0000000000076471
AUTHOR
Michael Hilker
Modified hemi-Fontan procedure on the beating heart
the heart by infusing the cardioplegic solution under aortic occlusion by means of the balloon throughout the procedure. Even though the balloon catheter passes through the aortic valve, significant aortic valve insufficiency is not likely to occur because of the small caliber of the balloon catheter. We believe that the clinical application of this double-lumen aortic occlusion catheter will protect the myocardium in patients with a thoracoabdominal aortic aneurysm or distal descending aortic aneurysm who undergo the operation through the left thoracotomy with DHCA.
Intramural delivery of Sirolimus prevents vascular remodeling following balloon injury
Abstract Objective. Several studies have demonstrated that Sirolimus-eluting stents reduce restenosis in patients with coronary artery disease. Here, we tested whether direct delivery of Sirolimus into the vessel wall during balloon angioplasty can modify vascular remodeling over several weeks. Methods and Results. During angioplasty of the rabbit iliac artery we administered an intramural infusion of Sirolimus or its vehicle directly through a balloon catheter into the vessel wall. After 3 weeks neointimal formation was decreased (0.71 ± 0.1 vs. 1.4 ± 0.12 intima/media ratio), and this process was attributed to the inhibitory properties of Sirolimus on ECM deposition and smooth muscle cell…
Improvement in Risk Stratification in Transcatheter Aortic Valve Implantation Using a Combination of the Tumor Marker CA125 and the Logistic EuroSCORE
Conventional risk scores have not been accurate in predicting peri- and postprocedural risk of patients undergoing transcatheter aortic valve implantation (TAVI). Elevated levels of the tumor marker carbohydrate antigen 125 (CA125) have been linked to adverse outcomes after TAVI. We studied the additional value of CA125 to that of the EuroSCORE in predicting long-term mortality after TAVI.During a median follow-up of 59 weeks, 115 of 422 patients (27%) died after TAVI. Mortality was higher with elevated CA125 (30 U/mL) and EuroSCORE (median) (47% vs 20%, P.001 and 38% vs 16%, P.001, respectively). In the multivariable analysis, CA125 (30 U/mL) remained an independent predictor of mortality …
Rapamycin vermindert die Neointimaausbildung nach vaskulärer Schädigung
Background: Proliferation and migration of vascular smooth muscle cells (SMCs) mark the key processes in the development of bypass graft disease and during neointima formation in restenosis after angioplasty. Growth factors are potent SMC mitogens as they are involved in SMC proliferation and in extracellular matrix (ECM) synthesis. Based on these premises, we examined the effect of the proliferation inhibitor rapamycin in human SMC culture and in a rabbit vascular injury model. Materials and methods: Injection of rapamycin or its vehicle was performed with an infusion-balloon catheter directly into the vessel wall during vascular injury. The intima/media ratio was determined histologicall…
Proliferative activity in stenotic human aortocoronary bypass grafts
Abstract Background: Aortocoronary bypass graft disease is responsible for long-term failure of autologous vein grafts. The analyses of proliferation and cell type characterisation in human bypass grafts harvested during re-do surgery make it possible to investigate the cellular processes leading to bypass graft failure. Methods: 30 stenotic vein grafts and 25 control veins were explantated during re-do heart surgery procedures. The total area and cell count of the neointima, media and adventitia were calculated computer-assisted. Actively proliferating cells were identified using antibody to Ki-67 and positive cells were determined by double-label immunocytochemistry with SMC α-actin, CD 3…
Gene expression profiling of human stenotic aorto-coronary bypass grafts by cDNA array analysis
Objective: Aorto-coronary bypass graft disease with its increasing clinical signification represents an unsolved problem in cardiological and heart surgery practice. Late occlusion of autologous saphenous vein grafts is due to medial and neointimal thickening secondary to migration and proliferation of smooth muscle cells (SMCs) and the subsequent formation of atherosclerotic plaques. This study is aimed at identifying differentially expressed genes in human stenotic bypass grafts to detect unknown pathomechanism and to identify novel targets for prophylactic treatment options. Methods: Stenotic saphenous aorto-coronary bypass grafts ðn ¼ 5Þ were retrieved during re-do aortocoronary bypass …
Mejora en la estratificación del riesgo tras el implante percutáneo de válvula aórtica mediante una combinación de marcador tumoral CA125 y EuroSCORE logístico
