Left Ventricular Assist Device for Right Side Assistance in Patients with Transposition

The Annals of Thoracic Surgery. Sep, 2002  |  Pubmed ID: 12238863

Right (systemic) ventricular dysfunction is well described after Senning operations for transposition of the great arteries, and patients with congenitally corrected transposition of the great arteries. Transplantation remains the only definitive therapy for refractory heart failure, however patients may deteriorate clinically prior to the availability of a donor heart. This report details the implantation of a TCI Heartmate (Thoratec Corp., Pleaston, CA) as a morphologic right ventricular assist device to bridge these patients to transplantation.

Viral Gene Transfer of the Antiapoptotic Factor Bcl-2 Protects Against Chronic Postischemic Heart Failure

Circulation. Sep, 2002  |  Pubmed ID: 12354736

Apoptosis secondary to acute ischemia and chronic remodeling is implicated as a mediator of heart failure. This study was designed to assess the effect of in vivo viral gene transfer of the anti-apoptotic factor Bcl-2 to block apoptosis and preserve ventricular geometry and function.

Blocking the Development of Postischemic Cardiomyopathy with Viral Gene Transfer of the Apoptosis Repressor with Caspase Recruitment Domain

The Journal of Thoracic and Cardiovascular Surgery. Jun, 2003  |  Pubmed ID: 12830068

Apoptosis caused by acute ischemia and subsequent ventricular remodeling is implicated as a mediator of heart failure. This study was designed to assess the efficacy of in vivo viral gene transfer of the antiapoptotic factor apoptosis repressor with caspase recruitment domain to block apoptosis and preserve ventricular geometry and function.

Role of the Abiomed BVS 5000 Device for Short-term Support and Bridge to Transplantation

ASAIO Journal (American Society for Artificial Internal Organs : 1992). Jul-Aug, 2004  |  Pubmed ID: 15307548

Over the last 10 years, we have gained experience implanting the Abiomed BVS 5000 (Abiomed, Inc., Danvers, MA) device for short-term mechanical support. We retrospectively reviewed our experience with this device. From April 1993 through January 2003, 71 patients underwent implantation of an Abiomed BVS 5000 device. This included 19 left ventricular assist devices (LVADs), 30 right ventricular assist devices (RVADs), and 22 biventricular assist devices (BIVADs). Demographics of device recipients, conditions for mechanical support, and outcome were evaluated for each device type. Devices were inserted for postcardiotomy cardiogenic shock in 53 (74.6%) patients and precardiotomy cardiogenic shock in 18 (25.4%) patients. Mean duration of support was 4.9+/-4.1 days, with 64 (90.1 %) patients supported for fewer than 10 days. Twenty-nine (40.8%) patients were successfully weaned from support after myocardial recovery: 7 (36.8%) LVADs, 13 (43.3%) RVADs, and 9 (40.9%) BIVADs. Eight (11.3%) patients received devices as a "bridge to bridge," undergoing implantation of a long-term HeartMate LVAD (Thoratec, Pleasanton, CA): six (31.6%) LVADs and two (9.1 %) BIVADs. Seven (9.9%) Abiomed patients were successfully bridged to transplantation: two (10.5%) LVADs, two (6.7%) RVADs, and three (13.6%) BIVADs. Overall, 44 (62.0%) patients survived support: weaned, "bridged to bridge," or transplanted. The Abiomed BVS 5000 can be used effectively for short-term stabilization and for bridging to transplant in select patients.

Simplified Placement of Multiple Artificial Mitral Valve Chords

The Heart Surgery Forum. 2005  |  Pubmed ID: 15870041

The use of artificial chords for the replacement of diseased mitral valve chordae and the correction of anterior and posterior leaflet prolapse is well described, although it is infrequently applied because of technical challenges.

The Impella Recover LP 5.0 Left Ventricular Assist Device: a Bridge to Coronary Artery Bypass Grafting and Cardiac Transplantation

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography. Apr, 2006  |  Pubmed ID: 16581490

Survival After Heart Transplantation is Not Diminished Among Recipients with Uncomplicated Diabetes Mellitus: an Analysis of the United Network of Organ Sharing Database

Circulation. Nov, 2006  |  Pubmed ID: 17088463

This study compares posttransplantation outcomes of survival and morbidity among recipients with and without diabetes mellitus (DM).

