bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Vasoactive Intestinal Peptide on Monocrotaline Induced Pulmonary Hypertensive Rabbits following Cardiopulmonary Bypass: A Comparative Study with Isoproteronol and Nitroglycerine
Authors: Gunaydin Serdar , Imai Yasuharu , Takanashi Yoshinori , Seo Kazuhiro , Hagino Ikuo , Chang Dehua , Shinoka Toshiharu 
Published: September 2022

Background: Vasoactive intestinal peptide (VIP) has regulatory effects on myocardial and vasomotor functions usually demonstrated by in vitro or isolated heart studies. We studied in vivo effects in monocrotaline induced pulmonary hypertensive rabbits immediately after cardiopulmonary bypass (CPB) and tested them versus calcium channel and beta-blockers. Methods: The study consisted of six groups ( N= 30; five rabbits/group): (1) Control with no pretreatment. monocrotaline injected groups: (solutions were perfused following termination of CPB for 60 min); (2) Control for pulmonary hypertension (PHT); (3) isoproteronol; (4) VIP 10−6 M; (5) VIP 10−5 M; (6) nitroglycerine. Normothermic CPB was instituted in thirty rabbits at a flowrate of 100 ml/kg/min for 120 min. Heart rate, mean arterial pressure (MAP), central venous, left atrium (LAP), pulmonary artery (PAP) pressures, pulmonary resistance (Rp), blood gases and ions were measured before and 15, 30, 45 and 60 min after CPB. The VIP 10−5 M group was subjected to an additional 1.7times10−6 M propranol and 2 mM verapamil infusions for a further 15 min. Results: LAP, PAP, Qp, and Rp were significantly higher in the PHT control group ( P<0.001). VIP 10−5 M increased MAP and decreased PAP significantly with respect to isoproteronol and VIP 10−6 M ( P<0.05). VIP 10−s M also decreased Rp significantly in the early post CPB 15th minute ( P<0.05), but did not show any superiority to other agents in the following minutes. Verapamil inhibited VIP 10−s M effects but propranol did not. Conclusion: VIP has dose responsive, positive inotropic and pulmonary vasodilatory effects in whole body CPB model acting via calcium channels.
Surgical Management of Left Ventricular Aneurysms by Endoventricular Pericardial Patch Plasty
Authors: Suzer Kaya , Yorgancioglu Cem , Gunaydin Serdar , Tokmakoglu Hilmi , Tezcaner Tevfik 
Published: September 2022

Background: Early and late surgical outcomes of endocardial resection and aneursymectomy repaired with an autologous pericardial patch were studied. Methods: We studied 125 patients who underwent endoaneurysmorrhaphy with pericardial patch during the period from June 1993 until June 2000. Preoperative, early and late postoperative results, annual postoperative echocardiography of all patients and hemodynamic controls of 35 patients within a mean follow-up of 64±8 months were analyzed. Results: Mean NYHA improved to postoperative 2.1±0.5 from preoperative 2.8±0.4. Mean number of bypass grafts was 2.6±1.1. Left ventricular ejection fraction rate improved to 36.2±8% in one month. 39.3±9% in 6 months, 42.3±8% in one year versus preoperative 29.2±9% (P≤0.05). Perioperative mortality was 6.4% (eight patients) and 11 deaths were observed in the late follow-up (9.4%). Conclusion: Endoaneurysmorrhaphy with pericardial patch may be an alternative option in the management of left ventricular aneurysms within acceptable surgical results.
Heparin Reversal in Off-Pump Coronary Artery Bypass Surgery: Complete, Partial, or no Reversal?
Authors: Gatti G. , Pugliese P. 
Published: September 2022

