Biomedical subjects

V Gulielmos

Publications and source records attributed to V Gulielmos.

At least 37 records · Page 2Linked to original sources

PubMed1999

New telemetric system for daily pulmonary function surveillance of lung transplant recipients.

BACKGROUND: Following lung transplantation, prompt diagnosis and therapy of acute pulmonary rejection and infection episodes relies primarily upon changes in pulmonary function and determines long-term outcome. We tested a new system that allows daily monitoring of the patient's pulmonary status even after discharge from the hospital. METHODS: Seven lung transplant recipients from our center were equipped with a telemetric monitoring device consisting of a portable flowmeter and a special modem unit. The flowmeter measures forced vital capacity (FVC), forced expiratory volume per second (FEV1), and mid expiratory flows (MEFs), encodes information like fever, cough, and dyspnea in a binary code form, and stores all values in a 32 kB memory unit. After its use, the patient positions the flowmeter onto the modem unit which automatically connects to a central computer at our center to transfer all saved data. The whole set can be used via any regular phone jack. The patient's file in the computer can be checked every day. RESULTS: All patients learned to use the unit during their postoperative stay or during later follow-up, and were able to apply the system at home. In a mean follow-up period of 10.3+/-2.2 months, 15 episodes of significant deterioration in home pulmonary function tests (PFTs) (>10%) were registered in 6 patients, which were all confirmed by in-hospital body plethysmography. They resulted in diagnoses of 4 episodes of acute rejection, 6 cases of beginning bacterial pneumonia, and 5 cases of, most likely, viral tracheobronchitis. Only 1 patient had to be admitted to the hospital. All patients PFTs returned to previous values after treatment. CONCLUSIONS: Telemetric monitoring of graft function in lung transplant recipients allows reliable early diagnosis and treatment of infection or rejection, which might help to prevent exacerbation of the pathology and reduce quantity of amounting graft dysfunction.

Forced Expiratory Volume↗

PubMed1999

The application of the Octopus stabilizing system for the treatment of high risk patients with coronary artery disease.

OBJECTIVES: If coronary disease is the target of a minimally invasive procedure, median sternotomy or cardiopulmonary bypass or both can be avoided. Similar to the development in other fields of surgery, minimally invasive surgical techniques are gaining increased acceptance in the field of cardiothoracic surgery. Our experience with an off pump coronary artery bypass (OPCAB) technique in a special patients group with serious risk factors for the application of cardiopulmonary bypass has been analyzed. METHODS: Between March 1996 and January 1999, 88 patients (64 male, 24 female) with impaired left ventricular function, or other high risk factors jeopardizing the use of cardiopulmonary bypass, such as impaired renal or lung function or heavily calcified aorta, received a beating heart procedure using the Medtronic Octopus stabilizing system. RESULTS: All patients survived the actual operation, however, two multimorbide patients died of pneumonia on postoperative day 31 and postoperative day 35. CONCLUSIONS: Patients with single-vessel to multivessel disease and serious risk factors for cardiopulmonary bypass can be safely treated by OPCAB surgery. At our institution this technique presents the procedure of choice in this particular patients group.

Aged↗

PubMed1999

Influence of median sternotomy on the psychosomatic outcome in coronary artery single-vessel bypass grafting.

OBJECTIVES: New less invasive surgical techniques for the treatment of coronary artery single-vessel disease have been developed by either avoiding median sternotomy or cardiopulmonary bypass or both, however, until now no prospective randomized trial has been carried out to compare these techniques to the conventional approach with special respect to the psychosomatical effects. METHODS: In a prospective randomized trial four different surgical techniques were compared. Group 1: conventional technique (median sternotomy, cardiopulmonary bypass) in ten patients (eight male, two female, age 59.6 +/- 11.0 years); Group 2: off-pump coronary artery bypass with median sternotomy in nine patients (six male, three female, age 65.7 +/- 11.1 years); Group 3: lateral minithoracotomy and cardiopulmonary bypass in eight patients (five male, three female, age 62.3 +/- 9.9 years). Group 4: off-pump procedure and lateral minithoracotomy in nine patients (eight male, one female, age 63.8 +/- 11.3 years). All patients due to coronary artery single-vessel disease. The tests used for psychosomatic situation were post-traumatic stress disorders scale, pain behavior rating scale, pain visual analog scale, and 6' walking-distance. For detection of false results due to surgical technical failures 3-month follow-up was undertaken including echocardiography and coronary angiogram. RESULTS: There were no deaths or major complications. Operative time was longer in lateral minithoracotomy procedures, but intensive care unit stay and hospitalization were equal in all groups. Pain visual analog scale and pain behavior rating scale showed a peak on post-operative day 4 in median sternotomy procedures. Post-traumatic stress disorder scale revealed higher values on post-operative day 4 and equalizing with lateral minithoracotomy procedures 1 month post-operatively. Six-minutes walking distance on post-operative day 4 was longer in the group with lateral minithoracotomy. Three-month follow-up revealed patency of all grafts. CONCLUSIONS: Even if surgery is successful in all procedures, operative time is longer in lateral minithoracotomy procedures without compromising intensive care unit stay and hospital stay. More pain with multiple post-traumatic stress disorders is related to median sternotomy, and post-operative convalescence is superior for lateral minithoracotomy procedures.