Transcatheter Aortic Valve Replacement in Patients with Critical Aortic Stenosis: Rationale, Device Descriptions, Early Clinical Experiences, and Perspectives

Seminars in Thoracic and Cardiovascular Surgery. 2006  |  Pubmed ID: 17157238

The development of lesser invasive transcatheter techniques for aortic valve replacement (AVR) to treat high surgical risk patients with severe aortic stenosis (AS) has engendered controversy among traditional cardiovascular therapists. Presently, there are two catheter-based treatment systems (the Cribier-Edwards Aortic Bioprosthesis and the CoreValve Revalving System) utilizing either a balloon-expandable or a self-expanding stent (or cage) platform which unfolds a pericardial tissue valve within the displaced diseased aortic valve. After ex vivo durability testing and animal studies, several clinical registries with these transcatheter AVR systems in almost 300 patients worldwide have demonstrated the following: (1) good acute hemodynamic performance with reduction in mean aortic valve gradients to <10 mm Hg; (2) frequent para-valvular regurgitation, which has improved with self-expanding devices and the use of larger (26 mm) valve sizes; (3) acceptable periprocedural (30-day) mortality (<10%) with the newest generation devices and improved operator techniques. Enlightened interdisciplinary treatment teams incorporating surgeons, interventionalists, and medical therapists as well as rigorously conducted randomized clinical trials will be required to determine if these innovative transcatheter AVR approaches will represent a viable therapy for high-risk patients with severe AS in the future.

The Effect of Ischemic Time on Survival After Heart Transplantation Varies by Donor Age: an Analysis of the United Network for Organ Sharing Database

The Journal of Thoracic and Cardiovascular Surgery. Feb, 2007  |  Pubmed ID: 17258599

(1) To examine the interaction of donor age with ischemic time and their effect on survival and (2) to define ranges of ischemic time associated with differences in survival.

The Lymphocytic Infiltration in Calcific Aortic Stenosis Predominantly Consists of Clonally Expanded T Cells

Journal of Immunology (Baltimore, Md. : 1950). Apr, 2007  |  Pubmed ID: 17404318

Valve lesions in degenerative calcific aortic stenosis (CAS), a disorder affecting 3% of those older than 75 years, are infiltrated by T lymphocytes. We sought to determine whether the alphabeta TCR repertoire of these valve-infiltrating lymphocytes exhibited features either of a polyclonal nonselective response to inflammation or contained expanded clones suggesting a more specific immune process. TCR beta-chain CDR3-length distribution analysis using PCR primers specific for 23 Vbeta families performed in eight individuals with CAS affecting tri- or bileaflet aortic valves revealed considerable oligoclonal T cell expansion. In five cases, beta-chain nucleotide sequencing in five selected Vbeta families showed that an average of 92% of the valve-infiltrating T cell repertoire consisted of expanded T cell clones, differing markedly in composition from the relatively more polyclonal peripheral CD8 or CD4 T cell subsets found even in this elderly population. Twenty-four of the valve-infiltrating T cell clones also had the same clone identified in blood, some of which were highly expanded. Interestingly, 22 of these 24 shared clones were CD8 in lineage (p = 1.5 x 10(-12)), suggesting a possible relationship to the expanded CD8(+)CD28(-) T cell clones frequently present in the elderly. Additionally, the sequences of several TCR beta-chain CDR3 regions were homologous to TCR beta-chains identified previously in allograft arteriosclerosis. We infer that these findings are inconsistent with a nonselective secondary response of T cells to inflammation and instead suggest that clonally expanded alphabeta T cells are implicated in mediating a component of the valvular injury responsible for CAS.

Transcatheter Aortic Valve Replacement: a Surgeon's Perspective

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. May, 2007  |  Pubmed ID: 19737680

Why Are We Still Talking About Open Repair of Descending Aneurysms?

The Journal of Thoracic and Cardiovascular Surgery. Aug, 2008  |  Pubmed ID: 18692627

Matching High-risk Recipients with Marginal Donor Hearts is a Clinically Effective Strategy

The Annals of Thoracic Surgery. Apr, 2009  |  Pubmed ID: 19324129

The purpose of this study is to determine the clinical outcomes associated with alternate listing transplantation, which utilizes "marginal" donor organs by transplanting them into high-risk recipients who fail to meet the standard criteria for transplantation.

Modified Bentall Operation with Bioprosthetic Valved Conduit: Columbia University Experience

The Annals of Thoracic Surgery. Jun, 2009  |  Pubmed ID: 19463647

A conduit was made by sewing a bovine pericardial valve into a graft conduit with the pseudo-sinuses of Valsalva. The graft collar below the valve cuff ring was sewn to the aortic annulus with interrupted pledgeted sutures. From August 2005 to February 2008, 68 patients underwent aortic root replacements with this technique. Operative mortality was 2.9% (2 acute aortic dissection patients died). During median follow-up of 11 months, 1 patient had reoperation for conduit failure due to infectious endocarditis. This technique is safe and feasible with favorable early outcomes. Because the valve is sewn above the outflow tract, superior hemodynamics are achieved. Reoperation may be accomplished by removal of the valve rather than full root re-replacement.

