A Bovine Pericardium Rigid Prosthesis For Left Ventricle Restoration: 12 Years Of Follow-up [prótese Rígida De Pericárdio Bovino Para Remodelamento Ventricular Esquerdo: 12 Anos De Seguimento]

Background: Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated. Methods: We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up. Results: The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ±20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003). Conclusion: The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.262164172Cooley, D.A., Hallman, G.L., Henly, W.S., Left ventricular aneurysm due to myocardial infarctionexperience with 37 patients undergoing aneurysmectomy (1964) Arch Surg, 88, pp. 114-121Jatene, A.D., Left ventricular aneurysmectomy. Resection or reconstruction (1985) J Thorac Cardiovasc Surg, 89 (3), pp. 321-331Dor, V., Saab, M., Coste, P., Kornaszewska, M., Montiglio, F., Left ventricular aneurysm: A new surgical approach (1989) Thorac Cardiovasc Surg, 37 (1), pp. 11-19Dor, V., Sabatier, M., di Donato, M., Montiglio, F., Toso, A., Maioli, M., Efficacy of endoventricular patch plasty in large postinfarction akinetic scar and severe left ventricular dysfunction: Comparison with a series of large dyskinetic scars (1998) J Thorac Cardiovasc Surg, 116 (1), pp. 50-59Braile, D.M., Mustafa, R.M., Ardito, R.V., Zaiantchick, M., Coelho, W.M., (1991) Correction of the Left Ventricle Geometry with Semi Rigid Bovine Pericardial Prosthesis Rev Bras Cir Cardiovasc, 6 (2), pp. 109-115Isomura, T., Horii, T., Suma, H., Buckberg, G.D., Septal anterior ventricular exclusion operation (Pacopexy) for ischemic dilated cardiomyopathy: Treat form not disease (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S245-S250. , RESTORE GroupJones, R.H., Velazquez, E.J., Michler, R.E., Sopko, G., Oh, J.K., O'Connor, C.M., Coronary bypass surgery with or without surgical ventricular reconstruction (2009) N Engl J Med, 360 (17), pp. 1705-1717di Donato, M., Castelvecchio, S., Kukulski, T., Bussadori, C., Giacomazzi, F., Frigiola, A., Surgical ventricular restoration: Left ventricular shape influence on cardiac function, clinical status, and survival (2009) Ann Thorac Surg, 87 (2), pp. 455-461Najafi, M., Sheikhvatan, M., Montazeri, A., Sheikhfathollahi, M., Predictors of quality of life among patients undergoing coronary artery bypass surgery (2008) Acta Cardiol, 63 (6), pp. 713-721Messaoudi, N., de Cocker, J., Stockman, B.A., Bossaert, L.L., Rodrigus, I.E., Is EuroSCORE useful in the prediction of extended intensive care unit stay after cardiac surgery? (2009) Eur J Cardiothorac Surg, 36 (1), pp. 35-39Santarpino, G., Onorati, F., Rubino, A.S., Abdalla, K., Caroleo, S., Santangelo, E., Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery (2009) Ann Thorac Surg, 87 (2), pp. 481-488Nashef, S.A., Roques, F., Michel, P., Gauducheau, E., Lemeshow, S., Salamon, R., European system for cardiac operative risk evaluation (EuroSCORE) (1999) Eur J Cardiothorac Surg, 16 (1), pp. 9-13Dor, V., Sabatier, M., di Donato, M., Maioli, M., Toso, A., Montiglio, F., Late hemodynamic results after left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or dyskinetic aneurysm of the left ventricle (1995) J Thorac Cardiovasc Surg, 110 (5), pp. 1291-1299Athanasuleas, C.L., Buckberg, G.D., Stanley, A.W., Siler, W., Dor, V., Didonato, M., RESTORE Group. Surgical ventricular restoration: The RESTORE Group experience (2004) Heart Fail Rev, 9 (4), pp. 287-297Salati, M., di Biasi, P., Paje, A., Santoli, C., Left ventricular geometry after endoventriculoplasty (1993) Eur J Cardiothorac Surg, 7 (11), pp. 574-578Buckberg, G.D., Coghlan, H.C., Torrent-Guasp, F., The structure and function of the helical heart and its buttress wrapping. VI. Geometric Concepts of Heart Failure and Use For Structural Correction (2001) Semin Thorac