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PubMed1999

Coronary artery bypass grafting via median sternotomy or lateral minithoracotomy.

OBJECTIVES: In order to evaluate the benefit provided through less invasive surgical techniques for the treatment of multivessel coronary artery disease, a prospective clinical trial was started. METHODS: Group 1 included 53 patients (38 males, 15 females, age 51-79 years, mean 62.8 +/- 6.1 years) receiving conventional bypass surgery, group 2 included 69 patients (59 male, 10 female, age 43-82 years, mean 61.9 +/- 8.6 years) receiving less invasive surgical procedure including minithoracotomy in combination with cardiopulmonary bypass. RESULTS: No perioperative death occurred in the whole series of patients. Time of operation was 267 +/- 61 min in group 2 and 162.9 +/- 53.6 min in group 1. Intensive Care Unit stay was 1 day for both groups and Hospitalization 6.9 +/- 6.0 for group 1 and 7.5 +/- 2.6 days for group 2. Perioperative bleeding was less in group 2 (P > 0.01). Back and chest pain assessment on postoperative day 3 showed less pain in group 2 (P < 0.05). Three-month follow-up revealed ischemia in stress electrocardiogram in two patients (3.8%) in group 1 and in 2 patients (2.9%) in group 2. Coronary angiograms confirmed the stress ECG findings. There was one (1.4%) redo operation in group 2 and two (3.8%) in group 1. CONCLUSIONS: Both techniques are equal efficient. Even though time of operation is longer in patients receiving less invasive procedure, intensive care unit stay and hospitalization is exactly as long. Patients receiving minimally invasive surgery bleed less and have less pain early postoperatively.

Adult↗

PubMed1999

Port Access surgery for congenital heart disease.

OBJECTIVES: Minimally invasive surgical techniques have been introduced into cardiac surgery in order to avoid median sternotomy related complications. Surgical trauma to the patient can be significantly reduced without compromising the safety. In addition, a small lateral chest incision results in improved cosmesis, especially in female patients. METHODS: Thirteen patients (median age 39 +/- 14 years, ranged from 17-61 years) with atrial septal defect were treated with a minimally invasive surgical method using a modified Port Access technique. In all patients access to the heart was achieved via a small (4-8 cm) right lateral chest incision in the 4th intercostal space. In these patients the selection of the Port Access system was used for cardiopulmonary bypass via the femoral vessel and for the application of cardioplegic solution. RESULTS: No deaths or intraoperative complications were observed in any of the patients. The postoperative course was uneventful and only minor complications were observed postoperatively. The median hospital stay was 8.0 +/- 1 days (median +/- SEM). CONCLUSION: This minimally invasive surgical technique for the treatment of atrial septal defects represent a safe alternative to conventional treatment of ASD using median sternotomy and standard cardiopulmonary bypass. The exposure of the right atrium via the 4th intercostal space is ideal and can be performed with excellent cosmetic results.

Adult↗

PubMed1998

Port-Access coronary artery bypass grafting with the use of cardiopulmonary bypass and cardioplegic arrest.

