Single center experience with the Sorin Bicarbon prosthesis. A 17-year follow-up

Objective: To evaluate the long-term results of aortic valve replacement (AVR) and mitral valve replacement (MVR) with the Sorin Bicarbon prosthesis (SBP). Methods: Five hundred seven patients (306 men, 201 women), mean age 62 10 years (range, 21-86 years), received an SBP between 1994 and 2000; AVR was performed in 344 (67%) and MVR in 163 (33%). The main concomitant procedure was coronary artery grafting in 79 patients (16%). Follow-up was 99%complete; mean follow-up was 12.7 4.0 years with a cumulative duration of follow-up of 6475 patient-years in the entire group (4348 patient-years for AVR and 2124 patient-years for MVR). Results: Hospital mortality was 2.7% (AVR, 2.03%; MVR, 4.3%). There were 169 late deaths (AVR, 128; MVR, 41). Actuarial survival at 17 years is 49.7% 5.3% for AVR and 62.0% 6.1% for MVR. At the last follow-up, 310 survivors (199 AVR, 111 MVR) are in New York Heart Association functional class I or II. At 17 years, actuarial freedom from valve-related deaths, embolism, and bleeding is 89.8% 4.8%, 85.8% 5.4%, and 96.2% 1.2% after AVR, and 91.9% 3.9%, 96.3% 1.8%, 95.0% 2.9% after MVR. Reoperation was required in 5 patients with AVR (thrombosis in 4 and perivalvular leak in 1). Actuarial freedom from reoperation is 98.1% 0.8% after AVR and 100% after MVR; freedom from endocarditis is 100% after AVR and 99.2% 0.7% after MVR. No cases of intrinsic structural valve failure were observed. Conclusions: The SBP has shown excellent results in terms of clinical improvement and freedom from valve-related complications, even up to 17 years after AVR and MVR. It therefore seems to be a safe option whenever a mechanical prosthesis is needed. (J Thorac Cardiovasc Surg 2014;148:2039-44

Single center experience with the Sorin Bicarbon prosthesis: A\ua017-year clinical follow-up.

To evaluate the long-term results of aortic valve replacement (AVR) and mitral valve replacement (MVR) with the Sorin Bicarbon prosthesis (SBP).Five hundred seven patients (306 men, 201 women), mean age 62 \ub1 10 years (range, 21-86 years), received an SBP between 1994 and 2000; AVR was performed in 344 (67\%) and MVR in 163 (33\%). The main concomitant procedure was coronary artery grafting in 79 patients (16\%). Follow-up was 99\% complete; mean follow-up was 12.7 \ub1 4.0 years with a cumulative duration of follow-up of 6475 patient-years in the entire group (4348 patient-years for AVR and 2124 patient-years for MVR).Hospital mortality was 2.7\% (AVR, 2.03\%; MVR, 4.3\%). There were 169 late deaths (AVR, 128; MVR, 41). Actuarial survival at 17 years is 49.7\% \ub1 5.3\% for AVR and 62.0\% \ub1 6.1\% for MVR. At the last follow-up, 310 survivors (199 AVR, 111 MVR) are in New York Heart Association functional class I or II. At 17 years, actuarial freedom from valve-related deaths, embolism, and bleeding is 89.8\% \ub1 4.8\%, 85.8\% \ub1 5.4\%, and 96.2\% \ub1 1.2\% after AVR, and 91.9\% \ub1 3.9\%, 96.3\% \ub1 1.8\%, 95.0\% \ub1 2.9\% after MVR. Reoperation was required in 5 patients with AVR (thrombosis in 4 and perivalvular leak in 1). Actuarial freedom from reoperation is 98.1\% \ub1 0.8\% after AVR and 100\% after MVR; freedom from endocarditis is 100\% after AVR and 99.2\% \ub1 0.7\% after MVR. No cases of intrinsic structural valve failure were observed.The SBP has shown excellent results in terms of clinical improvement and freedom from valve-related complications, even up to 17 years after AVR and MVR. It therefore seems to be a safe option whenever a mechanical prosthesis is needed

Single center experience with the Sorin Bicarbon prosthesis: A 17-year clinical follow-up

