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Axel Haverich

Publications and source records attributed to Axel Haverich.

At least 91 records · Page 5Linked to original sources
PubMed2004

Magnetic Vascular Port in minimally invasive direct coronary artery bypass grafting.

BACKGROUND: Minimally invasive direct coronary artery bypass grafting (MIDCAB) is a well-established operative procedure. However, it is technically demanding and is therefore somewhat underused. We evaluated the clinical and angiographic outcome of patients undergoing a MIDCAB procedure with the Ventrica Magnetic Vascular Port (MVP) system. METHODS AND RESULTS: A Ventrica MVP system was used in 10 of 11 selected MIDCAB patients. The system consists of 6 magnetic clips, with 3 clips forming a set. One magnetic clip set is positioned at the arteriotomy of the target artery and of the bypass graft using a preloaded delivery system. These ports then form an anastomosis by magnetic coupling. The mean age of the 10 patients (6 male) was 60.3+/-11.0 years. Three patients had an angiogram at the time of discharge and 8 returned for a 6-month angiogram. The total procedure time was 128.2+/-12.2 minutes. The mean anastomotic time was 199 seconds. The mean ischemic time during the anastomosis was 146+/-146 seconds. There were no in-hospital complications and no device-related adverse events. All 3 predischarge and all 8 6-month angiograms showed patent anastomoses. CONCLUSIONS: The magnetic vascular port facilitates the MIDCAB procedure significantly and reduces the ischemic time during the anastomosis. This minimally invasive procedure has the potential to be an alternative to percutaneous transluminal coronary angioplasty and stenting in proximal left anterior descending (LAD) stenosis. It may expand the acceptance of hybrid procedures in which a left internal mammary artery (LIMA)-to-LAD graft optimally supplies the anterior wall and the septum while the circumflex and right coronary artery may be treated interventionally.

Aged↗
PubMed2004

Evolving strategies for treatment of acute aortic dissection type A.

OBJECTIVE: To assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA). METHODS AND RESULTS: Between October 1990 and October 2003, we operated on 295 patients (pts) for AADA. Follow-up was complete for 257 pts (87%). Supracommissural replacement (SCR) of the ascending aorta was applied to 145 pts, 64 pts received a composite replacement (comp), and 48 pts were treated with the aorta valve-sparing (AVS) reimplantation technique. Pts in SCR were older compared with AVS and comp (P=0.002), gender (overall 65% male, P=0.143) and presence of Marfan syndrome (overall 5%, P=0.109) were comparable. Cannulation of the aorta was performed more often in AVS (58%) than in comp (19%) or SCR (22%; P<0.001). Mean operation time, extracorporeal circulation time, and aortic cross-clamp time differ significantly between groups (P<0.001, respectively). Stay in the intensive care unit (P=0.12) and time of hospitalization (P=0.32) were comparable. Overall perioperative mortality was 24% and did not show significant differences between groups (AVS 10.4% versus comp 28% versus SCR 26%; P=0.053). Incidence of neurological complications was similar between groups (P=0.95). Mean time of follow-up was shorter for AVS (19+/-20 months) compared with comp (48+/-48 months) and SCR (46+/-45 months). Survival at 5 years was comparable with 89% for AVS, 85% for comp, and 80% for SCR (P=0.61). Two patients from AVS (4.1%) required reoperation for failure of the reconstructed valve. Pts in comp required less aortic reoperations than pts in SCR (comp 6.3% versus SCR 22%; P=0.005). CONCLUSIONS: In acute aortic dissection type A, the reimplantation technique leads to results comparable to established techniques. Complete removal of diseased tissue, low incidence of reoperation, and lack of anticoagulation may favor this approach in selected patients.

Acute Disease↗
PubMed2004

Terminal complement blockade with pexelizumab during coronary artery bypass graft surgery requiring cardiopulmonary bypass: a randomized trial.