Several clinical studies have reported that avoiding cardiopulmonary bypass reduces postoperative bleeding. The purpose of this study is to verify that protamine during off-pump coronary artery bypass surgery produces significant reduction of postoperative bleeding. Sixty consecutive patients undergoing off-pump coronary artery bypass surgery were prospectively randomized in three groups: Group A received 1 mg of protamine every 100 IU of heparin, Group B 0.5 mg of protamine every 100 IU of heparin, and Group C none. The three groups were analyzed for differences in preoperative cardiac function, pre-, intra-, and post-operative coagulation profile, intraoperative variables, and postoperative bleeding. In the three study groups, no statistically significant difference was found in preoperative cardiac function, pre- and intraoperative coagulation profile, and prothrombin time, activated partial thromboplastin time, platelet count in the first postoperative day. In Group A, total postoperative bleeding, use of packed red blood cells, and mild pericardial effusion prevalence at discharge were significantly lower only when compared to Group C, but they were not significantly different when compared to Group B. In off-pump coronary artery bypass surgery, heparin should be reverted with protamine, otherwise the postoperative bleeding risk might increase. Partial heparin reversal might not increase postoperative bleeding risk, but it may reduce dose-dependent protamine adverse effects.
Early Reoperation for Iatrogenic Left Main Stenosis after Aortic Valve Replacement: A Perilous Situation
Authors: Chavanon O. , Carrier M. , Cartier R. , Hébert Y. , Pellerin M. , Perrault L. P. 
Published: September 2022

Background. Iatrogenic left main coronary artery (LMCA) stenosis secondary to direct ostial cannulation during aortic valve replacement still occurs and is a morbid situation due to the difficulties of early reoperation and in providing adequate myocardial protection. Methods. A retrospective analysis was performed and identified seven patients with an iatrogenic LMCA stenosis, after 2158 aortic valve replacements (AVR) (0.3%) in our institution since 1987. Results. All patients with LMCA stenosis after AVR had undergone direct ostial cannulation with self-inflating balloon cannulas at the time of AVR. At reoperation for LMCA stenosis, severe ischemia developed in one patient and injury to cardiac structures occurred in four patients. Four patients suffered a perioperative myocardial infarction and congestive heart failure developed in two patients at late follow-up. Conclusions. LMCA stenosis following coronary ostial cannulation at the time of AVR is a rare yet morbid complication. Reoperation for this condition is fraught with a high operative morbidity rate and poor long-term outcome. Prevention of this complication is quintessential, avoiding ostial cannulation with self-inflating balloons.
Use of Superficial Femoral Vein in the Treatment of Infected Aortoiliofemoral Prosthetic Grafts
Authors: Cardozo M. A. , Frankini A. D. , Bonamigo T. P. 
Published: September 2022

Purpose: To assess the use of the superficial femoral vein for the reconstruction of the aortoiliofemoral sector in the treatment of prosthetic infections. Methods: From December 1995 to November 1999, 12 patients with infection involving a synthetic vascular prosthesis were submitted to thirteen surgical procedures involving partial or total resection of a synthetic vascular prosthesis and restoration of arterial flow with an in situ femoral vein. Results: The overall operative mortality rate was 15.3% (2 out of 3 patients who underwent total graft replacement and 0 out of 9 patients who underwent unilateral graft replacement). Major amputations related to the surgical procedures were performed in two cases (an 87.5% rate of limb salvage). The series was followed up on average for 22 months (range: 6–65 months). No patient presented clinically significant edema or signs of chronic venous insufficiency in the lower limbs used as donors of autogenous venous grafts. All surviving patients presented complete resolution of the infectious signs and symptoms and none of them presented late thrombosis of the venous graft. Conclusion: The use of the superficial femoral vein is a good surgical alternative for the treatment of prosthetic infections with minimal venous morbidity of the lower limbs used as venous graft donors. The autogenous venous grafts present good long-term patency and excellent adaptation to the aortoiliofemoral position.
The Anatomy of the Aortic Root
Authors: Berdajs Denis , Lajos Patonay , Turina Marko 
Published: September 2022

