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Biomedical subjects

U Klima

Publications and source records attributed to U Klima.

30 records · Page 2Linked to original sources
PubMed1995

Aortic valve replacement: is the stentless xenograft an alternative to the homograft? Early results of a randomized study.

From November 1992 to October 1993 we randomized 101 patients over 60 years of age undergoing elective aortic valve replacement, with or without concomitant coronary artery bypass grafting, to receive either a cryopreserved aortic or pulmonary homograft (n = 38) or a stentless porcine aortic valve xenograft (Edwards Prima 2500) (n = 63). The majority of all valves (92%) were inserted freehand in the subcoronary position. Six homografts (16%) were implanted as a free-root replacement and two xenografts (3%) were used as a mini root. There were four in-hospital deaths (4%), three in the homograft group and one in the xenograft group (homograft, 7.9% versus xenograft, 1.6%; p = not significant). Forty-one patients were followed at 3- to 6-month intervals for 9 +/- 2 months (3 to 14 months) and valve pathology was assessed routinely by means of color flow Doppler echocardiography. Two patients in the homograft group developed new aortic insufficiency grade II; all others remained with trivial or no valve incompetence. The mean gradient remained unchanged to immediate postoperative measurements (homograft, 5 +/- 1 mm Hg versus xenograft, 11 +/- 4 mm Hg; p < 0.001). Despite a slightly higher transvalvular gradient, xenografts achieved excellent initial results when compared to homografts. Ease of implantation and freedom from thromboembolism indicate that xenografts can be an acceptable alternative to homografts, particularly in older patients with small aortic annuli. Long-term studies assessing the durability of the xenograft are necessary for final evaluation.

Aged↗
PubMed1995

Aortic valve replacement with cryopreserved pulmonary allografts: five years' follow-up.

Excellent clinical results with pulmonary autografts and experimental evidence that pulmonary valves can withstand the higher stress in the systemic circulation led us to use the cryopreserved pulmonary allograft for aortic valve replacement. From September 1988 until March 1993, 126 consecutive patients (61 +/- 10 years; 74 men and 52 women) underwent aortic valve replacement with a cryopreserved pulmonary allograft. All allografts were inserted freehand in the subcoronary position. There were four in-hospital deaths (3.2%), and 1 patient had severe valvular incompetence immediately postoperatively, requiring reoperation after 4 weeks. One hundred twenty-one patients were followed up in 3- to 6-month intervals for 25.3 +/- 16.3 months (range, 6 to 66 months), and valve performance was assessed routinely by means of color-flow Doppler echocardiography. Nine patients (7.1%) died during follow-up. Two patients died of multiple septic emboli during bacterial endocarditis, and 1 patient died of a massive stroke. The other 6 patients died of myocardial infarction (4), respiratory insufficiency due to chronic obstructive lung disease (1), and carcinoma (1). Ninety-four patients (78%) had absent or trivial aortic valve regurgitation. Valvular incompetence class II was present in 3 patients (2.5%), whereas 5 others (4%) demonstrated class II to III. Severe aortic regurgitation (class III or IV) could be detected in 10 patients (8.3%). All underwent reoperation and replacement of the valve with a prosthetic device. Bacterial endocarditis caused graft incompetence in 3 patients, valve degeneration was detected in another 3, and technical mistakes at valve implantation caused valve failure in the other 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1995

[Heart surgery in the elderly].

The number of octogenarian patients undergoing an open heart procedure in our unit is the fastest increasing group of patients. Between June 1985 and July 1994 112 octogenarians (mean age 81.7 years, 60 males, 52 females) underwent cardiac operations. The postoperative course was uneventful in 90 patients (80.4%). The perioperative mortality rate was 8.9% (10 patients). Mortality was lowest in the group receiving aortic valve replacement, with one death out of 30 patients (3.3%). The cause of death was left- or biventricular heart failure in more than half of the fatalities. Postoperative complications included: AV-block III (n = 1), postoperative bleeding (n = 2), unstable sternum (n = 3), acute cholecystitis (n = 1), low cardiac output syndrome (n = 1), stroke (n = 1), pneumothorax (n = 2) and urinary tract infections (n = 1). We consider open heart procedures in octogenarians, despite a mortality rate of 8.9%, as justified. According to the severity and course of clinical symptoms and the type of surgery required, selection of patients for operation should be decided on at an early stage of the disease. Not only life expectancy increases, but there is also a significant increase in life quality for these patients.

Aged↗
PubMed1994

[Use of autologous femoral vein in superior vena cava thrombosis. Case report and review of the literature].

We report on a 52-year old male patient who underwent implantation of an insulin pump because he had diabetes and in whom superior vena cava syndrome developed as a long-term complication. After unsuccessful lysis therapy superficial femoral vein was implanted to form a bypass from the internal jugular vein to the right atrium. The postoperative course was uneventful from the aspects of both the bypass and the leg after explantation of the superficial femoral vein. The bypass is still patent 7 months after the operation, and the patient has no symptoms. Autogenous superficial femoral vein can be used successfully in the reconstruction of large venous vessels. It should be the graft of choice for young patients with benign diseases. We compare our result and those obtained with different substitutes described in the literature that have been used for reconstruction in superior vena cava syndrome.

Femoral Vein↗
PubMed1994

Mycotic aneurysms of the thoracic aorta.

Between February 1982 and December 1992 we operated on five patients (three men, two women; aged 40 to 70 years) with mycotic aneurysms of the thoracic aorta. One patient had an aneurysm of the ascending aorta, once the aortic arch and in three cases the descending thoracic aorta were involved. In four of the five patients, excision of the aneurysm and in situ reconstruction of the aorta with a Dacron graft was performed, one patient required a Dacron graft repair and aortic valve replacement. We employed deep hypothermia with circulatory arrest (2), extracorporeal circulation (1), an axillofemoral shunt (1) and a centrifugal pump (1) for cerebral and spinal cord protection. One patient died 4 months postoperatively, the other four patients were without recurrent graft infection and are free of symptoms between 20 months and 5 years postoperatively.

