Results of aortic valve replacement with the pulmonary autograft-A critical appraisal of the Ross operation

La sustitución de la válvula aórtica utilizando la propia válvula pulmonar del paciente, el autoinjerto pulmonar, conocida como intervención de Ross, ha visto aumentada su popularidad después de una adopción inicial lenta. Hoy día muchos cirujanos la consideran como intervención de elección en niños y pacientes jóvenes. Sin embargo, hay ciertas dudas sobre el comportamiento y resultados alejados tanto del autoinjerto como del homoinjerto utilizado para la reconstrucción del tracto de salida del ventrículo izquierdo. En esta revisión se efectúa un análisis critico de los aspectos técnicos de la intervención y de sus modificaciones, se repasan los resultados disponibles de series amplias sobre niños y adultos incluyendo nuestros propios resultados y se discuten los problemas clave del procedimiento, el potencial de dilatación del autoinjerto en la circulación sistémica y la durabilidad del homoinjerto en el tracto de salida del ventrículo derecho. Concluimos que la intervención de Ross ofrece una reparación duradera y eficaz en niños y adultos jóvenes

Red cell distribution width and other red blood cell parameters in patients with cancer: association with risk of venous thromboembolism and mortality.

BACKGROUND:Cancer patients are at high risk of developing venous thromboembolism (VTE). Red cell distribution width (RDW) has been reported to be associated with arterial and venous thrombosis and mortality in several diseases. Here, we analyzed the association between RDW and other red blood cell (RBC) parameters with risk of VTE and mortality in patients with cancer. METHODS:RBC parameters were measured in 1840 patients with cancers of the brain, breast, lung, stomach, colon, pancreas, prostate, kidney; lymphoma, multiple myeloma and other tumor sites, that were included in the Vienna Cancer and Thrombosis Study (CATS), which is an ongoing prospective, observational cohort study of patients with newly diagnosed or progressive cancer after remission. Primary study outcome is occurrence of symptomatic VTE and secondary outcome is death during a maximum follow-up of 2 years. RESULTS:During a median follow-up of 706 days, 131 (7.1%) patients developed VTE and 702 (38.2%) died. High RDW (>16%) was not associated with a higher risk of VTE in the total study cohort; in competing risk analysis accounting for death as competing variable the univariable subhazard ratio (SHR) was 1.34 (95% confidence interval [CI]: 0.80-2.23, p = 0.269). There was also no significant association between other RBC parameters and risk of VTE. High RDW was associated with an increased risk of mortality in the total study population (hazard ratio [HR, 95% CI]: 1.72 [1.39-2.12], p<0.001), and this association prevailed after adjustment for age, sex, hemoglobin, leukocyte and platelet count (HR [95% CI]: 1.34 [1.06-1.70], p = 0.016). CONCLUSIONS:RDW and other RBC parameters were not independently associated with risk of VTE in patients with cancer and might therefore not be of added value for estimating risk of VTE in patients with cancer. We could confirm that high RDW is an independent predictor of poor overall survival in cancer

Annals of Hematology / Fibrinolysis in patients with a mild-to-moderate bleeding tendency of unknown cause

In more than 50% of patients with a mild-to-moderate bleeding tendency, no underlying cause can be identified (bleeding of unknown cause, BUC). Data on parameters of fibrinolysis in BUC are scarce in the literature and reveal discrepant results. It was the aim of this study to investigate increased fibrinolysis as a possible mechanism of BUC. We included 270 patients (227 females, median age 44 years, 2575th percentile 3258) with BUC and 98 healthy controls (65 females, median age 47 years, 2575thpercentile 3955). Tissue plasminogen activator (tPA-) antigen and activity, plasminogen activator inhibitor type-1 (PAI-1), tPA-PAI-1 complexes, thrombin activatable fibrinolysis inhibitor (TAFI), 2-antiplasmin, and D-dimer were determined. While PAI-1 deficiency was equally frequent in patients with BUC and controls (91/270, 34%, and 33/98, 34%, p = 0.996), tPA activity levels were more often above the detection limit in patients than in controls (103/213, 48%, and 23/98, 23%, p < 0.0001). We found lower levels of tPA-PAI-1 complexes (6.86 (3.9910.00) and 9.11 (7.1713.12), p < 0.001) and higher activity of TAFI (18.61 (15.8022.58) and 17.03 (14.0220.02), p < 0.001) and 2-antiplasmin (102 (94109) and 98 (90106], p = 0.003) in patients compared to controls. Detectable tPA activity (OR 3.02, 95%CI 1.755.23, p < 0.0001), higher levels of TAFI (OR 2.57, 95%CI 1.484.46, p = 0.0008) and 2-antiplasmin (OR 1.03, 95%CI 1.011.05, p = 0.011), and lower levels of tPA-PAI-1 complexes (OR 0.90, 95%CI 0.860.95, p < 0.0001) were independently associated with BUC in sex-adjusted logistic regression analyses. We conclude that the fibrinolytic system can play an etiological role for bleeding in patients with BUC.(VLID)349866

The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting

OBJECTIVES: The ideal prosthesis for young patients requiring aortic valve replacement has not been defined to date. Although the Ross procedure provides excellent survival, its application is still limited. We compared the long-term survival after the Ross procedure with mechanical aortic valve replacement. METHODS: All consecutive Ross procedures and mechanical aortic valve replacements performed between 1991 and 2008 at a single centre were analysed. Only adult patients between 18 and 50 years of age were included in the study. Survival and valve-related complications were evaluated. Furthermore, survival was compared with the age- and sex-matched Austrian population. RESULTS: A total of 159 Ross patients and 173 mechanical valve patients were included. The cumulative survival for the Ross procedure was significantly better, with survival rates of 96, 94 and 93% at 5, 10 and 15 years, respectively, in comparison to 90, 84 and 75% (P < 0.01) for patients with mechanical valves. A Cox regression analysis including patients' age, gender and valve type revealed age and the type of aortic valve replacement as independent significant factors influencing survival (for age, hazard ratio = 1.1, 95% confidence interval = 1.0-1.1, P = 0.03; and for valve type, hazard ratio = 2.6, 95% confidence interval = 1.2-5.8, P = 0.02). The observed survival was comparable to the expected standard survival for the Ross group but was significantly reduced in the mechanical valve group. CONCLUSIONS: In a real-world setting, the Ross procedure is associated with a long-term survival benefit in young adults in comparison to mechanical aortic valve replacement

Kaplan-Meier estimates for cumulative survival probability of cancer patients (total study cohort) with red blood cell distribution width (RDW)>16% and below (≤16%), respectively.

<p>Survival rates were significantly lower in patients with high RDW in comparison to those with a non-elevated RDW (p<0.001). Numbers in parentheses indicate numbers of deaths in the respective group and time period.</p

Red blood cell parameters and risk of VTE in patients with solid tumors (n = 1286). Significant results are highlighted in bold.

<p>Red blood cell parameters and risk of VTE in patients with solid tumors (n = 1286). Significant results are highlighted in bold.</p