ResumenIntroduccion y objetivos El rendimiento de las puntuaciones de riesgo tradicionales para predecir el riesgo tras el implante percutaneo valvula aortica (TAVI) no es adecuado. Las altas concentraciones plasmaticas de antigeno carbohidrato 125 (CA125) se han asociado a un aumento del riesgo de eventos adversos tras TAVI. En este trabajo se evalua el valor pronostico adicional del CA125 sobre la puntuacion EuroSCORE para la prediccion de riesgo a largo plazo. Metodos y resultados Durante una mediana de seguimento de 59 semanas, murieron 115 de 422 pacientes (27%) despues de la TAVI. La mortalidad fue mayor entre aquellos con CA125 elevado (> 30 U/ml) y EuroSCORE ≥ mediana (el 47 frente …
The autoantigen La/SS-B: Analysis of the expression of alternatively spliced La mRNA isoforms
The gene for the nuclear autoantigen La/SS-B encodes two La mRNA isoforms. In order to study the function and expression of both La mRNA forms, an in situ hybridization procedure was developed allowing the selective identification of either exon 1 or exon 1'. For this purpose, digoxigenin-labeled exon-specific sense and anti-sense probes were prepared by in vitro transcription from plasmids that contained the respective exon sequence. Detection of the probes was carried out by using rhodamine-conjugated anti-digoxigenin antibody and confocal laser scanning microscopy. Both La mRNAs were found in the cytoplasm of endothelial cells but not in smooth muscle cells. In addition to the in situ te…
Different La/SS-B mRNA isoforms are expressed in salivary gland tissue of patients with primary Sjogren's syndrome
Recently we isolated a La/SS-B mRNA isoform from a cDNA library made from peripheral blood lymphocytes of a patient with primary Sjögren's Syndrome. In the La/SS-B mRNA isoform the exon 1 was replaced. The alternative exon was termed exon 1'. Genomic analysis showed that the exon 1' La mRNA was the result of a promoter-switch in combination with alternative splicing. Due to the unusual structure of the exon 1' La/SS-B mRNA, the function and the behaviour under physiological and pathophysiological conditions in tissue of patients with primary Sjögren's syndrome or Systemic Lupus Erythematosus remained obscure. Therefore assays were established allowing a qualitative and quantitative estimati…
Tumor Marker Carbohydrate Antigen 125 Predicts Adverse Outcome After Transcatheter Aortic Valve Implantation
ObjectivesThis study sought to predict the value of tumor marker carbohydrate antigen 125 (CA125) before and after transcatheter aortic valve implantation (TAVI) for all-cause death and a composite endpoint of death, admission for heart failure, myocardial infarction, and stroke (major adverse cardiac events [MACE]).BackgroundRisk stratification after TAVI remains challenging. The use of biomarkers in this setting represents an unmet need.MethodsCA125 was measured in 228 patients before and after TAVI. The association with outcomes was assessed using parametric Cox regression and joint modeling for baseline and longitudinal analyses, respectively. CA125 was evaluated as logarithm transforma…
Cystic Medial Necrosis of the Internal Thoracic Artery:Case Report
In an internal thoracic artery intended as a graft in coronary angioplasty, multiple intramural haematomas impeded blood flow and consequently precluded use of the artery as a free graft. The cause was found to be cystic medical necrosis of the internal thoracic artery. A good result was obtained with three single aorto-coronary venous bypass grafts.
Die Eversions-Endarterektomie der A. carotis interna als Simultanoperation in der Koronarchirurgie
Im Zeitraum von Oktober 1993 bis Oktober 1996 wurde bei 27 Patienten simultan zur Koronaroperation eine Eversions-Endarterektomie (EEA) der A. carotis interna durchgefuhrt. Praoperativ hatten 2 Patienten eine Hemiparese erlitten, 3 Patienten hatten uber transitorisch ischamische Attacken (TIA) berichtet. Bei den ubrigen Patienten mit asymptomatischer Karotis-Interna-Stenose wurde die Operationsindikation aufgrund einer hochgradigen, wenn auch klinisch asymptomatischen Stenosierung (>90%) gestellt. Bei 23 Patienten lag eine einseitige Karotisstenose vor, bei 4 Patienten war auch die Gegenseite bis maximal 70% stenosiert, wobei sich die Wahl der Operationsseite nach der klinischen Symptomatik…
‘Soft’ Snaring of the Coronary Artery in Minimally-Invasive Coronary Surgery
A technique is described that allows a simple and safe temporary occlusion of the coronary artery in beating heart procedures using monofilament stay sutures underlaid with small pericardial pads. Postoperative serial levels of Troponin I remained low (<4 ng/L) and control angiography revealed no stenosis in the distal coronary artery.
