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Biomedical subjects

A Haverich

Publications and source records attributed to A Haverich.

At least 379 records · Page 21Linked to original sources
PubMed1989

[Indications and results of orthotopic heart transplantation in coronary heart disease].

In parallel to increasing numbers of orthotopic heart transplantations performed during recent years, the proportion of patients with preexisting ischemic cardiomyopathy (ICM) enlarged. The present study examined peri- and postoperative risk factors and the prognosis of patients with coronary artery disease after orthotopic heart transplantation in comparison to a group with dilatated cardiomyopathy (DCM). This comparison revealed a higher risk of severe rejection episodes in patients with coronary artery disease, whereas infections were not more frequent. Graft atherosclerosis was found in a higher incidence in patients with preexisting ICM than in the DCM group. The overall incidence of graft atherosclerosis was less than 10% at one and at two years after orthotopic heart transplantation. Postoperative renal function was more impaired in the group of ICM patients, although blood levels of cyclosporine A were lower in this group. In the ICM group one and two year survival rates were 75% and 74%, respectively. Although survival rates are lower in this patient group, if compared to DCM patients (84% and 83%), orthotopic heart transplantation seems to be acceptable therapeutic alternative for endstage coronary artery disease.

Adult↗
PubMed1989

The effect of controlled reperfusion in porcine hearts submitted to three hours of cold global ischemia.

At present, many investigations of myocardial function following ischemic insults concentrate on the modalities of reperfusion rather than on the mode of preservation. In this study, we tried to define the effect of reperfusion using warm blood cardioplegia (WBC) after medium-term (3 h) cold global ischemia, as required in cardiac transplantation. Twenty-one porcine hearts were harvested after preservation with cold cardioplegia (St. Thomas Hospital solution) and topical cooling. Normothermic reperfusion with blood was initiated after 3 h of ischemia utilizing a special extracorporeal pump circuit. Twelve hearts served as controls (group A), while substrate-enriched WBC was applied during the initial 20 min of reperfusion in nine hearts (group B). Hearts in both groups were then studied for myocardial function and metabolism under both working and nonworking conditions for a maximum of 180 min. In the nonworking mode, left ventricular dp/dt was significantly higher in group B than in group A at 15 min (2201 +/- 785 mm Hg/sec vs 1515 +/- 732 mm Hg/sec) and at 180 min (1730 +/- 471 mm Hg/sec vs 836 +/- 147 mm Hg/sec; P less than 0.05). After 3 h, lactate production was significantly higher in group A (371 +/- 45 mg/dl) than in group B (108 +/- 44 mg/dl; P less than 0.05). Creatine kinase release into the coronary sinus was also significantly elevated in group A at 15 min (2807 +/- 1478 IU/l vs 1148 +/- 1272 IU/l; P less than 0.05). Similarly, the hemodynamic data obtained under working conditions in group B were superior to those in group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Left ventricular function, tricuspid incompetence, and incidence of coronary artery disease late after orthotopic heart transplantation.

Functional results and data concerning the incidence and severity of graft atherosclerosis (GASC) and tricuspid incompetence (TI) in the intermediate term after orthotopic heart transplantation (HTX) are still striking. We examined 92 patients 1, 2, and 3 years after HTX by right and left heart catheterization in order to evaluate pump function, the status of the coronary arteries and the extend of TI, using a double indicator thermodilation technique. Mean left ventricular volumes and ejection fraction were normal 1 and 2 years post-transplant. The incidence of GASC was 8/87 (9.2%) at 1, and 11/92 (12%) at 2 years. It was more frequent (16%) in patients with preexisting coronary artery disease (IHD) than in patients with underlying dilative cardiomyopathy (DCM) (11%). At the end of the 1st postoperative year, 62% of patients were free of TI, whereas only 38% had normal valve function 2 years posttransplant. In 9/14 (64%) of patients, consecutively assessed at 1 and 2 years, TI had increased between both investigations. Preoperative haemodynamics, the number of endomyocardial biopsies and rejection episodes as well as preoperative cardiac size did not correlate with TI. Left ventricular volumes and ejection fraction are normal in the intermediate term after HTX. The incidence of GASC was less than 10% at 1 year and did not significantly increase thereafter. TI is a frequent and yet unexplained finding after HTX showing a considerable tendency to increase with time, but with little or not haemodynamic consequence.

Adult↗
PubMed1989

Pericardial flap-plasty for protection of the tracheal anastomosis in heart-lung transplantation.

Infection or dehiscence of the tracheal anastomosis remains a dreaded and almost always fatal complication following heart-lung transplantation (HLTX). A technique of pericardial flap-plasty combined with application of fibrin sealant and topical antibiotics was developed and applied in three patients undergoing HLTX. The method allows for safe protection of the anastomosis even in the presence of severe ischemia and partial necrosis of the donor trachea at the same time avoiding laparotomy for mobilization of the omentum.

Adult↗
PubMed1989

[Anesthesiology experiences in 199 heart transplants].

From June 1983 to October 1987 199 orthotopic heart transplantations were performed at the Medical School of Hannover. Eighty percent of the organs were explanted in foreign hospitals. Since the cold ischemic time lasts less than 4 hours, a sophisticated transport system is essential. The selection of donors (dissociated brain death, age less than 35 years, systolic blood pressure greater than 70 mm Hg, intensive care for less than 7 days) and recipients (age between 10 and 55 years, final stage of irreversible myocardial insufficiency) is governed by strict criteria. A fixed pulmonary hypertension of more than 8 Wood is an absolute contraindication. The pulmonary wedge pressure and the right atrial pressure are preoperatively raised more than three times from normal. The ejection fraction is reduced to 10%. Seventy percent of the patients suffer from dilated cardiomyopathy. The premedication with flunitrazepam is given orally. Anaesthesia is induced with fentanyl and etomidate followed by pancuronium for intubation. During the time of induction all lines have to be inserted under sterile conditions. For weaning from the heart lung machine always catecholamines (isoproterenol, adrenaline) are applied in combination with vasodilators (nitroglycerin, DHB). Postoperatively patients will be extubated after 17.8 +/- 2.2 hours. Rejection episodes belong to the most threatening sort of complications. For this reason endomyocardial biopsies are done routinely.

Adolescent↗
PubMed1989

Pulsed steroids for treatment of cardiac rejection after transplantation. What dosage is necessary?

For treatment of biopsy-proven rejections after cardiac transplantation, pulsed steroids of 1,000 mg methylprednisolone/day for 3 days have been conventionally used. This regimen results in severe side effects, both metabolically and with respect to the risk of infection. In a prospective and a more comprehensive retrospective clinical study, we investigated the effect of a 50% reduction in that dosage. A total of 512 positive biopsies were analyzed in 128 patients. Of these, 64 patients (120 biopsies) in group 1 received 500 mg/day for 3 days while the remaining 107 patients (392 biopsies) in group 2 were treated with 1,000 mg/day for 3 days (43 patients belonged to both groups 1 and 2). Response to treatment was assessed by control biopsies in a standardized time period until the next biopsy-proven rejection (maximum of 10 biopsies). The results in short and longer follow-up periods, considering the incidence and a newer empirical numerical grading scale, have demonstrated clearly comparable effects of myocardial histology. Reduced dosage of steroids is feasible and safe, and a decrease in steroid-related side effects can be achieved without jeopardizing the graft.

Adult↗
PubMed1989

The vascular endothelium as target of humoral auto-reactivity in myocarditis and rejection.

The vascular endothelium plays a key role in immunologic reactions that also involve the heart: Increased expression of class 1 and 2 antigens of the major histocompatibility complex a common finding in acute rejection after heart transplantation whereas in myocarditis this finding is less pronounced. Another form of involvement of the endothelial cells in the secondary immune response has been reported only infrequently; anti-endothelial antibodies, which may be cytolytic to living cultured human endothelial cells, were demonstrated to be bound to the endomyocardial biopsies of patients with different forms of rejection and with biopsy proven myocarditis and circulating in the peripheral blood of the patients as cytolytic autoantibodies.

Autoantibodies↗
PubMed1988

[Combined heart and kidney transplantation in terminal myocardial and renal insufficiency].

In a 38-year-old man combined heart and kidney transplantation was performed successfully in one operation. Both organs have functioned well postoperatively: the patient was discharged from hospital on the 19th postoperative day and has remained in functional class I (New York Heart Association) eight months later. Only two episodes of cardiac rejection have been observed during this period, responding to treatment, and there was no evidence of rejection of the kidney. Such combined heart-kidney transplantation from one donor seems to be a promising form of treatment for patients in end-stage myocardial and renal failure. The frequency of cardiac rejections my be lower after combined heart-kidney transplantation than after cardiac transplantation alone.

Adult↗
PubMed1988

[Hyperimmunoglobulin treatment in CMV infections following heart transplantation].

Clinically manifest cytomegalovirus (CMV) infections, with and without pulmonary involvement, occurred in two patients after heart transplantation. The diagnosis was confirmed immunologically. After administration of CMV hyperimmunoglobulin and prophylactic antibiotics and a reduction of immunosuppressives, rapid clinical improvement ensued so that both patients were discharged from hospital after seven and ten days, respectively.

Adolescent↗