Open Distal Anastomosis in Aortic Root Replacement Using Axillary Cannulation and Moderate Hypothermia

The Journal of Thoracic and Cardiovascular Surgery. Jun, 2009  |  Pubmed ID: 19464463

Recent advance in surgical technique facilitates more aggressive approaches for thoracic aortic diseases. We sought to address the outcomes of our strategy of open distal anastomosis with aortic root replacement using axillary cannulation and moderate hypothermia.

Matching Extended-SSD Electron Beams to Multileaf Collimated Photon Beams in the Treatment of Head and Neck Cancer

Medical Physics. Sep, 2009  |  Pubmed ID: 19810498

Matching the penumbra of a 6 MeV electron beam to the penumbra of a 6 MV photon beam is a dose optimization challenge, especially when the electron beam is applied from an extended source-to-surface distance (SSD), as in the case of some head and neck treatments. Traditionally low melting point alloy blocks have been used to define the photon beam shielding over the spinal cord region. However, these are inherently time consuming to construct and employ in the clinical situation. Multileaf collimators (MLCs) provide a fast and reproducible shielding option but generate geometrically nonconformal approximations to the desired beam edge definition. The effects of substituting Cerrobend for the MLC shielding mode in the context of beam matching with extended-SSD electron beams are the subject of this investigation.

Posttransplant Survival is Not Diminished in Heart Transplant Recipients Bridged with Implantable Left Ventricular Assist Devices

The Journal of Thoracic and Cardiovascular Surgery. Dec, 2009  |  Pubmed ID: 19931672

The purpose of this study was to compare posttransplantation morbidity and mortality in orthotopic heart transplant recipients bridged to transplant with a left ventricular assist device with nonbridged recipients. To account for potential differences across device types, we stratified bridge-to-transplant recipients by type of ventricular assist device: extracorporeal (EXTRA), paracorporeal (PARA), and intracorporeal (INTRA).

Stentless Bioprosthesis in a Valved Conduit: Implications for Pulmonary Reconstruction

The Annals of Thoracic Surgery. Dec, 2009  |  Pubmed ID: 19932287

Pulmonic valve reconstruction is required for various congenital heart diseases and in concert with aortic valve autograft replacement (ie, the Ross procedure). Current techniques using homografts and autografts are often associated with significant morbidity and mortality, and are technically challenging. Furthermore, the long-term durability of these repairs has been questioned, leading to more frequent use of synthetic valved conduits. We report a case of pulmonary valve replacement and right ventricular outflow tract reconstruction using a stentless bioprosthetic aortic valve and polyester graft as a novel approach after radical pulmonary artery sarcoma resection.

Use of Carotid-subclavian Arterial Bypass and Thoracic Endovascular Aortic Repair to Minimize Cerebral Ischemia in Total Aortic Arch Reconstruction

The Journal of Thoracic and Cardiovascular Surgery. Mar, 2010  |  Pubmed ID: 20080269

Total aortic arch replacement typically requires hypothermic circulatory arrest, carrying risks of cerebral ischemia. We recently introduced left carotid-subclavian bypass before total aortic arch replacement with thoracic stent grafting to achieve hybrid arch reconstruction with short periods of selective antegrade cerebral perfusion.

Modified Bentall Operation with a Novel Biologic Valved Conduit

The Annals of Thoracic Surgery. Mar, 2010  |  Pubmed ID: 20172157

The optimal conduit for a modified Bentall operation remains unknown. The current study tested hemodynamics and early clinical results of the newly developed valved conduit composed of the 3f Aortic Bioprosthesis (ATS Medical, Minneapolis, MN) and the Vascutek Gelweave Valsalva Aortic Root Graft (Terumo Cardiovascular Systems, Ann Arbor, MI).

