30 research outputs found
New Technique for Aortic Valve Functional Annulus Reshaping Using a Handmade Prosthetic Ring
Background. Despite a wide development in aortic
leaflets repair techniques, aortic valve annuloplastic procedures
are still poorly investigated. We present our
aortic valve annuloplastic system consisting of a handmade
prosthetic ring with 2 components for reshaping
the aortic annulus and sinotubular junction (STJ) and
illustrates our surgical approach and clinical results.
Methods. Since February 2003, 45 patients with aortic
valve regurgitation underwent aortic annuloplasty using
the new ring. Mean patient age was 58 16 years (range,
46 to 76 years). The ring has 2 components: a circular ring
used to undersize the circumference of the aortoventricular
junction and 3-crown-like shape ring used for STJ
remodeling. The circular ring was sutured into the left
ventricular outflow tract in the aortic subvalvular position
and the STJ ring was sutured from the outside of the
aortic root just at the level of the STJ. The 3 vertical bands
of the STJ ring were fixed to the underlying circular ring
to stabilize the continuity between the STJ and nadir of
the aortic valve.
Results. No in-hospital death occurred. Two patients
had residual trivial aortic valve regurgitation postoperatively,
and 3 patients required treatment for residual
aortic regurgitation (more than mild). Mean length of the
coaptation surface was 10 2 mm. The mean clinical
follow-up (100% complete) was 22 16 months. All
patients were free from cardiac and valve-related events,
and no complications due to ring implantation occurred.
Conclusions. This ring reshapes the functional aortic
annulus and stabilizes all components of the native
aortic valve stent to improve long-term results of valve
repair
Treatment of pulmonary hypertension in patients undergoing cardiac surgery with cardiopulmonary bypass: a randomized, prospective, double-blind study.
OBJECTIVE: Pulmonary hypertension can already be present in patients undergoing cardiac surgery or can be exacerbated by cardiopulmonary bypass. Postoperative treatment is still a challenge for physicians. The aim of this study was to evaluate the effects of inhaled prostacyclin (iPGI2) and nitric oxide (iNO) compared with those of intravenous vasodilators.
METHODS: This prospective, randomized, double-blind study included 58 patients affected by severe mitral valve stenosis and pulmonary hypertension with high pulmonary vascular resistance (> 250 dynes x s x cm(-5)) and a mean pulmonary artery pressure > 25 mmHg. All patients were monitored by central venous, radial arterial and Swan-Ganz catheters. Data were recorded at six different time points, before induction of anaesthesia, during and after surgery. Prostacyclin and nitric oxide were administered by inhalation 5 min before weaning from cardiopulmonary bypass and continued in the intensive care unit. Right ventricular function was evaluated by transoesophageal echocardiography.
RESULTS: Hospital mortality was 3.4%. After drug administration, the mean pulmonary artery pressure and pulmonary vascular resistance were significantly decreased in the iNO and iPGI2 groups with respect to the baseline values (P < 0.05) and such a decrease was maintained throughout the study; this was not observed in the control group. In the iNO and iPGI2 groups we demonstrated a significant increase in cardiac indices and right ventricular ejection fraction after drug administration with respect to baseline. Furthermore, patients in the inhaled drug groups were weaned easily from cardiopulmonary bypass (P = 0.04) and had a shorter intubation time (P = 0.03) and intensive care unit stay (P = 0.02) than the control group.
CONCLUSIONS: Our data suggest that both iNO and iPGI2 are effective in the treatment of pulmonary hypertension. iPGI2 has a number of advantages over iNO, including its easy administration and lower cost. Intravenous vasodilator treatment, on the other hand, is effective in terms of mortality but has a higher morbidity rate
Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTICâHF: baseline characteristics and comparison with contemporary clinical trials
Aims:
The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTICâHF) trial. Here we describe the baseline characteristics of participants in GALACTICâHF and how these compare with other contemporary trials.
Methods and Results:
Adults with established HFrEF, New York Heart Association functional class (NYHA)ââ„âII, EF â€35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokineticâguided dosing: 25, 37.5 or 50âmg bid). 8256 patients [male (79%), nonâwhite (22%), mean age 65âyears] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NTâproBNP 1971âpg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTICâHF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressureâ<â100âmmHg (n = 1127), estimated glomerular filtration rate <â30âmL/min/1.73 m2 (n = 528), and treated with sacubitrilâvalsartan at baseline (n = 1594).