Expression of the proto-oncogene c-myc in human stenotic aortocoronary bypass grafts.
Summary Proliferation and differentiation of vascular smooth muscle cells (VSMC) are central events in vascular pathobiology and play a major role in the development of stenotic and restenotic lesions [ 15, 27 ] . The proto-oncogene c-myc and other early cell cycle-regulating genes have been implicated in the induction of cell proliferation and differentiation under diverse pathophysiological conditions [ 11, 13 ] . In the present study we analyzed c-myc mRNAexpression by indirect nonradioactive in situ hybridization technique (NISH) in human stenotic venous bypass grafts (n = 32) retrieved during re-do operations of coronary artery disease and compared the results with 28 native veins (ven…
Revaskularisation mit der A. gastroepiploica dextra — Bewertung der Indikation und des perioperativen Risikos
Bei 35 Patienten (mittleres Alter 64,0 Jahre (±10,4 Jahre) wurde bei fehlender oder unbrauchbarer V. saphena magna neben der einoder beidseitigen A. thoracica interna (ITA) die rechte A. gastroepiploica (GEA) zur Revaskularisation der rechten Koronararterie (RCA) verwendet. Ausgeschlossen wurden Patienten mit erheblicher Adipositas (Broca-Index >20%) sowie Patienten mit abdominellen Voroperationen. In einem Fall konnte die GEA wegen Plaquebildung nicht verwendet werden. Bei 23 Patienten wurde die GEA mit dem R. interventricularis posterior (RIVP), bei 11 Patienten mit der RCA vor bzw. in Hohe der Crux anastomosiert.
A review of 507 off-pump coronary bypass patients: a single center experience.
This retrospective study evaluates perioperative results of 'Off-pump' coronary artery bypass surgery (OPCAB) experience in a single center. Five hundred and seven patients were operated (median sternotomy) from 1998 to 2002 using OPCAB. Patient data were registered and risk prediction calculated using the full logistic version of EuroSCORE. Overall, 1091 distal anastomoses were performed and only five (1%) patients required conversion to cardiopulmonary bypass. The predicted mortality was 3.8+/-4.5%, the observed mortality was 2.37%. OPCAB technique has become a standard approach in our department with low mortality and morbidity rates even in treatment of multivessel disease or high-risk …
Extrathoracic Arteriosclerotic Vascular Changes Preclude the Use of the Internal Thoracic Artery for Coronary Artery Bypass Grafting
During a two-years period we have treated 6 patients where use of the internal thoracic artery for coronary artery grafting was precluded because of extrathoracic arteriosclerotic vascular lesions. In four patients with severe aorto-iliac occlusive disease preoperative digital angiography demonstrated collateralisation of the lower extremity by either the left, right, or both internal thoracic arteries (ITA). In these cases use of the ITA was excluded in order to preserve the collateral supply and coronary bypass grafting was performed using only saphenous vein. In two patients with proximal occlusion of the left subclavian artery the right ITA was used as in-situ bypass to graft the left a…
Cardiac pacing in premature infants and neonates: steroid eluting leads and automatic output adaptation
Abstract Background . Appropriate generator and lead selection as well as techniques of implantation are most important aspects of cardiac pacing in the extremely young patient. Here we report the clinical results using a new technique with automatic output adaptation based on evoked response in combination with steroid-eluting epicardial leads in small children. Methods . One neonate and 2 premature infants underwent permanent pacemaker implantation because of congenital high-degree atrioventricular block or postoperative complete heart block, respectively. Steroid-eluting epicardial leads and a multiprogrammable pacemaker with automatic output adaptation were used. Results . Intermuscular…