Cardiovasc Surg, 13 (4), pp. 386-401di Donato, M., Sabatier, M., Dor, V., Gensini, G.F., Toso, A., Maioli, M., Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery (2001) J Thorac Cardiovasc Surg, 121 (1), pp. 91-96Suma, H., Horii, T., Isomura, T., Buckberg, G., A new concept of ventricular restoration for nonischemic dilated cardiomyopathy (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S207-S212. , RESTORE GroupForm versus disease: Optimizing geometry during ventricular restoration (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S238-S244. , RESTORE GroupKieser, T.M., The left ventricle: To reconstruct or not: Lessons from the STICH trial (2009) J Thorac Cardiovasc Surg, 138 (3), p. 784Suma, H., Isomura, T., Horii, T., Buckberg, G., Role of site selection for left ventriculoplasty to treat idiopathic dilated cardiomyopathy (2004) Heart Fail Rev, 9 (4), pp. 329-336. , RESTORE GroupDancini, J.L., Rodrigues, J.J., Santos, J.S., Pinto, R.F.A., Burgos, F.J.C., Conforti, C.A., Left ventricular aneurysmectomy: Late followup (1996) Rev Bras Cir Cardiovasc, 1 (11), pp. 23-29Almeida, R.M.S., Lima, J.D., Bastos, L.C., Carvalho, C.T., Loures, D.R., Endoventricular circular patch plasty with septal exclusion: Initial experience (2000) Rev Bras Cir Cardiovasc, 4 (15), pp. 302-307Campagnucci, V.P., Rivetti, L.A., Pinto e Silva, A.M.R., Gandra, S.M.A., Pereira, W.L., Aneurismectomia de ventrículo esquerdo com o coração batendo ininterruptamente: Resultados imediatos (2006) Rev Bras Cir Cardiovasc, 21 (1), pp. 55-61Herrera, C.B., Insalralde, A., Brandi, A.C., Santos, C.A., Herrera, D.D., Soares, M.J.F., Correção de aneurisma de ventrículo esquerdo em paciente chagásico empregando prótese de pericárdio bovino (2000) Rev Bras Cir Cardiovasc, 15 (1), pp. 72-74Sgarbi, C.J., Ardito, R.V., Santos, R.C., Bogdan, R.A.B., Arruda Jr., F.V., Silva, E.M., Correção cirúrgica do aneurisma de ventrículo esquerdo: Comparação entre as técnicas de sutura linear e reconstrução geométrica (2000) Rev Bras Cir Cardiovasc, 15 (4), pp. 293-301Versteegh, M.I., Lamb, H.J., Bax, J.J., Curiel, F.B., van der Wall, E.E., de Roos, A., MRI evaluation of left ventricular function in anterior LV aneurysms before and after surgical resection (2003) Eur J Cardiothorac Surg, 23 (4), pp. 609-613Use of cardiac magnetic resonance imaging in surgical ventricular restoration (2006) Eur J Cardiothorac Surg, 29 (SUPPL. 1), pp. S216-S224. , Buckberg GD;RESTORE GroupWalker, J.C., Guccione, J.M., Jiang, Y., Zhang, P., Wallace, A.W., Hsu, E.W., Helical myofiber orientation after myocardial infarction and left ventricular surgical restoration in sheep (2005) J Thorac Cardiovasc Surg, 129 (2), pp. 382-39

Associated Factors With Survivals In Patients Undergoing Orthotopic Heart Transplant Using Retrograde Blood Microcardioplegia [fatores Associados à Sobrevida Em Pacientes Submetidos A Transplante Cardíaco Utilizando Microcardioplegia Sanguínea Retrógrada]

Background: Several techniques and cardioplegic solutions have been used for heart preservation during transplant procedures. Unfortunately, there is a lack of ideal method for myocardial preservation in the clinical practice. The use of retrograde cardioplegia provides continuous infusion of cardioplegic solution during the graft implantation. This strategy may provide better initial recovery of the graft. The objective of this study is to describe the experience of a single center where all patients received the same solution for organ preservation and were subjected to continuous retrograde blood microcardioplegia during implantation of the graft and to evaluate factors associated to early and late mortality with this technique. Methods: This is a retrospective, observational and descriptive study of a single center. Results: During the study period were performed 35 heart transplants. Fifteen (42.9%) patients were in cardiogenic shock. The probability of survival was 74.8±7.8%, 60.4±11.3% and 15.1±13.4% at 1 year, 5 years and 10 years of follow-up, respectively. The median survival time was 96.6 months. Conclusion: The use of myocardial protection with retrograde cardioplegic solution may reduce the risks associated morbidity due to cold ischemia time during the heart transplant, and we suggest that this benefit may be even greater in cases of cold ischemia time longer ensuring protection to the myocardium.273347354Carrier, M., Leung, T.K., Solymoss, B.C., Cartier, R., Leclerc, Y., Pelletier, L.C., Clinical trial of retrograde warm blood reperfusion versus standard cold topical irrigation of transplanted hearts (1996) Ann Thorac Surg., 61 (5), pp. 1310-1314Zeng, Z., Jiang, Z., Wang, C.S., Luo, H., Huang, Y.F., Jin, X.H., Preoperative evaluation improves the outcome in heart transplant recipients with pulmonary hypertension--retrospective analysis of 106 cases (2010) Transplant Proc., 42 (9), pp. 3708-3710Rossi, D., Pinna, G.D., La Rovere, M.T., Traversi, E., Prognostic significance of tissue-Doppler imaging in chronic heart failure patients on transplant waiting list: A comparative study with right heart catheterization (2011) Eur J Echocardiogr., 12 (2), pp. 112-119Lichtenstein, S.V., Abel, J.G., Panos, A., Slutsky, A.S., Salerno, T.A., Warm heart surgery: Experience with long cross-clamp times (1991) Ann Thorac Surg., 52 (4), pp. 1009-1013Juffe Stein, A., New frontiers in myocardial preservation (1995) Rev Esp Cardiol., 48 (SUPPL. 7), pp. 24-28Wheeldon, D., Sharples, L., Wallwork, J., English, T., Donor heart preservation survey (1992) J Heart Lung Transplant., 11 (5), pp. 986-993Braile, D., Como eu faço: Cardioplegia sanguínea isotérmica retrógrada de baixo volume (1992) Rev Bras Cir Cardiovasc., 7 (3), pp. 221-229Bacal, F., Souza Neto, J.D., Fiorelli, A.I., Mejia, J., Marcondes-Braga, F.G., Mangini, S., II Diretriz Brasileira de Transplante Cardíaco (2009) Arq Bras Cardiol., 94 (1 SUPPL. 1), pp. e16-e73Yacoub, M.P., Mankad, P., Ledingham, S., Donor procurement and surgical techniques for cardiac transplantation (1990) Semin Thorac Cardiovasc Surg., 2 (2), pp. 153-161Sievers, H.H., Weyand, M., Kraatz, E.G., Bernhard, A., An alternative technique for orthotopic cardiac transplantation, with preservation of the normal anatomy of the right atrium (1991) Thorac Cardiovasc Surg., 39 (2), pp. 70-72Dreyfus, G., Jebara, V., Mihaileanu, S., Carpentier, A.F., Total orthotopic heart transplantation: An alternative to the standard technique (1991) Ann Thorac Surg., 52 (5), pp. 1181-1184Aziz, T., Burgess, M., Khafagy, R., Wynn Hann, A., Campbell, C., Rahman, A., Bicaval and standard techniques in orthotopic heart transplantation: Medium-term experience in cardiac performance and survival (1999) J Thorac Cardiovasc Surg., 118 (1), pp. 115-122Trento, A., Czer, L.S., Blanche, C., Surgical techniques for cardiac transplantation (1996) Semin Thorac Cardiovasc Surg., 8 (2), pp. 126-132Branco, J.N.R., Teles, C.A., Aguiar, L.F., Vargas, G.F., Hossne Jr., M.A., Andrade, J.C.S., Transplante cardíaco ortotópico: Experiência na Universidade Federal de São Paulo (1998) Rev Bras Cir Cardiovasc., 13 (4), pp. 285-294Assef, M.A.S., Valbuena, P.F.M.F., Neves Jr., M.T., Correia, E.B., Vasconcelos, M., Manrique, R., Transplante cardíaco no Instituto Dante Pazzanese de Cardiologia: Análise da sobrevida (2001) Rev Bras Cir Cardiovasc., 16 (4), pp. 289-304Loganathan, S., Radovits, T., Hirschberg, K., Korkmaz, S., Koch, A., Karck, M., Effects of Custodiol-N, a novel organ preservation solution, on ischemia/reperfusion injury (2010) J Thorac Cardiovasc Surg., 139 (4), pp. 1048-1056Corps, C.L., Attia, M.S., Potts, D., Lodge, J.P., PBSH: A new improved cardiac preservation solution in comparison with three clinically