Objective: Since the aortic root preserving methods are spreading in heart surgery, the importance of aortic root anatomy is increasing. The surgical and anatomical descriptions of the aortic root are not always congruent. Therefore, the present study focuses on the surgical aspects of the aortic root anatomy. Methods: We measured the distances between the three commissures, the distances between the basal point of the sinus and the sinotubular junction and the heights of the sinuses. The circumference of the sinotubular junction and the annuli fibrosi were also obtained. In addition, the volume of every sinus was directly measured. Finally both vertical and horizontal histological sections of annuli fibrosi were made. Results: All measured parameters were averaged and the standard deviation (SD) was calculated, except in the case of the tilt angle. The distance for the right sinus commissures was 18.82 mm (SD 1.93 mm), and that of the non- and left coronary sinus were 17.43 (SD 2.06) and 15.21 (SD 1.88) mm, respectively. The mean height of the right, non- and left coronary sinus were 19.45 (SD 1.91), 17.68 (SD 1.77) and 17.45 (SD 1.39) mm, respectively. These differences between the height of the sinuses determines a mean tilt angle of 5.47° for the sinotubular junction and aortic root base. The mean circumference of the aortic root base and of the sinotubular junction was 69.20 (SD 6.93), and 65.82 (SD 8.31) mm. respectively. Mean volumes of the right, non- and left coronary sinuses were 1.6 (SD 0.34). 1.33 (SD 0.27) and 1.04 (SD 0.23l) ml. According to the histological sections we can say that the histological border of the annuli fibrosi is positioned at the interleaflate triangles. Conclusion: According to the measured data we can state that all parameters follow the pattern in which the right sinus structures had the greatest dimensions followed by the non coronary sinus, and finally the left coronary sinus. The tilt angle for aortic root base and sinotubular junction, and the difference in the diameters could be of hemodynamic and of surgical relevance
How Effective is Acute Normovolaemic Haemodilution in Femoro-Distal Bypass Surgery?
Authors: Spark J. I. , Chetter I. C. , Kester R. C. , Scott D. J. A. 
Published: September 2022

Background: Recent guidelines have emphasised the use of autologous blood in the surgical setting. The aim of this study was to analyse the efficacy and efficiency of acute normovolaemic haemodilution (ANH) as a blood conservation intervention in patients undergoing elective femoro-distal surgery for critical limb ischaemia. Methods: Forty patients were studied prospectively. The volume of the blood collected was derived as follows: Blood volume removed = patient's blood volume (initial haematocrit - final haematocrit/average haematocrit) where final haematocrit is 30% and patient's blood volume is 70 and 65 ml/kg for a man and a woman, respectively. Results: Twenty-five patients were suitable for ANH and 15 patients were excluded because of poor ventricular function, anaemia or renal disease. Nine of the 25 patients (44%) had < 500ml of surgical blood loss and would have avoided homologous blood transfusion (HBT). Four of the patients lost >2000ml of blood and could not avoid HBT through ANH. Twelve patients had moderate blood loss (950–1400 ml), with eight of these patients requiring transfusion. Four patients avoided exposure to homologous blood. Conclusion: ANH is in evolution and as a single blood conservation intervention, contributes only modestly to blood conservation.
Platelet-Monocyte Aggregates in Patients with Chronic Venous Insufficiency Remain Elevated following Correction of Reflux
Authors: Rohrer Michael J. , Claytor R. Brannon , Garnette Charles S. C. , Powell Craig C. , Barnard Marc R. , Furman Mark I. , Michelson Alan D. 
Published: September 2022

Introduction. An increased number of circulating platelet-monocyte aggregates (PMAs) is present in patients with all clinical classes of chronic venous insufficiency (CVI). The purpose of this study was to determine whether patients with CVI maintain elevated levels of PMAs following complete surgical correction of chronic venous insufficiency. Methods. Patients with superficial venous insufficiency and a normal deep venous system documented by duplex scan were included in the study. Venous blood was drawn from a superficial vein in the leg and an antecubital vein prior to vein stripping and again six weeks postoperatively. Control subjects without evidence of venous disease had blood drawn from an antecubital vein. Whole blood flow cytometry was used to analyze the samples for the presence of platelet-monocyte aggregates following incubation with buffer or 0.5 μM adenosine diphosphate (ADP). Results. Postoperative duplex scanning demonstrated elimination of venous reflux in the superficial venous system and normal deep vein physiology in all nine patients, Preoperatively, patients with CVI had significantly elevated levels of circulating PMAs in both arm and leg samples without stimulation by an agonist compared to controls (15.2±1.1 and 14.3±1.3 vs 7.4 ±0.3 for controls, p<0.02 for each), and after stimulation by 0.5 μM ADP (33.7±4.7 and 34.3±5.2 vs 12.5±3.8 for controls, p<0.04 for each). There was no significant change in the number of PMAs in either patient arm or leg blood samples six weeks following correction of venous reflux by removal of the diseased veins. Conclusions. Complete correction of chronic venous insufficiency did not diminish the elevated circulating levels of platelet-monocyte aggregates. We conclude that the presence of an increased number of PMAs identified in patients with CVI is not secondary to the presence of venous reflux, but may be involved with the primary etiology of chronic venous insufficiency. This finding also suggests that a stimulus other than venous hypertension may be important in triggering the leukocyte activation seen in patients with chronic venous disease.
Sequential Use of Internal Thoracic Artery in Myocardial Revascularization: Mid- and Long-Term Results of 430 Patients
Authors: Bakay C. , Erek E. , Salihoǧlu E. , Kinoǧlu B. , Öztürk S. 
Published: September 2022

