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ABSTRACT: : Bilateral anterior transsternal thoracotomy incision (clamshell technique) is the standard approach used for bilateral sequential lung transplantation (LTX). The morbidity and wound complications of this large incision can be considerable and costly. Muscle sparing anterior thoracotomies without division of the sternum may lead to decreasing the sequelae of wound complications. The objective of this study was to determine the rate of wound complications in the nonsternal incising lung transplant patients.
: We used the single-institution-based transplant data bank, phone questionnaire, and ambulatory care unit follow-up data to investigate retrospectively the incidence of wound healing complications following muscle and sternum sparing and mammary artery protecting limited access small submammary anterior thoracotomy incisions (AT) for LTX surgery. In the need for cardiopulmonary bypass, the femoral artery and vein were cannulated.
: After exclusion of seven clamshell operations for LTX combined with cardiac surgery, 91 recipients (65% male), aged 19 to 68 years (mean, 54 ± 8 years), underwent 84 AT and 48 lateral thoracotomies (LT) for idiopathic pulmonary fibrosis (IPF) (48%), obstructive disease (40%), cystic fibrosis (CF) (5%), and pulmonary arterial hypertension (PAH) (7%). AT ranged from 5.5 to 26 cm (mean, 20.3 ± 4.8 cm) and LT from 12 to 25 cm (mean, 19.8 ± 2.4 cm) and was not significantly different (P = 0.37). Warm ischemic times ranged from 30 to 92 minutes (mean, 56 ± 11 minutes). Four patients required rethoracotomy for bleeding/hematoma formation. Cardiopulmonary bypass/intraop extracorporeal membrane oxygenation (ECMO) was used in 64%. Superficial wound infection and subsequent drainage/care was needed in four LTX incisions. Reoperation for lung herniation using patch repair technique for thoracic wall stabilization was required in two AT and three LT.
: Sternum sparing and mammary artery protecting limited access submammary anterior and lateral thoracotomy incisions for LTX surgery are safe and effective. This approach avoids complications related to sternal transaction and may minimize the development of severe wound complications following LTX surgery.
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 03/2011; 6(2):116-21.
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ABSTRACT: Co-ordinated electrical activation of the heart is maintained by intercellular coupling of cardiomyocytes via gap junctional channels located in the intercalated disks. These channels consist of two hexameric hemichannels, docked to each other, provided by either of the adjacent cells. Thus, a complete gap junction channel is made from 12 protein subunits, the connexins. While 21 isoforms of connexins are presently known, cardiomyocytes typically are coupled by Cx43 (most abundant), Cx40 or Cx45. Some years ago, antiarrhythmic peptides were discovered and synthesised, which were shown to increase macroscopic gap junction conductance (electrical coupling) and enhance dye transfer (metabolic coupling). The lead substance of these peptides is AAP10 (H-Gly-Ala-Gly-Hyp-Pro-Tyr-CONH(2)), a peptide with a horseshoe-like spatial structure as became evident from two-dimensional nuclear magnetic resonance studies. A stable D: -amino-acid derivative of AAP10, rotigaptide, as well as a non-peptide analogue, gap-134, has been developed in recent years. Antiarrhythmic peptides act on Cx43 and Cx45 gap junctions but not on Cx40 channels. AAP10 has been shown to enhance intercellular communication in rat, rabbit and human cardiomyocytes. Antiarrhythmic peptides are effective against ventricular tachyarrhythmias, such as late ischaemic (type IB) ventricular fibrillation, CaCl(2) or aconitine-induced arrhythmia. Interestingly, the effect of antiarrhythmic peptides is higher in partially uncoupled cells and was shown to be related to maintained Cx43 phosphorylation, while arrhythmogenic conditions like ischaemia result in Cx43 dephosphorylation and intercellular decoupling. It is still a matter of debate whether these drugs also act against atrial fibrillation. The present review outlines the development of this group of peptides and derivatives, their mode of action and molecular mechanisms, and discusses their possible therapeutic potential.
Archiv für Experimentelle Pathologie und Pharmakologie 11/2009; 381(3):221-34. · 2.65 Impact Factor
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ABSTRACT: We report two cases of pulmonary tuberculosis in heart transplant recipients: a 46-year-old man with pulmonary tuberculosis due to Mycobacterium tuberculosis and a 64-year-old man with nontuberculous mycobacterial infection with pulmonary infiltrates due to Mycobacterium xenopi. The time intervals from transplantation to diagnosis were 3 and 4 years, respectively. The patient with tuberculosis underwent standard treatment with isoniazid, rifampin, ethambutol, and pyrazinamide. The patient with the nontuberculous mycobacterial infection received treatment with clarithromycin and ciprofloxacin for 18 months in addition to rifampin for the first 3 months. Both patients responded well to treatment. No recurrences were observed during follow-up. The interactions between antibiotic treatment and cyclosporine therapy should be observed closely in organ transplant recipients, requiring frequent level determinations and dosing changes.
The Annals of thoracic surgery 09/2005; 80(2):719-21. · 3.74 Impact Factor
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ABSTRACT: To assess the prognosis and to develop management strategies for primary cardiac tumors all patients were included in an ongoing study.
From Oct. 1994 until December 2003 we prospectively evaluated all patients with cardiac tumors. Follow up examinations were performed every 12 months.
There were a total of 77 primary cardiac tumors. Seventy-three were benign: myxoma (n=59), papillary fibroelastoma (n=11), lipoma (n=2), fibroma (n=1) and four malignant sarcoma (n=4). The myxoma group consisted of 19 males and 40 females aged 12 to 88 years. Myxomas were located in the: left atrium in 50 (85%), left ventricle in 3 (5%), right atrium in 4 (7%) and on the mitral valve in 2 patients (3%). Papillary fibroelastoma was located on the aortic valve (n=4), mitral valve (n=3), right ventricle (n=2), left ventricle (n=1) and tricuspid valve (n=1). Both lipoma and the only fibroma were located in the right atrium. There were 4 primary cardiac sarcomas, located in the right ventricle (n=2), the pulmonary valve (n=1) and left atrium (n=1). Minimal invasive right thoracotomy was utilized in 19 of 73 patients all with benign tumor. There were two early deaths (3%): a myxoma patient with triple vessel disease and a LVEF less than 30% and one sarcoma patient. No recurrence or late death was observed in the group of benign tumors. However, two remaining patients with sarcoma had recurrent disease 10 and 15 month later, respectively. All patients were followed up with a total follow up of 203 patient years.
Surgical excision of benign cardiac tumors is a safe and curative treatment, which is feasible using minimally invasive right thoracotomy approach and provides excellent results. However, therapy of malignant cardiac tumors continues to have a poor prognosis despite individualization of approach.
Interactive cardiovascular and thoracic surgery 09/2005; 4(4):311-5.
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ABSTRACT: We describe a novel sensitive and simplified gradient HPLC assay for quantification of the immunosuppressant mycophenolic acid (MPA) in rat and human plasma. In contrast to previously reported MPA assays, our method used a single step extraction comprising addition of acetonitrile, which contained phenolphthalein glucoronic acid as internal standard, for protein precipitation. Linearity: 0.1–100 μg/ml (r2>0.999), mean recoveries: MPA 98.0%, internal standard 105.2%, mean intra-day precision: 4.3%, mean day-to-day precision: 4.3%, mean day-to-day accuracy: −1.5%. Sensitivity was sufficient to allow for quantification of mycophenolic acid in as little as 50 μl plasma.
Journal of chromatography. B, Biomedical sciences and applications 02/1999;
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ABSTRACT: The role of Swan-Ganz catheterization for cardiac surgery and perioperative management has recently been scrutinized.
Prospective observational study for serious complications related to Swan-Ganz catheterization. 7150 patients undergoing cardiac operations at a major European heart center and academic setting. 3730 Swan-Ganz catheter placements for cardiac surgery (7.5 French Swan-Ganz Catheter Baxter, heparin coated).
We observed four serious complications related to Swan-Ganz catheterization and placement (0.1%): A right ventricular free wall perforation occurred, one trouble with knotting, and two pulmonary artery ruptures. The right ventricular perforation was controlled with a suture, the knot was tightened, and the catheter withdrawn through insertion. The first case of pulmonary artery rupture was treated conservatively. All of these patients survived. The other pulmonary artery rupture occurred during coronary artery bypass grafting. Emergency lobectomy was performed. This patient died due to bleeding during the early postoperative course.
The incidence of serious Swan-Ganz catheter complications in our patient population is comparable to the incidence reported in the literature. Based on these results the use of Swan-Ganz catheters in cardiac surgery is still justified since the rate of associated serious complications is extremely low. Despite the rare occurrence of serious complications and the infrequent fatal outcomes, the benefit of its use in selected cases of cardiac surgery overweight its associated complications.
Journal of Cardiac Surgery 21(3):292-5. · 0.87 Impact Factor