Conclusions:
GALACTICâHF enrolled a wellâtreated, highârisk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation
Evolution Of Moderate Chronic Ischemic Mitral Regurgitation In Patients Underwent Only Coronary Artery Surgery: Clinical And Echocardiographic Follow-up At Rest And Under Exrecise
Management of moderate chronic ischemic mitral valve regurgitation (oIMR) is still
debated. Several authors favouring surgical treatment in combining with coronary artery bypass
grafting (CABG) while others suggested conservative approach. However, evolution of moderate
oIMR after only CABG is still unclear. Aim of this study was to evaluate prospectively, at rest
and under exercise condition, the clinical outcomes and echocardiographic results of patients with
moderate cIMR underwent onlv CABG
POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: A randomized trial
Objective: Surgical management of moderate chronic ischemic mitral valve regurgitation is still debated. The
aim of this study was to evaluate the effect of adding mitral valve repair to coronary artery bypass grafting on
clinical outcomes and left ventricular remodeling in patients who underwent coronary artery bypass grafting alone
versus coronary artery bypass grafting plus mitral valve repair in a randomized trial.
Methods: Between February 2003 and May 2007, 102 patients were eligible for this study and were randomly
assigned to one of 2 groups by means of card allocation: coronary artery bypass grafting plus mitral valve repair
(CABG plus MVR group; 48 patients, 47%) or coronary artery bypass grafting alone (CABG group; 54 patients,
53%). The 2 groups were similar regarding demographics, perioperative clinical data, and outcomes. There were
differences regarding cardiopulmonary bypass (P<.0001) and aortic crossclamp (P<.0001) times. Exercise
tests were performed for all survivors to evaluate tolerance to exercise and variability on grade of mitral regurgitation
and systolic pulmonary arterial pressure. The study was blinded for physicians and nurses involved in
postoperative care and clinical follow-up. The mean follow-up was 32 18 months.
Results: Overall in-hospital mortality was 3% (3 patients). One (1.8%) patient died in the CABG group, and 2
(4.1%) patients died in the CABG plus MVR group. Survival rates standard error at 5 years for patients in the
CABG and CABG plus MVR groups were 88.8% 3.2% and 93.7% 3.1%, respectively. A significant difference
was found between the 2 groups with regard to mean New York Heart Association class (P<.0001), left
ventricular end-diastolic diameter (P<.01), left ventricular end-systolic diameter (P<.01), pulmonary arterial
pressure (P<.0001), and left atrial size (P<.01). At follow-up, coronary artery bypass grafting alone was able to
reduce mitral regurgitation grade in 40%of patients, whereas in the remaining patients mitral regurgitation grade
remained stable or worsened. In the CABG group, among the 17 patients with mild mitral regurgitation and 12
patients with moderate mitral regurgitation at rest, 7 (40%) and 9 (75%) patients, respectively, had worsening in
mitral regurgitation grade and pulmonary artery pressure during exercise.
Conclusions: The efficacy of adding mitral valve repair to coronary artery bypass grafting is well demonstrated
by the improvement of New York Heart Association functional class and percentage of left ventricular ejection
fraction and by the decrease of mitral regurgitation grade, left ventricular end-diastolic diameter, left ventricular
end-systolic diameter, pulmonary artery pressure, and left atrial size. Moreover, coronary artery bypass grafting
alone left more patients with heart failure symptoms at rest and during exercise. Combined coronary artery bypass
grafting and mitral valve repair have no effect on survival at short-term follow-up, and the trends that are evident
will likely become more significant with time
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Progranulin Adsorbs to Polypropylene Tubes and Disrupts Functional Assays: Implications for Research, Biomarker Studies, and Therapeutics.
Progranulin (PGRN) is a tightly regulated, secreted glycoprotein involved in a wide range of biological processes that is of tremendous interest to the scientific community due to its involvement in neoplastic, neurodevelopmental, and neurodegenerative diseases. In particular, progranulin haploinsufficiency leads to frontotemporal dementia. While performing experiments with a HIS-tagged recombinant human (rh) PGRN protein, we observed a measurable depletion of protein from solution due to its adsorption onto polypropylene (PPE) microcentrifuge tubes. In this study, we have quantified the extent of rhPGRN adsorption to PPE tubes while varying experimental conditions, including incubation time and temperature. We found that âŒ25-35% of rhPGRN becomes adsorbed to the surface of PPE tubes even after a short incubation period. We then directly showed the deleterious impact of PGRN adsorption in functional assays and have recommended alternative labware to minimize these effects. Although the risk of adsorption of some purified proteins and peptides to polymer plastics has been characterized previously, this is the first report of rhPGRN adsorption. Moreover, since PGRN is currently being studied and utilized in both basic science laboratories to perform in vitro studies and translational laboratories to survey PGRN as a quantitative dementia biomarker and potential replacement therapy, the reported observations here are broadly impactful and will likely significantly affect the design and interpretation of future experiments centered on progranulin biology