Background: There is still controversy about early and late results of sequenital use of internal thoracic artery (ITA) in coronary artery bypass (CAB) operations. Methods: In this study, we report on a series of 430 consecutive patients who underwent CAB operations between 1986 and 1998, with the use of at least one sequential ITA graft. The patients, 379 men and 51 women had a mean age of 56.4 years (range 29–80 years). Both ITA grafts were used in 227 (52.8%) patients. A total of 1744 (mean 4.05 per patient) distal coronary anastomoses were performed: 1172 of which (mean 2.72) were arterial and 980 (mean 2.28) were sequential ITA anastomoses. Results: Thirty-day mortality was 1.8% ( n = 8 patients). Perioperative myocardial infarction occurred in 12 patients (2.8%) and five of them (1.2%) were confined to the sequential ITA grafted area. Follow-up ranged from 1 month to 13 years (mean 63 ±37.7 months) for 372 patients (86.5%). Nine patients died during follow-up period. According to Kaplan-Meier method, 5 and 10 year survival rates were 95.6 and 93.4%, respectively. Coronary angiography was performed in 64 patients (17.2%) after a mean of 33 months. In 31 of these patients angiography was performed due to return of symptoms. Overall patency rate of sequential ITA anastomoses was 91.7% (111/121). Two patients underwent repeat CAB operations. Conclusion: Sequential use of ITA grafts was not associated with the increased perioperative mortality and morbidity and has the potential to improve the long-term results of CAB surgery because of excellent patency rates of sequential ITA anastomoses.
Preoperative Prediction of Early Mortality and Morbidity in Coronary Bypass Surgery
Authors: Wouters Stijn C. W. , Noyez Luc , Verheugt Freek W. A. , Brouwer Rene M. H. J. 
Published: September 2022

Objective. A scoring system to predict early mortality and morbidity in CABG, distinguishing low and high risk patients. Methods. 563 patients (1998) served as development dataset, 969 patients as validation set. Univariate and logistic regression analysis was used to identify risk factors. Results. Gender, hypertension, pulmonary disease, reoperation, age. operative status and left-ventricular function were predictive variables for early mortality. The area under the ROC curve was 0.81. We identified a low risk, mortality of 1.8% and a high-risk group, mortality of 13.4%. Diabetes, hypertension, kidney and lung disease, reoperation, operative status and left ventricular function were predictive variables for morbidity. The area under the ROC curve was 0.73. We identified a low risk, morbidity of 17%, and a high-risk group, morbidity of 41%. Conclusion. This scoring system is a simple system identifying a low and high-risk group for morbidity and early mortality.
Carotid Endarterectomy in the Elderly: Does Gender Effect Outcome?
Authors: Ozsvath Kathleen J. , Darling R. Clement , Tabatabai Laila , Roddy Sean P. , Paty Philip S. K. , Chang Benjamin B. , Kreienberg Paul B. , Mehta Manish , Shah Dhiraj M. 
Published: September 2022

