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Biomedical subjects

C Zussa

Publications and source records attributed to C Zussa.

33 records · Page 2Linked to original sources
PubMed1990

Efficacy and safety of predeposit blood autodonation in 500 cases of myocardial revascularization.

Since 1985 all patients scheduled for coronary artery bypass grafting have been evaluated for admission to a program of predeposited blood autodonation. From a total of 816 consecutive patients, 505 were admitted to the program (group 1). The other 311 (group 2) were excluded on the basis of one or more of the following criteria: 1) emergency surgical indication, 2) hemoglobin less than 12 g/dl, or 3) uncontrolled angina or clinically manifest cardiac failure. Postoperative use of homologous blood products was required by 16% of the group 1 and 44% of the group 2 patients (p less than 0.001). Altogether 597 patients (73%) had no contact with homologous blood products. There was no intergroup difference in the incidence of postoperative complications. Non-A, non-B hepatitis developed in three group 1 and four group 2 patients. Its incidence was 0.9% among all discharged patients and 3.2% of the homologous blood recipients. The findings emphasize the safety and value of the autodonation with predeposit program in significantly reducing the requirement for homologous blood in coronary artery bypass grafting.

Blood Banks↗
PubMed1990

Chordal replacement in mitral valve repair.

Chordal replacement greatly extends the possibility of repair of atrioventricular valves. Both glutaraldehyde-tanned xenograft pericardial chordae (GTXP) and extruded polytetrafluorethylene chordae (ePTFE) heal to papillary muscles and cusps. Neither type elongates or shrinks. GTXP may thicken and stiffen with time. ePTFE is covered by a normal fibrosa and intima (a new chorda is grown around the ePTFE suture) experimentally and in small sizes (e.g., CV 5), retains flexibility. The results of late follow-up (5-10 years) with GTXP chordae and early follow-up (6-58 months) with ePTFE chordae are encouraging.

Adult↗
PubMed1986

Carpentier-Edwards bioprosthesis: a 7-year follow-up in 361 patients.

Three hundred sixty-one patients undergoing heart valve replacement with Carpentier-Edwards bioprostheses (CE) were evaluated: 169 patients underwent replacement of the mitral valve (MVR), 124 of the aortic valve (AVR), one of the tricuspid valve (TVR) and 67 of 2 or more valves (mVR). A total of 420 CEs were implanted. Overall operative mortality was 4.7% (7.1 for MVR, 1.6 for AVR, 4.5 for mVR). Early complications included hemorrhage (5 cases), thromboembolism (one case), paraprosthetic leak (one case). Actuarial survival rates at 5 years were computed for overall deaths, cardiac deaths and prosthetic deaths. In the 3 subgroups these 3 rates were respectively 78.7 +/- 5.6%, 82.9 +/- 5.4%, 96.4 +/- 1.6% for MVR, 88.9 +/- 3.3%, 94.2 +/- 2.3%, 98.7 +/- 1.3% for AVR, and 82.3 +/- 5.9%, 88.3 +/- 5.1%, 98.5 +/- 1.5% for mVR. Actuarial freedom from prosthetic complications at 7 years was 59.6 +/- 7.5%, 78.1 +/- 4.1% and 61.9 +/- 8.0% for MVR, AVR and mVR patients. Thromboembolism-free rates were 87.2 +/- 3.9% and 99.2 +/- 0.8% for MVR and AVR, while the thromboembolic linearized rate was 2.8% per patient-year and instantaneous risk of thromboembolism was 4.1% at one and instantaneous risk of thromboembolism was 4.1% at one year for MVR. Anticoagulant-related hemorrhage linearized occurrence was 1.0%, 1.2% and 0.8% per patient-year among the 3 subgroups. Prosthetic endocarditis occurred in 12 patients with a linearized rate of 1.1% per patient-year. Eleven of these patients were treated successfully. Three episodes of primary tissue failure were recorded (0.2% linearized rate per year, instantaneous risk 3.5% at the sixth year).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1985

Porcine cardiac bioprostheses: evaluation of long-term results in 990 patients.

Clinical results with porcine bioprostheses were reviewed for 990 patients who underwent heart valve replacement from January, 1974, to December, 1980. Eight hundred and seventy-four Hancock, 283 Carpentier-Edwards, and 10 Liotta bioprostheses were used. In 23 patients, 26 mechanical prostheses were implanted as well. Overall operative mortality was 60 out of 990 (6.06%): 30 out of 506 (5.9%) for mitral valve replacement (MVR), 13 out of 287 (4.5%) for aortic valve replacement (AVR), 1 out of 4 (25%) for tricuspid valve replacement, 0 out of 2 for pulmonary valve replacement, and 16 out of 191 (8.4%) for multiple valve replacement. Cumulative follow-up covered 1,793 patient-years. (Actuarial survival at 7 years was 76.6 +/- 3% for MVR. At 6 years, it was 83.2 +/- 2.8% for AVR and 55 +/- 13.5% for multiple valve replacement.) Prosthesis-related survival at 7 years was 91.7 +/- 1.9% for MVR, and at 6 years, it was 96.6 +/- 1.5% for AVR and 95.1 +/- 2.2% for multiple valve replacement. Bioprosthesis survival, considering deaths or complications that led to reoperation as final events, was 84.2 +/- 3.7% at 7 years for mitral valves and 87.7 +/- 3.8% at 6 years for aortic valves. Emboli per 100 patient-years numbered 3.2 for MVR, 0.5 for AVR, and 1.6 for multiple valve replacement. Twenty-seven patients underwent reoperation, 12 for perivalvular leak, 5 for endocarditis, 6 for valve thrombosis, and 4 for primary tissue failure (linearized rates of 0.7, 0.3, 0.3, and 0.2% per patient-year, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Postoperative histological diagnosis in two cases of unsuspected bioprosthetic endocarditis.

Two cases of preoperatively unsuspected porcine bioprosthetic endocarditis are presented. Both cases, thought to be a sterile thrombosis and a primary tissue failure respectively, were correctly diagnosed only with histological examination. Cultures and histological examination of the explanted tissue are necessary for a definite diagnosis in every case of prosthetic malfunction.

Adult↗
PubMed1984

Endocarditis in patients with bioprostheses: pathology and clinical correlations.

We studied 13 porcine bioprostheses removed from patients with endocarditis at our institute during the last 4.5 years. All bioprostheses had been removed at reoperation and were analyzed using anatomical and histological techniques. Each bioprosthesis was found to have developed rather constant lesions which were not related to the type of bioprosthesis. The stage of infection was not related to the duration of implantation. The presence of perivalvular abscesses was an ominous finding, often being the seat of persistent endocarditis. Our good clinical results of reoperation lead us to suggest that this be performed early once valvular or prosthetic malfunction is detected. Bioprostheses are, in our experience, the best choice in the surgical treatment of prosthetic valve endocarditis.

Adult↗
PubMed1984

Ascending aortic aneurysms: composite conduit replacement.

From July 1980 to February 1984, 26 patients underwent composite replacement of ascending aortic aneurysm and aortic valve with coronary reimplantation. This group included 14 patients with dissecting aneurysm (ten and four respectively, belonging to Types I and II), and 12 patients with chronic aneurysm (six atherosclerotic aneurysms, two Marfan's syndrome and four annuloaortic ectasia cases). Hospital mortality was 35.7% (5/14) in the dissection subgroups and 16.6% (2/12) in the chronic aneurysm subgroup (difference NS). No operative risk factor was recognized. The 19 survivors have been followed up for a total of 393 patient-months (range 5 to 49 months). Controls included echocardiography and computed tomography scanning. Two patients died because of rupture of a persistently dissected aorta; another patient died of an unknown cause. Total actuarial survival rate at 4 years was 58.3 +/- 10.4% (83.3 +/- 10.7% for chronic aneurysms and 42.3 +/- 13.4% for dissecting aneurysms). Among late survivors, there were no paravalvular leaks, new dissections, or thromboembolisms, although two perigraft hematomas and a persistent dissection were later disclosed. When appropriate, composite conduit replacement of the ascending aorta can increase the survival rate, and can also be useful in high-risk patients.

Journal Article↗
PubMedDate not supplied

Coronary artery bypass grafting for unstable angina. Risk factors of operative mortality.

In order to identify factors affecting early mortality in patients undergoing CABG for unstable angina, several risk factors have been analysed in a group of 120 patients. Systemic hypertension and left ventricular impairment were shown to be significant risk factors (Systemic hypertension, P less than 0.01; EF less than or equal to 0.35, P less than 0.01; LVEDP greater than or equal to 20 mmHg, P less than 0.025). Overall mortality rate was 5% (6/120). No influence could be recognized for age, sex, previous MI, emergency surgery, extension of coronary disease, completeness of revascularization and mode of onset of symptoms.

Adult↗