proven solutions (2010) Transplant Proc., 42 (5), pp. 1587-1590Lee, S., Huang, C.S., Kawamura, T., Shigemura, N., Stolz, D.B., Billiar, T.R., Superior myocardial preservation with HTK solution over Celsior in rat hearts with prolonged cold ischemia (2010) Surgery., 148 (2), pp. 463-473Wu, K., Türk, T.R., Rauen, U., Su, S., Feldkamp, T., de Groot, H., Prolonged cold storage using a new histidine-tryptophanketoglutarate-based preservation solution in isogeneic cardiac mouse grafts (2011) Eur Heart J., 32 (4), pp. 509-516Martins, A.S., Silva, M.A., Padovani, C.R., Matsubara, B.B., Braile, D.M., Catâneo, A.J., Myocardial protection by continuous, blood, antegrade-retrograde cardioplegia in rabbits (2007) Acta Cir Bras., 22 (1), pp. 43-46Carrier, M., Grégoire, J., Khalil, A., Thai, P., Latour, J.G., Pelletier, L.C., Myocardial distribution of retrograde cardioplegic solution assessed by myocardial thallium 201 uptake (1994) J Thorac Cardiovasc Surg, 108 (6), pp. 1115-1118Ikonomidis, J.S., Yau, T.M., Weisel, R.D., Hayashida, N., Fu, X., Komeda, M., Optimal flow rates for retrograde warm cardioplegia (1994) J Thorac Cardiovasc Surg., 107 (2), pp. 510-519Fiocchi, R., Vernocchi, A., Mammana, C., Iamele, L., Gamba, A., Continuous retrograde warm blood reperfusion reduces cardiac troponin I release after heart transplantation: A prospective randomized study (2000) Transpl Int., 13 (SUPPL. 1), pp. S240-S244Suzuki, S., Sasaki, H., Matsuo, T., Tomita, E., Sada, M., Mizuochi, I., Experimental heart transplantation in dogs: Preservation of isolated hearts for 36 hours by retrograde coronary sinus microperfusion (1984) Nippon Geka Gakkai Zasshi., 85 (6), pp. 541-547Jung, S.H., Kim, J.J., Choo, S.J., Yun, T.J., Chung, C.H., Lee, J.W., Longterm mortality in adult orthotopic heart transplant recipients (2011) J Korean Med Sci., 26 (5), pp. 599-60

Development Of Cardioplegic Solution Without Potassium: Experimental Study In Rat [desenvolvimento De Solução Cardioplégica Sem Potássio: Estudo Experimental Em Ratos]

Introduction: Myocardial preservation during open heart surgeries and harvesting for transplant are of great importance. The heart at the end of procedure has to resume its functions as soon as possible. All cardioplegic solutions are based on potassium for induction of cardioplegic arrest. Objective: To assess a cardioplegic solution with no potassium addition to the formula with two other commercially available cardioplegic solutions. The comparative assessment was based on cytotoxicity, adenosine triphosphate myocardial preservation, and caspase 3 activity. The tested solution (LIRM) uses low doses of sodium channel blocker (lidocaine), potassium channel opener (cromakalin), and actin/myosin cross bridge inhibitor (2,3-butanedione monoxime). Methods: Wistar rats underwent thoracotomy under mechanical ventilation and three different solutions were used for in situ perfusion for cardioplegic arrest induction: Custodiol (HTK), Braile (G/A), and LIRM solutions. After cardiac arrest, the hearts were excised and kept in cold storage for 4 hours. After this period, the hearts were assessed with optical light microscopy, myocardial ATP content and caspase 3 activity. All three solutions were evaluated for direct cytotoxicity with L929 and WEHI-164 cells. Results: The ATP content was higher in the Custodiol group compared to two other solutions (P<0.05). The caspase activity was lower in the HTK group compared to LIRM and G/A solutions (P<0.01). The LIRM solution showed lower caspase acti-vity compared to Braile solution (P<0.01). All solutions showed no cytotoxicity effect after 24 hours of cells exposure to cardioplegic solutions. Conclusion: Cardioplegia solutions without potassium are promised and aminoacid addition might be an interesting strategy. 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