BACKGROUND: To reduce surgical trauma, we performed minimally invasive Port-Access (Heartport Inc, Redwood City, CA) coronary artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest. METHODS: Thirty-six men and 6 women with a median age of 59 years (range, 31 to 75 years) and isolated lesions of the left anterior descending branch of the coronary artery underwent Port-Access coronary artery bypass grafting. A small (6- to 9-cm) incision was made parasternally on top of the fourth rib. The left internal thoracic (mammary) artery was dissected and taken down through the minithoracotomy either alone or using an additional thoracoscopic approach. Cardiopulmonary bypass was instituted through femoral cannulation, and an additional endoarterial balloon catheter (Heartport Inc) was introduced into the ascending aorta for aortic occlusion, aortic root venting, and the delivery of cold antegrade crystalloid cardioplegia. After cardioplegic arrest, the left internal mammary artery was anastomosed to the left anterior descending artery under direct vision. RESULTS: The median left internal mammary artery takedown time was 49.5 +/- 21.9 minutes, the duration of cardiopulmonary bypass was 59.5 +/- 32.8 minutes, the aortic occlusion time was 28.5 +/- 7.9 minutes, the intensive care unit stay was 1.0 +/- 3.2 days, and the total hospital stay was 5.0 +/- 2.5 days. Intraoperative angiograms were done in the first 10 patients and showed patent left internal mammary artery grafts without anastomotic complications in all cases. Two arterial dissections, including one aortic dissection, were observed in patients with preexisting peripheral vascular disease. The other complications were minor. All but 1 patient recovered well, with no major limitations in their daily activities. CONCLUSIONS: Using this minimally invasive method, sternotomy-related complications can be avoided, the hospital stay can be reduced, and a safe coronary artery bypass grafting procedure can be performed with the advantage of cardiopulmonary bypass and cardioplegic arrest as are used routinely in conventional coronary artery operations.

Adult↗

PubMed1998

Minimally invasive surgical technique for the treatment of multivessel coronary artery disease.

BACKGROUND: To avoid sternotomy-related complications after cardiac operations, we developed a minimally invasive surgical technique for the treatment of multivessel coronary artery disease. METHODS: From November 1996 to May 1997, 39 patients (age range, 50 to 78 years) with coronary artery disease were treated with the use of this technique. Through a small (6- to 9-cm) left lateral chest incision in the third intercostal space, the left internal mammary artery was harvested directly. With the use of cardiopulmonary bypass and cardioplegic arrest in all patients except 1, the left internal mammary artery was anastomosed to the left anterior descending artery. In addition, vein grafts and other arterial conduits were used for revascularization of the other coronary arteries. RESULTS: There were no intraoperative complications. All the patients survived the procedure and had an uneventful postoperative course. Wound complications occurred in 2 patients. The median (+/- standard error of the mean) hospital stay was 6 +/- 1 days. CONCLUSIONS: This technique combines minimally invasive surgical conditions with the safety standards of routine cardiac operations. With the use of this approach, even extensive coronary artery disease can be treated.

Aged↗

PubMed1998

Minimally invasive bilateral internal mammary artery bypass grafting.

We report about a 71-year-old man with coronary artery double-vessel disease who received minimally invasive coronary artery bypass grafting through a 9-cm left lateral chest incision in the third intercostal space. Both mammary arteries were harvested either directly (left internal mammary artery) or thoracoscopically (right internal mammary artery) and anastomosed to the left anterior descending artery and the circumflex artery through this single left lateral chest incision. The postoperative course was uneventful, and the patient was discharged on postoperative day 5.

Aged↗

PubMed1998

Minimally invasive surgical treatment of coronary artery multivessel disease.

BACKGROUND: If coronary artery multivessel disease is the target of a minimally invasive procedure, either median sternotomy or cardiopulmonary bypass can be avoided. METHODS: We used an alternate technique instead of minithoracotomy and cardiopulmonary bypass to treat 102 patients (82 men, 20 women; age range, 39 to 82 years; median, 61.0 +/- 8.9 years) for coronary artery single-vessel, double-vessel, or multivessel disease between November 1996 and January 1998. Twenty-nine patients (22 men, 7 women; age range, 46 to 78 years; median, 69.0 +/- 8.4 years), who were in a high-risk group for the development of perioperative complications because of the use of cardiopulmonary bypass, received median sternotomy and a beating heart procedure using the Octopus stabilizing technique. The left anterior descending coronary artery was the target vessel in all patients except for 1, in whom the left internal mammary artery was used. RESULTS: There was no intraoperative death in either series. In the beating heart group (Octopus) 2 patients died on postoperative day 31 and 35, respectively, of postoperative pneumonia. CONCLUSIONS: Both techniques present safe alternative procedures to conventional coronary artery bypass grafting in patients with coronary artery multivessel disease.

Adult↗

PubMed1998

Minimally invasive cardiac surgery for the treatment of coronary artery multi-vessel disease.