CONTEXT: Inflammation and ischemia-reperfusion injury during coronary artery bypass graft (CABG) surgery requiring cardiopulmonary bypass are associated with postoperative myocardial infarction (MI) and mortality. OBJECTIVE: To determine the efficacy and safety of pexelizumab, a C5 complement inhibitor, in reducing perioperative MI and mortality in CABG surgery. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled trial, including 3099 patients (> or = 18 years) undergoing CABG surgery with or without valve surgery at 205 hospitals in North America and Western Europe from January 2002 to February 2003. INTERVENTIONS: Patients were randomly assigned to receive intravenous pexelizumab (2.0 mg/kg bolus plus 0.05 mg/kg per hour for 24 hours; n = 1553) or placebo (n = 1546) 10 minutes before undergoing the procedure. MAIN OUTCOME MEASURES: The primary composite end point was the incidence of death or MI within 30 days of randomization in those undergoing CABG surgery only (n = 2746). Secondary analyses included the intent-to-treat analyses of death or MI composite at days 4 and 30 in all 3099 study patients. RESULTS: After 30 days, 134 (9.8%) of 1373 of patients receiving pexelizumab vs 161 (11.8%) of 1359 of patients receiving placebo (relative risk, 0.82; 95% confidence interval, 0.66-1.02; P =.07) died or experienced MI in the CABG surgery only population. In the intent-to-treat analyses, 178 (11.5%) of 1547 patients receiving pexelizumab vs 215 (14.0%) of 1535 receiving placebo died or experienced MI (relative risk, 0.82; 95% confidence interval, 0.68-0.99; P =.03). The trial was not powered to detect a reduction in mortality alone. CONCLUSIONS: Compared with placebo, pexelizumab was not associated with a significant reduction in the risk of the composite end point of death or MI in 2746 patients who had undergone CABG surgery only but was associated with a statistically significant risk reduction 30 days after the procedure among all 3099 patients undergoing CABG with or without valve surgery.

Aged↗
PubMed2004

[Functional aspects of endothelial phenotypes in the human heart. Immunohistochemical study for the evaluation of endothelial adhesion molecule expression].

BACKGROUND AND PURPOSE: The endothelial lining is a confluent monolayer of thin and rhomboid-shaped cells, that covers the inner surface of all blood vessels. However, the essential role of endothelial cells in all aspects of cardiovascular physiology, homeostasis and the pathogenesis of most cardiovascular diseases no longer remains controversial. Although much evidence has been achieved regarding the molecular functioning of transcription factors and regulatory proteins, many questions on endothelial heterogeneity with regard to function and morphology at various vascular sites remain unanswered. In this study, an immunohistochemical map of endothelial adhesion molecule expression at various vascular sites of the healthy human heart is created. Using this map, the authors examined whether expression patterns are distinctive by their molecular function at their site of origin. Furthermore, immunohistochemical findings were associated with the clinical situation. MATERIAL AND METHODS: Tissue samples from eleven different vascular locations of healthy human hearts were analyzed using immunohistochemistry. Endothelial adhesion molecules of the selectin, immune globulin supergen, and integrin families, some complementary cellular adhesion molecules, and the von Willebrand factor were analyzed. RESULTS: Endothelial adhesion molecule expressions were found to be characteristic of all vascular sites investigated. Thus, molecules involved in inflammatory reactions were predominantly expressed within the myocardial microvasculature, whereas molecules serving for endothelial anchorage toward extracellular matrix components could be observed especially on endocardial and valvular surfaces. Apart from that, a parallel expression of immunologically relevant as well as integrin molecules were found to be characteristic of coronary arteries. CONCLUSION: To the authors' knowledge, this is the first report on site-specific expression characteristics for all vascular sites of the human heart. Thus, our data provide important novel information, which ultimately will help to bring some light into the field of cardiac physiology.

Cell Adhesion Molecules↗
PubMed2004

[Heart transplantation and assist devices].

BACKGROUND: Although drug therapy of patients with chronic heart failure has improved significantly over the years, mortality still remains high. At present, heart transplantation is the gold standard therapy for patients with end stage heart disease. Due to the limited number of organs, a growing number of patients require the implantation of mechanical assist devices. HEART TRANSPLANTATION: Because of the excellent long-term survival after cardiac transplantation, current studies focus on long-term complications. The aim of these studies is the establishment of an immunosuppressive strategy that effectively prevents cardiac allograft vasculopathy in combination with a low incidence of negative side effects. Furthermore, quality of life is a major focus of current interest. ASSIST DEVICES: Assist device implantation has changed from an experimental to a routine procedure in several centers. Still, many problems have to be solved. Especially because of recurrent infections the long-time use of assist devices is limited. For final judgment, results of current studies have to be awaited.

Clinical Trials as Topic↗
PubMed2004

Impact of multivessel coronary artery disease on outcome after isolated minimally invasive bypass grafting of the left anterior descending artery.

BACKGROUND: The outcome in patients treated surgically for coronary artery disease is known to be influenced by the extent of the disease. Whether this factor also has an effect in patients undergoing isolated minimally invasive revascularization of the left anterior descending (LAD) artery using the internal thoracic artery (ITA) (MIDCAB) has not been looked at. Thus, this study sought to evaluate the impact of multivessel disease (MVD) on midterm outcome after MIDCAB. METHODS: From 1996 to 1999, 411 patients received a MIDCAB at our institution and were now followed up. Isolated disease of the LAD (SVD -single vessel disease) was presented in 262 patients (63.7%) and 149 patients (36.3%) had MVD at the time of operation. The reasons for apparent incomplete revascularization in patients with MVD were very small target vessels (< 1.0-mm diameter), stenoses of less than 50%, distal localization of the stenoses, long-term patency after angioplasty, or an extensive risk for sternotomy and(or) cardiopulmonary bypass. The midterm outcome was evaluated by questionnaires sent to the patients and their physicians. RESULTS: The mean follow-up was 29.4 +/- 11.1 months. The incidence of myocardial infarction was significantly higher in MVD as compared to SVD patients (8.1% vs 1.9%, p = 0.04). Patients with MVD had significantly more subsequent percutaneous transluminal coronary angioplasty (10.7% vs 5.3%, p = 0.049) and a similar number of repeat surgical revascularizations as compared to SVD patients. Patients with MVD had a significantly higher total 3-year mortality as compared to SVD patients by Kaplan-Meier estimate (8.7% vs 3.1%, relative risk [RR] = 2.56, p = 0.011). The 3-year cardiac mortality was significantly higher in patients with MVD as compared to SVD (4.0% vs 0.4%, RR = 9.48, p = 0.0054). After adjustment of baseline characteristics by Cox regression analysis, the 3-year risk of cardiac death was significantly higher in the MVD groups (RR = 2.2, confidence interval [CI] 95%: 1.8 to 4.65, p = 0.029). CONCLUSIONS: Patients with isolated disease of the LAD appear to benefit from ITA grafting in the form of a MIDCAB procedure. Here, it should be an approach of choice. The results show that MVD is an independent risk factor for outcome in patients undergoing a MIDCAB procedure. Nevertheless, the midterm morbidity and mortality in MVD patients after a MIDCAB procedure where the LAD is the only target vessel for interventional or surgical treatment is acceptable despite a higher morbidity than in SVD patients.

Aged↗
PubMed2004

Impact of diabetes on outcome following isolated minimally invasive bypass grafting of the left anterior descending artery.

BACKGROUND: The outcome in patients treated by conventional coronary artery bypass grafting (CABG) for coronary artery disease is negatively influenced by the presence of diabetes. The relative effect of diabetes in patients undergoing isolated minimally invasive revascularization of the left anterior descending artery (LAD) using the internal thoracic artery (ITA) has as yet not specifically been looked at. Thus, this study sought to evaluate the impact of diabetes on mid-term outcome following minimally invasive coronary artery bypass grafting (MIDCAB). METHODS: From 1996 to 1999, 411 patients received a MIDCAB procedure at our institution and were now followed up. In this study population there were 63 diabetic patients (15.3%) and 348 nondiabetic patients (84.7%). Isolated proximal stenoses or an occlusion of the LAD were present in 262 patients (63.7%), whereas 149 (36.3%) had multi-vessel disease (MVD) at the time of the MIDCAB procedure. The clinical outcome was evaluated by questionnaires sent to the patients and their physicians. RESULTS: The mean follow-up was 29.4 +/- 11.1 months. The incidence of myocardial infarction was significantly higher in diabetics as compared to nondiabetics (9.5% vs 3.2%, p = 0.034). Diabetics and nondiabetics had similar rates of subsequent revascularization procedures during follow-up. Cumulative total survival of diabetic and nondiabetic patients was not statistically different. The 3-year cardiac mortality was however significantly higher in diabetic than in nondiabetic patients if MVD was initially present (Kaplan-Meier estimate: 10.7% vs 2.5%, relative risk [RR] = 5.5, p = 0.017 by log-rank test). The 3-year cardiac mortality in diabetic and nondiabetic patients with isolated disease of the LAD (single vessel disease [SVD]) was not significantly different. After adjustment of baseline characteristics by Cox regression analysis the 3-year risk of cardiac death was significantly higher in the diabetic group (RR = 1.82, CI 95%:1.2 to 3.3, p = 0.045). CONCLUSIONS: The results support diabetes to be an independent risk factor for outcome in patients with MVD undergoing a MIDCAB procedure in analogy to those undergoing CABG procedures. Diabetics with isolated disease of the LAD, however, benefit out of proportion from this treatment modality.

Aged↗
PubMed2004

Guided tissue regeneration: porcine matrix does not transmit PERV.

OBJECTIVE: For cardiovascular tissue engineering, acellularized scaffolds of porcine matrices have been successfully used. However, the possibility of porcine endogenous retrovirus (PERV) transmission remains debatable. In this study, we investigated whether acellularized porcine vascular scaffolds cause cross-species transmission of PERV in a xenogenic model. METHODS: Porcine pulmonary arteries were acellularized and implanted into sheep in orthotopic position (n=6). Cardiopulmonary bypass support was used for all operations. Blood samples were collected regularly up to 6 months after the operation, and cellular components were tested for PERV infection by PCR and RT-PCR. Grafts were explanted 6 and 12 months after implantation. Tissue samples were characterized by histology and electron microscopy and tested for PERV sequences. RESULTS: All animals survived the procedure and follow up until explantation of the grafts. PERV DNA was detectable in acellularized scaffolds of porcine matrices. Acellular porcine pulmonary arteries scaffolds were repopulated in vivo by autologous cells of the host, leading to a vessel consisting of all cellular components of the vessel wall. No PERV sequences were detectable neither in all tested peripheral blood samples nor in tissue samples of in vivo recellularized grafts up to 6 months after implantation. Electron microscopy revealed no signs of graft infection by retrovirus. CONCLUSIONS: Guided tissue regeneration of acellularized vascular porcine matrix scaffolds leads to structured vessels up to one year without risk of PERV transmisson.

Animals↗
PubMed2004

Transthoracic Doppler validation in mammary artery grafts after minimal invasive direct coronary artery bypass operation.

OBJECTIVE: This study was performed to validate noninvasive transthoracic Doppler ultrasound (TTD) with simultaneous invasive Doppler guidewire measurements in patients after minimal invasive direct coronary artery bypass operation. METHODS: A total of 14 patients were examined 3 to 8 days after minimal invasive direct coronary artery bypass operation. TTD was performed to measure systolic and diastolic peak velocities of the left internal mammary artery (LIMA) at rest and during adenosine-induced hyperemia. Simultaneous Doppler guidewire measurements were performed. RESULTS: LIMA flow was detected in 12 of 14 patients (86%). There was high agreement between TTD and Doppler guidewire measurements of LIMA flow velocities (systolic peak velocity: r = 0.86, y = 11.3 + 0.82x +/- 7.9; diastolic peak velocity: r = 0.95, y = 5.7 + 1.02x +/- 7.5; average peak velocity: r = 0.95, y = 5.2 + 0.94x +/- 5.4; and flow velocity reserve: r = 0.97, y = 5.2 + 0.99x +/- 4.5). CONCLUSION: TTD represents an accurate method to evaluate flow velocities and flow velocity reserve of LIMA bypass grafts even in the early phase after minimal invasive direct coronary artery bypass operation.

Adult↗
PubMed2004

Pulmonary preservation with LPD and celsior solution in porcine lung transplantation after 24 h of cold ischemia.

OBJECTIVE: Pulmonary preservation for transplantation is associated with ischemia reperfusion injury resulting in endothelial cell and surfactant dysfunction. The purpose of the study was to compare two extracellular type solutions, low potassium dextrane (LPD) and Celsior in their ability of ameliorating lung ischemia reperfusion injury. METHODS: In 12 donor pigs, the left lung was perfused with either LPD (n = 6) or Celsior (n = 6) solution. After 24 h cold storage, the lungs were transplanted into 12 recipient animals. After reperfusion of the left lung, the right pulmonary artery and bronchus were clamped. Bronchoalveolar lavage fluid (BALF) was obtained before the surgical procedure and 2 h after reperfusion. Surfactant activity was measured from BALF using a pulsating bubble surfactometer. Hemodynamic and respiratory parameters were assessed in 30-min intervals for 7 post-operative hours. RESULTS: In both study groups two of six animals died from severe ischemia reperfusion injury, thus survival did not differ between groups. Rise of pulmonary vascular resistance index (P = 0.01) and sequestration of neutrophiles (P = 0.08) was less pronounced in Celsior group when compared to LPD animals. A difference in surfactant activity between both groups was not evident after 2 h of reperfusion. CONCLUSIONS: Both solutions might provide safe pulmonary preservation for 24 h of cold ischemia. While surfactant activity was affected to the same extent in both groups, Celsior solution provided slightly superior endothelial preservation.

Animals↗
PubMed2004

Hypothermic circulatory arrest with and without cold selective antegrade cerebral perfusion: impact on neurological recovery and tissue metabolism in an acute porcine model.

OBJECTIVE: Clinically, selective antegrade cerebral perfusion (SACP) seems to be associated with a better neurological outcome compared to hypothermic circulatory arrest (HCA) alone, but the pathophysiological mechanisms are not well understood. Therefore, this study was undertaken to assess the effects of HCA with and without SACP on the cerebral integrity using multimodal neurophysiological monitoring. METHODS: 12 pigs were randomly assigned to 100 min HCA at 20 degrees C brain temperature with (n = 6) and without (n = 6) SACP. Haemodynamics, metabolics and neurophysiology (EEG, SSEP, ICP, spectroscopy, cerebral tissue monitoring) were monitored. Animals were sacrified 4 h after reperfusion and the brains perfused for histopathological assessment. RESULTS: There were no clinically relevant differences in hemodynamics between groups. During reperfusion, EEG and SSEP recovery was significantly faster in the SACP group (P < 0.05). The rise in ICP during reperfusion was markedly reduced in the SACP group (P < 0.01) for the trend). Three hours after reperfusion, median ICP was 130% compared to baseline in the SACP group and 225% in the HCA group (P < 0.01). Invasive as well as noninvasive cerebral monitoring indirectly indicates the occurrence of tissue acidosis in the HCA group even 4 h after HCA. CONCLUSIONS: Cold SACP is associated with better neurophysiological recovery and less cerebral edema, indicated by lower intracranial pressures during reperfusion. Neurophysiological recovery correlated well with the rise in ICP. HCA alone causes prolonged acidosis in the brain tissue during reperfusion. From these data, SACP appears to be superior to HCA alone, but further studies have to elucidate the optimal regimes for SACP.

Animals↗
PubMed2004

Increased plasma homocysteine concentrations accelerate cardiac allograft vasculopathy.

BACKGROUND: A toxic and pro-oxidative effect of homocysteine on the coronary endothelium may accelerate cardiac allograft vascular disease (CAVD). In this study, we evaluated the influence of hyperhomocysteinemia on the course of CAVD. METHODS: We investigated plasma homocysteine (tHCY) concentrations in 183 consecutive heart transplant recipients (158 men and 25 women, mean aged 53.1 +/- 10.0 years, at 6.7 +/- 3.2 years after transplantation) to evaluate the course of CAVD. We used serial coronary angiography to assess coronary status and graded the severity of CAVD based on the extent of luminal obstruction in the main coronary arteries (graded as 1-4). We defined progression as increased focal stenosis of >/=30% or as detection of a new coronary lesion after a mean observation period of 2.8 +/- 1.0 years. A multivariate analysis (backward logistic regression) was performed that included potential risk factors for CAVD. We excluded patients undergoing dialysis. RESULTS: Initially, tHCY concentrations were increased in the entire cohort (mean, 18.6 +/- 7.6 mumol/liter) and ranged from 6.6 to 46.9 mumol/liter. A total of 105 patients (57.0%) had CAVD at first angiography, and progression was detected in 52 transplant recipients (28.0%). Patients with progressive CAVD had significantly greater tHCY concentrations (21.6 +/- 6.2 mumol/liter) at baseline investigation compared with patients who had stable courses (17.4 +/- 7.7 mumol/liter; p < 0.001). These results were independent of parameters such as sex, age, dyslipoproteinemia, cyclosporine blood concentrations, and indication for transplantation. CONCLUSIONS: Progression of CAVD is strongly associated with increased tHCY concentrations. The intervals between routine surveillance angiography should be shortened in patients with hyperhomocysteinemia, and routine medical treatment to decrease homocysteine concentrations should be considered.

Coronary Disease↗
PubMed2004

Aortic root surgery in Marfan syndrome: Comparison of aortic valve-sparing reimplantation versus composite grafting.

OBJECTIVE: The objective of this study was to compare the results of aortic valve-sparing reimplantation and aortic root replacement with mechanical valve conduits in patients with Marfan syndrome undergoing operation for aortic root aneurysms. Patients and methods Between March 1979 and April 2002, 119 patients with clinical evidence of Marfan syndrome underwent composite graft replacement with mechanical valve conduits (n = 74) or aortic valve-sparing reimplantation according to David (n = 45). The underlying causes were aortic dissection type A (43 patients) and aneurysms (76 patients). RESULTS: Patients undergoing aortic valve reimplantation were younger compared with patients undergoing composite grafting (28 vs 35 years, P =.002) and had longer intraoperative aortic crossclamp times (125 vs 78 minutes, P <.0001) and extracorporeal circulation times (162 vs 124 minutes, P <.0001). Early postoperative mortality was 6.8% (n = 5) in patients undergoing composite grafting and 0% in patients undergoing aortic valve reimplantation (P =.15). Mean follow-up was 30 months for patients undergoing aortic valve reimplantation and 114 months for patients undergoing composite grafting. Freedom from reoperation and death after 5 years postoperatively was 92% and 89% in patients undergoing composite grafting and 84% and 96% in patients undergoing aortic valve reimplantation (P =.31; P =.54), respectively. Thromboembolic complications or late postoperative bleeding occurred in 17 patients undergoing composite grafting, and an early postoperative event occurred in 1 patient undergoing aortic valve reimplantation. CONCLUSIONS: The results of aortic valve reimplantation and composite grafting of the aortic valve and ascending aorta with mechanical valve conduits are similar with regard to early and mid-term postoperative mortality and to the incidence of late reoperations in patients with Marfan syndrome. The low risk of thromboembolic or bleeding complications favors aortic valve reimplantation in these patients.

Adolescent↗
PubMed2004

Replacement of the aortic root for acute prosthetic valve endocarditis: prosthetic composite versus aortic allograft root replacement.