Objectives: Carotid endarterectomy (CEA) has a positive effect on stroke free survival in patients with either symptomatic or asymptomatic severe carotid bifurcation stenosis. However, most trials have excluded octogenarians. In addition, concerns have arisen regarding the benefits of CEA in the elderly population, especially in women. In this study, we performed an outcome analysis in patients undergoing CEA comparing those eighty and older to their younger counterparts. Additionally, we evaluated the elderly group based on gender. Methods: Over the past 10 years, all patients undergoing CEA for asymptomatic and symptomatic carotid disease have been entered into our vascular surgery registry. Demographics, indications for operative intervention, outcomes and survival of patients who had undergone CEA were reviewed. Procedures were preferentially performed under regional anesthesia with selective shunting. Chi square analysis was used to assess significance and assumed for P< 0.05. Results: Over the last 10 years, 125 carotid endarterectomies were performed in 125 patients eighty years of age or older. Fifty-six were male and 69 were female. Mean age was 83 (range: 80–97). Asymptomatic disease was identified in 28 of the male patients (50%) and 44 of the female patients (64%). There were no deaths and a permanent neurological deficit occurred in one female patient. There was no difference in thirty-day morbidity or mortality in female patients compared to males. Conclusions: These observations suggest that CEA can be safely performed in selected elderly patients with asymptomatic or symptomatic carotid artery stenosis. Furthermore, women over 80 may expect equally optimistic results as their male counterparts.
Outcome of Endovascular Intervention for Infrainguinal Vein Graft Stenosis
Authors: Tong Y. , Matthews P. G. , Royle J. P. 
Published: September 2022

Assisted graft patency rate following revision of a graft stenosis is far better than that following thrombectomy of an occluded graft. Graft revision by endovascular means has been proposed as a suitable alternative to more invasive surgery. This study reports our experience with endovascular treatment of vein graft stenosis. Between December 1992 and September 2000, percutaneous transluminal balloon angioplasty (PTA) was performed on 90 vein graft stenoses in 87 infrainguinal vein bypass grafts identified by routine graft duplex scan (peak systolic velocity, PSV > 300 cm/sec). All 90 stenoses treated by PTA were retrospectively analysed for stenosis-free patency rate (life-table analysis). Re-stenosis was defined by PSV exceeding 300 cm/sec at the same site of the vein graft where a stenosis was dilated. Ninety vein graft stenoses (72 primary stenoses and 18 recurrent stenoses) in 33 femoropopliteal (above knee), 30 femoropopliteal (below knee) and 24 femorotibial vein bypass grafts were treated by PTA. The timing of PTA ranged from one to 252 months (mean. 23.9 months) from the initial surgery. Cumulative stenosis-free patency rate after PTA was 55.8% at 6 months, 54.0% at one year and 45.0% at three years. Stenosis-free patency rate at six months was significantly lower for revision of recurrent stenosis (25.9%) than for primary stenosis (61.6%) ( P = 0.01). The revision of duplex scan detected vein graft stenosis with endovascular intervention was associated with an acceptable stenosis-free patency rate. However, recurrent stenosis treated by PTA had a significantly inferior outcome. Direct surgical revision would be more appropriate for recurrent lesions.
Assessment of Prosthetic Vascular Graft Thrombogenicity Using the Technetium-99m Labeled Glycoprotein IIb/IIIa Receptor Antagonist DMP444 in a Dog Model
Authors: Scharn Dirk M. , Oyen Wim J. G. , Klemm Peter L. , Wijnen Marc H. W. A. , vanderVliet J. Adam 
Published: September 2022

Introduction: Prosthetic graft patency greatly depends on graft thrombogenicity. The concept of graft thrombogenicity is poorly understood and difficult to measure or quantify. In a study we tested the experimental radiopharmaceutical DMP444 and developed a suitable dog model. This agent is a radiolabelled (99mTechnetium) glycoprotein llb/llla receptor antagonist with a high affinity for activated platelets. It binds to platelets that are intimately involved in thrombus formation. The agent does not affect thrombocyte function, when used in a dose necessary for imaging. DMP444 does not require platelet harvesting and processing. Early imaging of thrombocyte aggregation sites such as vascular prostheses is possible within 4 hours after injection. Material and methods: Adult Beagle dogs weighing 12–15 kg were used for the experiments. In 16 dogs a prosthetic patch was sewn onto the abdominal aorta (Bovine pericard: n= 4, Dacron: n=6. Human Umbilical Vein: n=6). Imaging cycles after injection of 99mTechnetium-labelled DMP444 were performed on days 1,7, 14 and 28 after surgery. Results: We noticed differences in thrombus formation on the tested graft materials. The bovine pericard patches ( n=4) showed a relatively high rate of thrombocyte aggregation. In the Dacron patches ( n=6) aggregation was not seen. In 1 of 6 cases of human umbilical vein patches a measurable focal aggregation was recorded. Conclusion: The method outlined in this study is a relatively simple and reproducable method to visualize thrombocyte aggregation.