OBJECTIVE: In order to avoid sternotomy-related complication after cardiac surgery minimally invasive cardiac surgery has been developed successfully for the treatment of coronary artery disease, however, those techniques were still limited to the treatment of single-vessel disease. Therefore a new surgical technique for the treatment of multi-vessel disease has been developed. METHODS: From November 1996 to May 1997 61 patients (age 39-78 years) with coronary artery disease were treated with this new technique. This technique included a small (6-9 cm) left lateral chest incision via the 3rd intercostal space. The left internal thoracic mammary artery (LIMA) was harvested through the chest incision and access to the central portion of the heart including the ascending aorta was obtained. During LIMA harvesting saphenous vein segments were harvested. Cardiopulmonary bypass was instituted through femoral vein cannulation and cannulation of the ascending aorta in most cases. After external aortic cross clamping cold antegrade cardioplegia was applied. In all patients except one the LIMA was used for the left anterior descending artery (LAD). In addition vein grafts were used for revascularisation of the other coronary arteries. RESULTS: There were no intraoperative complications and all patients survived the procedure. All patients could be weaned from CPB and the postoperative course was uneventful in most patients. Wound complication occurred in two patients. The median hospital stay was 6 days (median +/- SEM). CONCLUSIONS: This new technique combines minimally invasive surgical conditions with the safety standards of routine cardiac surgery. With this approach even extensive coronary artery disease can be treated.

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PubMed1998

Minimally invasive mitral valve surgery--clinical experiences with a PortAccess system.

OBJECTIVE: This is the initial experience with a new minimally invasive surgical technique for the treatment of mitral valve disease using a PortAccess system. METHODS: Between May 1996 and May 1997, 21 patients (nine male, 12 female, aged 30-75 years, median 64 years) underwent minimally invasive mitral valve surgery. The underlying diseases were: mitral valve insufficiency (n = 11), mitral valve stenosis (n = 5) and combined mitral valve disease (n = 5). Through a small right thoracotomy (6-8 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter (Heartport Inc., Redwood City, CA) was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (four patients) or replacement (15 patients) was performed. RESULTS: There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography. There was no postoperative study-related complication. Time of ventilation, intensive care unit and hospital-stay were comparable with the data of patients undergoing conventional mitral valve surgery. CONCLUSIONS: This technique of PortAccess mitral valve surgery combines the advantage of less invasive operative trauma with the safety of conventional mitral valve surgery.

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PubMed1998

Clinical experiences with minimally invasive mitral valve surgery using a simplified Port Access technique.

OBJECTIVE: Using the initial experiences with the Port-Access technique for the treatment of mitral valve disease some changes were made thus resulting in more simple and faster procedures. METHODS: Twenty-nine patients (13 male, 16 female, aged 30 to 75 years, median 62.5 +/- 11.0 years) underwent minimally invasive mitral valve surgery between May 1996 and December 1997. The underlying diseases were: mitral valve insufficiency (n = 16), mitral valve stenosis (n = 7) and combined mitral valve disease (n = 6). Through a small right thoracotomy (5-7 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (five patients) or replacement (24 patients) was performed. RESULTS: There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography in three patients. There was no postoperative study-related complication. Time of ventilation and intensive care unit were comparable with the data of patients undergoing conventional mitral valve surgery but hospital stay was shorter in the last 10 consecutive cases. CONCLUSIONS: This simplified technique of mitral valve surgery combines the advantage of less invasive operative and good cosmetic results with the safety of conventional mitral valve surgery. At our institution this technique presents in well selected patients suffering from mitral valve disease the procedure of choice.

Cardiac Surgical Procedures↗

PubMed1998

Experiences with a minimally invasive surgical technique for the treatment of coronary artery multivessel disease in 100 patients.

OBJECTIVE: The treatment of coronary single vessel disease under minimally invasive surgical conditions was followed by the treatment of coronary multivessel disease using a new technique. METHODS: Using this technique 100 patients (80 male, 20 female, median age 61.0+/-8.9 years, ranged from 39 to 82 years) with coronary single vessel disease, double vessel disease or multivessel disease were treated between November 1996 and December 1997. Via a small (6-9 cm) left lateral chest incision in the second or third intercostal space, the left internal thoracic mammary artery (LIMA) was harvested and access to the central portion of the heart including the ascending aorta was obtained. In parallel, saphenous vein segments were harvested. Arterial cannulation was instituted via the ascending aorta, thus avoiding retrograde flow. In all patients except three the LIMA was used for the left anterior descending artery (LAD). In addition vein grafts were used for revascularization of the other coronary arteries. All cardiac anastomoses were performed during cardioplegic arrest after external aortic cross clamping and antegrade application of cardioplegia. RESULTS: No death or intraoperative complications were observed in this series. The median hospital stay was 6.0+/-1.4 days (median+/-SEM). Postoperative complications were reexplored for bleeding (n = 1), delayed wound healing (n = 2), wound infections (n = 4), lymphatic fistulas (n = 4), and a chest wall hernia (n = 1). CONCLUSIONS: This minimally invasive surgical technique presents a safe alternative to conventional coronary artery surgery avoiding sternotomy related complications and decreasing hospital stay and morbidity.