Less Invasive Left Ventricular Assist Device Placement for Difficult Resternotomy

The Journal of Thoracic and Cardiovascular Surgery. Oct, 2010  |  Pubmed ID: 20541223

Combinatorial Binding of Transcription Factors in the Pluripotency Control Regions of the Genome

Genome Research. Jul, 2011  |  Pubmed ID: 21527551

The pluripotency control regions (PluCRs) are defined as genomic regions that are bound by POU5F1, SOX2, and NANOG in vivo. We utilized a high-throughput binding assay to record more than 270,000 different DNA/protein binding measurements along incrementally tiled windows of DNA within these PluCRs. This high-resolution binding map is then used to systematically define the context of POU factor binding, and reveals patterns of cooperativity and competition in the pluripotency network. The most prominent pattern is a pervasive binding competition between POU5F1 and the forkhead transcription factors. Like many transcription factors, POU5F1 is co-expressed with a paralog, POU2F1, that shares an apparently identical binding specificity. By analyzing thousands of binding measurements, we discover context effects that discriminate POU2F1 from POU5F1 binding. Proximal NANOG binding promotes POU5F1 binding, whereas nearby SOX2 binding favors POU2F1. We demonstrate by cross-species comparison and by chromatin immunoprecipitation (ChIP) that the contextual sequence determinants learned in vitro are sufficient to predict POU2F1 binding in vivo.

On-pump Versus Off-pump Surgical Revascularization in Patients with Acute Coronary Syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy Trial

The Journal of Thoracic and Cardiovascular Surgery. Aug, 2011  |  Pubmed ID: 21529848

Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach.

Aortic Root and Right Ventricular Outflow Tract Reconstruction Using Composite Biological Valved Conduits After Failed Ross Procedure

The Annals of Thoracic Surgery. Jun, 2011  |  Pubmed ID: 21619955

The Ross procedure or pulmonary autograft has been frequently used for surgical treatment of aortic valve disease. One considerable disadvantage of the Ross procedure is the involvement of two valves (aortic and pulmonary) in treatment of single (aortic) valve disease. Both the aortic and pulmonary valves are at risk for future degeneration. Concurrent failure of both valves after a Ross procedure is rare but presents a significant technical challenge when reoperation is necessary. We describe a novel approach to this complication using composite biological valved conduits comprised of stentless bioprosthetic valves and polyester grafts.

Circulating Activated and Effector Memory T Cells Are Associated with Calcification and Clonal Expansions in Bicuspid and Tricuspid Valves of Calcific Aortic Stenosis

Journal of Immunology (Baltimore, Md. : 1950). Jul, 2011  |  Pubmed ID: 21677140

We sought to delineate further the immunological significance of T lymphocytes infiltrating the valve leaflets in calcific aortic stenosis (CAS) and determine whether there were associated alterations in circulating T cells. Using clonotypic TCR β-chain length and sequence analysis we confirmed that the repertoire of tricuspid CAS valves contains numerous expanded T cell clones with varying degrees of additional polyclonality, which was greatest in cases with severe calcification. We now report a similar proportion of clonal expansions in the much younger bicuspid valve CAS cases. Peripheral blood flow cytometry revealed elevations in HLA-DR(+) activated CD8 cells and in the CD8(+)CD28(null)CD57(+) memory-effector subset that were significantly greater in both bicuspid and tricuspid CAS cases with more severe valve calcification. Lesser increases of CD4(+)CD28(null) T cells were identified, principally in cases with concurrent atherosclerotic disease. Upon immunostaining the CD8 T cells in all valves were mainly CD28(null), and CD8 T cell percentages were greatest in valves with oligoclonal repertoires. T cell clones identified by their clonotypic sequence as expanded in the valve were also found expanded in the circulating blood CD28(null)CD8(+) T cells and to a lesser degree in the CD8(+)CD28(+) subset, directly supporting the relationship between immunologic events in the blood and the valve. The results suggest that an ongoing systemic adaptive immune response is occurring in cases with bicuspid and tricuspid CAS, involving circulating CD8 T cell activation, clonal expansion, and differentiation to a memory-effector phenotype, with trafficking of T cells in expanded clones between blood and the valve.

Designing a Stentless Valve Conduit for Use in a Biological Bentall Procedure

The Journal of Heart Valve Disease. Sep, 2011  |  Pubmed ID: 22066366

Various modifications of the Bentall procedure have been described using mechanical valve conduits. A further modification, using a bioprosthetic valve, has grown in popularity as this prevents the need for lifelong anticoagulation. Additional innovation using a stentless bioprosthetic valve has the theoretical advantages of allowing for a larger bioprosthesis and an improved durability. The technical aspects involved in designing a stentless valve conduit for use in a biological Bentall procedure are described.

Quality, Not Volume, Determines Outcome of Coronary Artery Bypass Surgery in a University-based Community Hospital Network

The Journal of Thoracic and Cardiovascular Surgery. Feb, 2012  |  Pubmed ID: 22104669

The present study examined the relationship between hospital and surgeon coronary artery bypass grafting procedural volume, mortality, morbidity, and National Quality Forum care processes in a university-based community hospital quality improvement program.