Adult↗
PubMed1994

The octogenarians--a new challenge in cardiac surgery?

The per- and early postoperative outcomes of 75 consecutive octogenarians (38 male, 37 female, mean age 81.7 years) who underwent open heart surgery were analysed to identify independent variables of risk factors influencing morbidity and mortality. There were 48 coronary bypasses. 20 valve replacements, and 7 combined procedures. Multivariate analysis revealed that functional class (New York Heart Association), operative procedure, aortic cross clamp time, total bypass time, and age are independent predictors for morbidity and mortality (p < 0.05). There were 6 postoperative deaths (8%). Postoperative complications included haemorrhage (2), stroke (1), unstable sternum (2), acute cholecystitis (1), pneumothorax (2), and urinary tract infection. It is concluded that octogenarians may benefit from open heart surgery at an acceptable risk.

Aged↗
PubMed1994

Coronary disease and tracheal stenosis with tracheo-oesophageal fistula: a combined surgical procedure.

A patient with coronary disease class III of the New York Heart Association and tracheal stenosis with a tracheo-oesophageal fistula, which developed after long-term intubation, is described. As both conditions were symptomatic, an aortocoronary double bypass was combined with resection of the trachea and closure of the fistula. Postoperative recovery was uneventful and the patient is symptom-free after 3 years.

Adult↗
PubMed1993

Cardiac angiosarcoma--a diagnostic dilemma.

A 25-year-old man suffering from sudden onset of haemoptysis after 1 week of orthopnoea, fatigue and general weakness was admitted to a cardiology department in Vienna. No diagnosis was made. Four weeks later cardiopulmonary resuscitation and pericardiocentesis were necessary because of cardiac tamponade. Although all modern imaging procedures were performed, a diagnosis of rapidly progressive primary cardiac angiosarcoma could not be established. Definitive diagnosis was established only after exploratory median sternotomy. The patient exhibited no response to chemotherapy. He died 5 days after surgery as a result of respiratory failure.

Adult↗
PubMed1993

[Surgical management of coronary heart disease and simultaneous carotid artery stenosis].

Simultaneous carotid endarterectomy and open-heart procedures (bypass, aortic and mitral valve replacement, arterial myxoma) were performed on 89 patients. The indication for carotid endarterectomy were either preoperative neurological symptoms (n = 36) or radiologically verified, hämodynamically relevant stenosis of more than 50-60% (n = 53). The postoperative course was uneventful in 80 patients (90%). Neurological complications occurred in 5 patients; 4 had required surgery for pre-operative neurological symptomatology and 1 of these patients died from postoperative stroke. Cardiac complications occurred in 4 patients, one of whom died because of bypass thrombosis with subsequent myocardial infarction. Many authors have different opinions regarding indication, technical procedures and optimum time of operation. We consider the simultaneous operative procedure of carotid endarterectomy and open heart procedures justified in view of the neurological complication rate of approximately 5% in our group of patients.

Aged↗
PubMed1992

Aortic valve replacement with the pulmonary autograft--experience of 23 cases.

Since 1988 an intensive homograft-program has existed at the Linz General Hospital. We have installed an own hospital-based homograft bank, where the allografts, after a 24-hour sterilization-period in an antibiotic solution and a controlled freezing procedure, are stored in liquid nitrogen at -196 degrees C. In 1991 for the first time aortic valve replacement was performed by pulmonary autograft in 23, mainly younger, patients. Essentially our technique conforms with that of D. N. Ross, in the course of which 18 autografts were implanted in subcoronary position and 5 aortic-root replacements were performed. 3 patients died perioperatively, 2 times a severe post-operative bleeding with following hypoxemic brain damage being the cause; 3 more patients had to be rethoracotomized because of postoperative bleedings. All these were attributed to a technical difficulty, which was overcome. In one patient a left-ventricular assist device had to be installed due to a left-ventricular failure, a successful heart transplantation followed on the 8th postoperative day. A follow-up was conducted in all patients every 3 months. In 2 patients a substantial valve incompetence of grade II-III and grade III was detected, all other patients showed no regurgitation of clinical relevance. Despite our initial difficulties it is our opinion that the many advantages-no anticoagulation necessary, no valve sound, less incidence of bacterial endocarditis, and longer durability-do justify this operative procedure.

Adolescent↗
PubMed1992

[Development of arterial revascularization of the myocardium at the Linz general hospital. Personal experiences with 1000 patients].

Arterial revascularization of the myocardium, particularly the use of the internal mammary artery (IMA) as a bypass graft in coronary artery surgery has become an established procedure over the past decade. From March 1986 to June 1991, of 2070 patients who underwent coronary heart surgery at our department, revascularization of the myocardium was performed with an IMA graft in 1000 cases, whereby the percentage increased from 10.4% in 1986 to 75.0% in 1991 (p less than 0.01). The range of indications gradually widened throughout the period, age no longer being a contradiction today. One reason for this development is the substantial improvement in IMA preparation technique. No increase was found in rethoracotomy rate or in the rate of perioperative infarctions. The mean age of patients receiving an IMA graft increased from 55.2 years (1986) to 64.7 years (1991) and therefore reflects the change in ranges of indication. 54 IMA jump grafts were anastomosed, in 30 cases bilateral IMAs were used and the IMA was implanted as a free graft twice. In the future these successful results with the implementation of IMA grafts will lead to a further displacement of the saphenous vein as main bypass material.

Austria↗