[Show abstract][Hide abstract] ABSTRACT: Granulocyte apoptosis is a key control process in the clearance of neutrophils from inflammatory sites, and its rate is modulated by a number of inflammatory mediators. In this study, we investigated whether the use of left ventricular-assisted technique (LVA) in beating heart myocardial revascularization would exert less impact on neutrophil apoptosis compared with conventional cardiopulmonary bypass (CPB).
Forty consecutive patients who underwent myocardial revascularization were randomly assigned to LVA (group A, 21 patients) or CPB (group B, 19 patients). Blood samples for detection of interleukin-6, interleukin-8, and tumor necrosis factor-alpha were measured at baseline and at various time points postoperatively. Neutrophil apoptosis was detected by light microscopy as well as by the annexin-V assays together with the activity of caspase 3 on postoperative samples.
Preoperative clinical and demographic data did not differ between the two groups. The two groups also were similar with respect to mortality, number of grafts performed, duration of extracorporeal circulation, and need for inotropes. However postoperatively, spontaneous apoptosis was significantly delayed in neutrophils from CPB patients compared with LVA patients. Neutrophils were activated, as indicated by increased surface expression of CD11b. Caspase 3 activity was found to be significantly reduced in neutrophils from CPB patients after 18 and 24 hours of culture.
Patients who underwent beating heart myocardial revascularization with LVA show a better preserved neutrophil apoptosis than patients treated with the CPB.
No preview · Article · Dec 2009 · World Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: We sought to determine the long-term rate of progression of left ventricular outflow tract (LVOT) obstruction and aortic insufficiency (AI) in adult patients operated on for discrete subaortic stenosis (DSS).
Between 1975 and 1995, 52 patients underwent surgery for DSS; their mean age was 25.4 +/- 14.8 years. Mean preoperative LVOT gradient was 72.8 +/- 25.7 mm Hg. Excision of the subaortic membrane was carried out in all patients, myectomy of the interventricular septum was additionally carried out in 8 patients (15.4 %), and aortic valve replacement (AVR) was performed in 15 patients (28.8 %).
There were 2 operative deaths (3.8 %). Early postoperative LVOT gradient was 9.7 +/- 6.5 mm Hg. Follow-up ranged from 8.1 to 26.6 years. There were 8 late deaths (16.3 %), and mean LVOT gradient was 13.3 +/- 10.7 mm Hg. Five patients required reoperation for recurrent obstruction; 4 patients had a gradient of more than 30 mm Hg. The AI, in patients who did not undergo aortic valve replacement, did not substantially change during follow-up.
DSS is a variable, unpredictable and progressive disease; recurrent obstruction may reappear despite the adequacy of surgical excision, and is not related to preoperative gradient. Mild AI remains substantially unchanged and AVR is indicated in severe AI.
No preview · Article · Mar 2005 · The Thoracic and Cardiovascular Surgeon
[Show abstract][Hide abstract] ABSTRACT: Hypertrophic obstructive cardiomyopathy is a dynamic obstruction of the left ventricular outflow tract caused by septal hypertrophy and systolic anterior motion of the mitral valve. When the condition cannot be controlled by medical therapy the most frequently used surgical approach is left ventricular myotomy-myectomy. Mitral valve replacement (to correct another mechanism of obstruction) is another surgical option; however, its use for this condition is controversial. We review the long-term results of patients who underwent limited left ventricular myotomy-myectomy and mitral valve replacement at our institution. Eighteen patients who had hypertrophic obstructive cardiomyopathy and severe mitral insufficiency underwent surgery between 1978 and 1983: 7 were men and 11 were women (mean age, 41.8 +/- 10.5 years). Preoperatively, most of the patients (78.8%) were in New York Heart Association functional class III or IV. The operation consisted of a shallow myectomy of the hypertrophied septum and mitral valve replacement. One patient died in the hospital (5.5%); 3 patients died later during follow-up. The remaining 14 patients are alive and in good condition (mean follow-up, 21.9 +/- 1.7 years). Functional class improved postoperatively in all surviving patients. The mean left ventricular outflow tract gradient fell from 78.1 +/- 20.9 mmHg preoperatively to 9.4 +/- 5.2 mmHg postoperatively (P <0.001). At present, surgical treatment of hypertrophic obstructive cardiomyopathy does not include mitral valve replacement. However, our long-term results show that limited ventricular myectomy and mitral valve replacement predictably and consistently lower the left ventricular outflow tract gradient and resolve the mitral valve insufficiency.
No preview · Article · Jan 2004 · Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital