitory ischemic attacks in two cases, hemorrhoidal bleeding in one and wound infections in four cases. One patient died of a traumatic accident during sexual activity. The use of a BVAD is feasible for outpatient use as a bridge to transplantation. It ensures the survival of the patient, enables recovery from multiorgan failure and offers an acceptable quality of life.

Adult↗
PubMed2000

The trifluorophosphonium ion, PF3H+, preparation and structure.

The PF3H+ ion is prepared as PF3H+.SbF6-.HF by protonation of PF3 with HF/SbF5 at low temperatures in anhydrous HF. Crystals are obtained directly from this solvent. A crystal structure determination shows the presence of a pseudo-tetrahedral PF3H+ ion with a mean P-F distance of 148.7(2) pm, a P-H distance of 122(4) pm, and a mean PF2 angle of 106.1(1) degrees. Raman spectra were recorded of PF3H+SbF6-.HF and PF3D+.SbF6-.DF and assigned with the help of ab initio calculations. AsF3 does not react with HF/SbF5, whereas SF4 forms SF3+SbF6-.HF, which is isostructural with PF3H+SbF6-.HF.

Journal Article↗
PubMed2000

[Advances and perspectives in mechanical heart assist].

Mechanical circulatory support devices were first developed to permanently replace the failing heart. Today, however, the majority of these devices are used as a mechanical bridge in patients awaiting heart transplantation. With this indication, important information on using mechanical assist devices has been assembled. We present our experience, which has been gained since 1987 in the area of patient selection, post-implant patient care and device maintenance. More than 450 patients have since been implanted with assist devices at our institution. Mechanical circulatory support may not only lead to recovery from secondary organ failure, but also to myocardial remodeling and recovery of the heart function in some patients. Additionally we report our experience with a newly developed implantable axial flow pump and discuss the possibility and costs of permanent support in some patients.

Adult↗
PubMed1999

Isolation and Structure of the OCNCO(+) Ion.

Strongly bent at the nitrogen atom (130.7 degrees ), the OCNCO(+) ion (see structure) is the closest relative to carbon suboxide OCCCO. According to calculations the linear OCNCO(+) ion is only a few kJ mol(-1) higher in energy.

Journal Article↗
PubMed1995

Preservation of papillary muscles and chordae during mitral valve replacement: possibilities and limitations.

The various techniques of preserving the chordal apparatus in mitral valve replacement applied in 1,453 cases at a single institution between 1986 and 1994 are described. The techniques include preservation of chordal attachment to the posterior mitral leaflet only and to both leaflets with five different technical variations. The specific advantages and risks of these techniques are demonstrated and discussed. It is concluded, that preservation of the entire subvalvular structures is feasible in almost all cases. Different procedures should be employed according to the variety of mitral disease, in particular with respect to mitral leaflet mobility.

Chordae Tendineae↗