To evaluate the long-term results of aortic valve replacement (AVR) and mitral valve replacement (MVR) with the Sorin Bicarbon prosthesis (SBP).Five hundred seven patients (306 men, 201 women), mean age 62 ± 10 years (range, 21-86 years), received an SBP between 1994 and 2000; AVR was performed in 344 (67\%) and MVR in 163 (33\%). The main concomitant procedure was coronary artery grafting in 79 patients (16\%). Follow-up was 99\% complete; mean follow-up was 12.7 ± 4.0 years with a cumulative duration of follow-up of 6475 patient-years in the entire group (4348 patient-years for AVR and 2124 patient-years for MVR).Hospital mortality was 2.7\% (AVR, 2.03\%; MVR, 4.3\%). There were 169 late deaths (AVR, 128; MVR, 41). Actuarial survival at 17 years is 49.7\% ± 5.3\% for AVR and 62.0\% ± 6.1\% for MVR. At the last follow-up, 310 survivors (199 AVR, 111 MVR) are in New York Heart Association functional class I or II. At 17 years, actuarial freedom from valve-related deaths, embolism, and bleeding is 89.8\% ± 4.8\%, 85.8\% ± 5.4\%, and 96.2\% ± 1.2\% after AVR, and 91.9\% ± 3.9\%, 96.3\% ± 1.8\%, 95.0\% ± 2.9\% after MVR. Reoperation was required in 5 patients with AVR (thrombosis in 4 and perivalvular leak in 1). Actuarial freedom from reoperation is 98.1\% ± 0.8\% after AVR and 100\% after MVR; freedom from endocarditis is 100\% after AVR and 99.2\% ± 0.7\% after MVR. No cases of intrinsic structural valve failure were observed.The SBP has shown excellent results in terms of clinical improvement and freedom from valve-related complications, even up to 17 years after AVR and MVR. It therefore seems to be a safe option whenever a mechanical prosthesis is needed

Structure Model and Toxicity of the Product of Biodissolution of Chrysotile Asbestos in the Lungs

Asbestos is a commercial term indicating six natural silicates with asbestiform crystal habit. Of these, five are double-chain silicates (amphibole) and one is a layer silicate (serpentine asbestos or chrysotile). Although all species are classified as human carcinogens, their degree of toxicity is still a matter of debate. Amphibole asbestos species are biopersistent in the human lungs and exert their chronic toxic action for decades, whereas chrysotile is not biopersistent and transforms into an amorphous silica structure prone to chemical/physical clearance when exposed to the acidic environment created by the alveolar macrophages. There is evidence in the literature of the toxicity of chrysotile, but its limited biopersistence is thought to explain the difference in toxicity with respect to amphibole asbestos. To date, no comprehensive model describing the toxic action of chrysotile in the lungs is available, as the structure and toxic action of the product formed by the biodissolution of chrysotile are unknown. This work is aimed at fulfilling this gap and explaining the toxic action in terms of structural, chemical, and physical properties. We show that chrysotile's fibrous structure induces cellular damage, mainly through physical interactions. Based on our previous work and novel findings, we propose the following toxicity model: inhaled chrysotile fibers exert their toxicity in the alveolar space by physical and biochemical action. The fibers are soon leached by the intracellular acid environment into a product with residual toxicity, and the dissolution process liberates toxic metals in the intracellular and extracellular environment

In vitro and in vivo characterization of the bifunctional \u3bc and \u3b4 opioid receptor ligand UFP-505

Background and Purpose: Targeting more than one opioid receptor type simultaneously may have analgesic advantages in reducing side-effects. We have evaluated the mixed \u3bc opioid receptor agonist/ \u3b4 opioid receptor antagonist UFP-505 in vitro and in vivo. Experimental Approach: We measured receptor density and function in single \u3bc, \u3b4 and \u3bc /\u3b4 receptor double expression systems. GTP\u3b335S binding, cAMP formation and arrestin recruitment were measured. Antinociceptive activity was measured in vivo using tail withdrawal and paw pressure tests following acute and chronic treatment. In some experiments, we collected tissues to measure receptor densities. Key Results: UFP-505 bound to \u3bc receptors with full agonist activity and to \u3b4 receptors as a low efficacy partial agonist At \u3bc, but not \u3b4 receptors, UFP-505 binding recruited arrestin. Unlike morphine, UFP-505 treatment internalized \u3bc receptors and there was some evidence for internalization of \u3b4 receptors. Similar data were obtained in a \u3bc /\u3b4 receptor double expression system. In rats, acute UFP-505 or morphine, injected intrathecally, was antinociceptive. In tissues harvested from these experiments, \u3bc and \u3b4 receptor density was decreased after UFP-505 but not morphine treatment, in agreement with in vitro data. Both morphine and UFP-505 induced significant tolerance. Conclusions and Implications: In this study, UFP-505 behaved as a full agonist at \u3bc receptors with variable activity at \u3b4 receptors. This bifunctional compound was antinociceptive in rats after intrathecal administration. In this model, dual targeting provided no advantages in terms of tolerance liability. Linked Articles: This article is part of a themed section on Emerging Areas of Opioid Pharmacology. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.14/issuetoc