OBJECTIVE: Aortic root replacement for prosthetic aortic valve endocarditis with accompanying destruction of the aortic root is a well-established surgical intervention. However, there is still no consensus whether prosthetic material or allogeneic material should be used. Here we report on our experience with prosthetic composite and aortic allograft root replacement in such patients during a 10-year interval. METHODS: From 1991 through 2001, 29 patients with prosthetic aortic valve endocarditis combined with aortic root destruction underwent reoperation at our institution. Sixteen patients received aortic root replacement with a cryopreserved aortic root allograft (group A) and 13 with a prosthetic composite graft (group B). The interval between the initial operation and reoperation was 29 months (range, 5-168 months) in group A and 55 months (range, 7-248 months) in group B. RESULTS: Hospital mortality was 18.5% (n = 5 patients, 3 in group A and 2 in group B). Median follow-up was 21 months (range, 1-48 months) for group A and 34 months (range, 1-152 months) for group B (P >.2). Survival at 1 and 5 years was 81% +/- 10% and 81% +/- 10% in group A and 85% +/- 10% and 85% +/- 10% in group B, respectively. No patient underwent reoperation for recurrent prosthetic aortic valve endocarditis. CONCLUSIONS: Our results indicate that excellent long-term results can be achieved regardless of the material used for aortic root replacement in patients with prosthetic aortic valve endocarditis.

Acute Disease↗
PubMed2004

Mycophenolate mofetil for secondary prevention of cardiac allograft vasculopathy: influence on inflammation and progression of intimal hyperplasia.

BACKGROUND: Cardiac allograft vasculopathy (CAV) remains the single most important complication impairing long-term survival after heart transplantation (HTx). Intimal hyperplasia as a response to immunologic and non-immunologic injury is involved in the pathogenesis. Because improved immunosuppressive properties with mycophenolate mofetil (MMF) have been shown within the first year, beneficial effects on intimal hyperplasia and systemic inflammation might be found late after HTx as well. METHODS: After a baseline examination with intravascular ultrasound (IVUS, volumetric assessment) 30 patients (2.0 +/- 1.1 years post-HTx) were prospectively randomized to receive either MMF (2 g/day) or to continue with azathioprine (AZA) as part of a triple immunosuppression protocol with cyclosporine and prednisolone. Markers of systemic inflammation and changes in vascular geometry were evaluated by IVUS after 1 year of follow-up. RESULTS: With regard to inflammation, significantly lower values were found for high-sensitive C-reactive protein (CRP) in the MMF group (AZA 1.8 +/- 1.2 mg/liter. vs MMF 1.0 +/- 4.1 mg/liter, p = 0.02). Tumor necrosis factor (TNF)-alpha, interleukin (IL)-10, IL-6 and transforming growth factor (TGF)-beta did not differ between the groups. IVUS revealed no significant differences between groups. There was a weak trend toward a larger increase in plaque volume (AZA 13 +/- 43 mm(3) vs MMF 27 +/- 41 mm(3), p = 0.33), whereas MMF-treated patients tended to show a small increase in vessel dimensions (AZA +10 +/- 63 mm(3) vs MMF +50 +/- 87 mm(3), p = 0.17). CONCLUSIONS: Changing immunosuppression from a standard AZA-based regimen to MMF resulted in a decrease in systemic inflammatory activity as indicated by levels of high-sensitive CRP. However, progression of intimal hyperplasia did not differ significantly, and the weak trend toward vascular enlargement could indicate some influence on vascular geometry.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Quality of life 1 year after lung transplantation.

Lung transplantation is a viable therapeutic option for patients with end-stage lung disease. The focus of interest has shifted from advances in surgical techniques to improved quality of life for the transplant recipient. A prospective longitudinal repeated measures design was used to determine the impact of lung transplantation on quality of life and life satisfaction. Using 4 measurement points (before transplantation, after 8 weeks, and after 6 and 12 months), 61 patients were followed from before to 1 year after successful lung transplantation. Quality of life was measured using 2 generic (SF-36, Quality of Life Profile for Chronic Diseases) and 1 lung-specific (Saint George's Respiratory Questionnaire) questionnaires. All dimensions of the health-related scores improved significantly after transplantation, except bodily pain. Patients reported the most significant improvements until 6 months after transplantation. Lung transplantation had no influence on social functioning or role emotional. The Saint George's Respiratory Questionnaire ratings showed similar significantly better scores for transplant recipients at 6 months, and stagnations for most dimensions afterward.

Adult↗