Adult↗

PubMed1998

Port-Access cardiac surgery using endovascular cardiopulmonary bypass: theory, practice, and results.

BACKGROUND: Reduction of surgical trauma is the aim of minimally invasive cardiac surgery. This can be achieved by reducing the size of the incision or by eliminating or changing the cardiopulmonary bypass system. However, certain cardiac surgical procedures, such as valvular surgery and complex multivessel coronary artery surgery, are not feasible without the use of cardiopulmonary bypass. Therefore endovascular cardiopulmonary bypass may allow reduction of surgical trauma for these patients. METHODS: Since its first application in April 1995, more than 1100 procedures have been performed worldwide using the EndoCPB endovascular cardiopulmonary bypass system. The authors' experience consists of 60 Port-Access coronary artery bypass grafting procedures, 34 Port-Access mitral valve procedures (18 replacements, 16 repairs), 5 atrial septal defect closures, and 3 atrial myxoma removals. RESULTS: The patient survival rate was 99%, the incidence of perioperative stroke was 1%, and the incidence of aortic dissection was 1%. In the Port-Access mitral valve and atrial septal defect patients, the survival rate was 100% with no peri- or postoperative complications. Peri- and postoperative transesophageal echocardiography revealed no perivalvular leak or remaining mitral insufficiency after valve repair. CONCLUSIONS: The EndoCPB endovascular cardiopulmonary bypass system allows the application of true Port-Access minimally invasive cardiac surgery in procedures that require the use of cardiopulmonary bypass and cardioplegic arrest. Sternotomy and its potential complications can be avoided, and the surgical procedures can be performed safely on an empty, arrested heart with adequate myocardial protection.

Adult↗

PubMed1998

[Minimally invasive interventions in heart surgery].

Recently a number of minimally invasive surgical techniques have been developed in order to reduce surgical trauma especially to avoid median sternotomy and cardio-pulmonary bypass (CPB). In March 1996 we started successfully a clinical trial with the Port Access technique at our institution for the first time in Europe for the treatment of coronary artery single vessel disease. In addition mitral valve disease, aortic valve disease and ASD were treated successfully with minimally invasive surgical techniques. We developed a new minimally invasive surgical technique (Dresden technique) for the treatment of coronary artery multi vessel disease at our institution. Besides we used several minimally invasive surgical techniques without CPB. Our results indicate that minimally invasive surgical techniques routinely used will decrease the morbidity and time of convalescence after cardiac surgery. These techniques can be applied for a variety of cardiac diseases.

Adult↗

PubMed1998

[A comparative study of minimal invasive harvesting of vena saphena magna segments].

From July 1997 to February 1998 we performed either minimally invasive or endoscopic saphenous vein harvesting in 55 patients and compared the results with those of 46 patients after conventional saphenous vein harvesting. Minimally invasive and endoscopical vein harvesting can be safely performed after a longer learning curve. Patients after minimally invasive and endoscopical saphenous vein harvesting showed fewer wound healing problems and better cosmetic results than after conventional vein harvesting.

Aged↗

PubMed1998

[Minimal invasive surgical treatment of coronary multi-vessel disease].

To reduce surgical trauma and median sternotomy related complications in cardiac surgery, a new minimally invasive surgical technique has been developed for the treatment of coronary artery multivessel disease using a small left lateral chest incision in the 3rd intercostal space. This technique enables direct LIMA harvesting and performance of bypass surgery upon all coronary vessels with cardiopulmonary bypass and cardioplegic arrest. So far, 123 patients have been treated with this procedure and survived with fewer complications, and we believe that routine application of this procedure will lead to reduced morbidity in patients receiving coronary artery bypass surgery, short hospital stay and early convalescence, combined with good cosmetic results.

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PubMed1998

[Flow cytometry controlled induction therapy with ATG and noninvasive monitoring of rejection--a modern management concept after heart transplantation].

We introduce our concept of non-invasive transplant monitoring. The introduction of individualized immunosuppression by means of flow cytometry leads to a lower incidence of acute graft rejection and preserves immuncompetence. With the simultaneous use of echocardiography and intramyocardial electrogram (IMEG) acute graft rejections can be safely identified without using any invasive method.

Adult↗