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Biomedical subjects

F Stumpe

Publications and source records attributed to F Stumpe.

At least 55 records · Page 3Linked to original sources
PubMed1996

Doppler echocardiographic assessment of the new ATS medical prosthetic valve in the aortic position.

Advancing The Standard (ATS) Medical (ATS Medical Inc., Minneapolis, MN) is a new mechanical bileaflet valve, composed of pyrolitic carbon. The aim of this study was to define in a blinded manner the Doppler echocardiographic characteristics of normally functioning ATS Medical prostheses with respect to their size. Forty consecutive patients (29 men, mean age 58 +/- 13 years), clinically stable, and without evidence of valve dysfunction, were studied from 1993 to 1995. Doppler echocardiography was performed at least 3 months after valve replacement with ATS Medical valves (5 n degrees 21, 8 n degrees 23, 12 n degrees 25, 10 n degrees 27, 5 n degrees 29). Maximum and mean transprosthetic pressure gradients were calculated by the simplified Bernoulli equation. Functional valve surface area was assessed by the continuity equation using the external diameter of the prostheses to calculate the subaortic surface area. The Doppler velocity index was obtained by the ratio of subaortic and transaortic velocities and the performance index was calculated dividing the effective orifice area by the actual orifice area. For the most commonly used aortic valve (25 mm), the maximum pressure gradient was 17 +/- 8 mmHg, the mean gradient 11 +/- 4 mmHg, the functional surface area 2.2 +/- 0.4 cm2, the Doppler velocity index 0.44 +/- 0.07, and the performance index 0.68 +/- 0.11. This study provides the normal range for Doppler hemodynamic characteristics of the various sizes of the ATS valve.

Adult↗
PubMed1995

[Cardiac surgery in octogenarians].

37 patients aged 80 or over underwent cardiac surgery during an 11-year period. Operative indications included angina, dyspnea and syncope. The majority of patients (n = 32) had a left ventricular ejection fraction greater than 0.5. There were 28 aortic valve procedures, of which seven were combined with coronary artery bypass grafts (CABG), and 2 with mitral valve repair; in addition, 7 isolated CABG procedures and one isolated mitral valve repair were performed. 36-day mortality was 5.4% (2 patients); 9 patients died at a later date (2.5 to 118 months after surgery). The most frequent postoperative complications were atrial fibrillation, pulmonary infection or atelectasis, transient delirium and atrioventricular conduction disturbances. Mean hospital stay was 14.5 days. 1- and 5-year actuarial survival rates were 83% and 57%. In a control group of patients aged 60-69 matched for preoperative characteristics, there were no in-hospital fatalities and 1- and 5-year survival were, respectively, 100% and 82%. Among complications, only conduction disturbances and transient delirium were significantly more frequent in the octogenarian group. At follow-up, the proportion of severely symptomatic octogenarians had diminished to 24% from 84%. In conclusion, cardiac surgery can be performed on octagenarians with adequate myocardial reserve, exposing them to a perioperative mortality that is in the range of younger age groups while offering an equivalent prospect for functional improvement.

Age Factors↗
PubMed1995

[Patient management following cardiac transplantation].

Prognosis of heart transplant patients has dramatically improved in the last decade thanks to the use of cyclosporine as immunosuppressive treatment. Optimal follow-up and early recognition of complications and side effects of treatment lead to longer survival and marked improvement of these patients' quality of life. However, the incidence of complications remains high and their management calls for particular care. We review our experience of heart transplantation in Lausanne and describe in detail the results and complications such as rejection, transplant coronary artery disease, hypertension, renal failure, metabolic disorders, cancer and conduction problems. Cooperation of the medical team (cardiologist, surgeon, anesthetist, general practitioner) is essential to long term success of the transplant program.

Arrhythmias, Cardiac↗
PubMed1995

Incidence of deep and superficial sternal infection after open heart surgery. A ten years retrospective study from 1981 to 1991.

Between January 1981 and December 1991, 4137 adult patients underwent various cardiac procedures via a median sternotomy under cardiopulmonary bypass. The overall infection rate was 1.33%, including superficial wound infections (SWI) (1.18%) and deep sternal infection (DSI) (0.145%). Pericardial and retrosternal suction drains with a vent allowed a better drainage of blood and serosities and probably contributed to our low DSI rate. Eleven factors predisposing to infection were evaluated by Fisher's exact test. Only the operative urgency (P = 0.006), reexploration for bleeding (P = 0.00001) and preoperative renal failure (P = 0.0005) were statistically significant. Twenty of our infected patients had no risk factors for infection. When the risk factors described in the literature were applied to our infected patients, only one had no risk factor.

Adolescent↗
PubMed1995

Surgery in native valve endocarditis: indications, results and risk factors.

Seventy-nine patients (mean age 49 years) underwent valve replacement or repair for active (58.2%) or healed (41.8%) native valve endocarditis between 1976 and 1992. The most common indication for surgery was congestive heart failure (73.4%), followed by multiple systemic emboli (21.5%). Emergency operation was necessary in 27.8% of the cases. Operative mortality was 3.8% (3 patients) and late mortality 15.1% (12 patients). Streptococci were the most common infecting agents (41.8%), followed by Staphylococcus aureus (11.4%). No organisms were isolated in 27 cases (34.2%). Follow-up spanned 379.8 patient-years with a maximum of 15.8 years. Fifteen late valve-related events (periprosthetic leak, recurrent endocarditis, thrombo-embolic events and hemolysis) and 20 other late complications (anticoagulant-related hemorrhage, arrhythmias or congestive heart failure) occurred in 22 patients. The linearized rate for all late complications is 5.8% per patient-year. The influence of eight preoperative variables on overall mortality and late valve-related complications was assessed: age, valve(s) affected, active or healed infection, bacteriology, annular abscess, emergency or elective surgery, preoperative renal function and NYHA class. Only Staphylococcus aureus (P = 0.0012) was a significant predictor of late valve-related complications. Furthermore, no difference in survival or in valve-related complications was found between the active and healed infections.

Actuarial Analysis↗
PubMed1994

[Infectious complications in cardiac transplantation: Lausanne experience].

Infectious complications, a major cause of morbidity and mortality after heart transplantation, were reviewed in 49 heart transplant patients at Lausanne. The follow-up lasted 32 months on average. 43 patients (88%) presented 108 infections (2.20 episodes of infection/patient). 38 severe infections (0.78 episodes/patient) were diagnosed in 27 patients (55%). 2 of the 9 deaths which occurred were due to infection. The viruses, principally of the herpes group, were responsible for 37% of all the infections, and bacteria for 28%. About a third of the viral and bacterial infections were severe. The other documented infections were caused by fungi (13%), which were most often responsible for superficial infections, and rarely by protozoa (5%). Finally, in 17% of infectious episodes, the pathogen could not be identified. Cytomegalovirus was the pathogen the most frequently responsible in severe infections. The highest incidence of infections occurred during the first 2-3 months after transplantation and was reduced considerably after the 6th month. The distribution of different pathogens was related to specific periods after the transplant. Our results confirm that infection is a major complication of heart transplantation. Clinical and prophylactic aspects of some infections are reviewed.

Cytomegalovirus Infections↗
PubMed1994

Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis.

Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are more effective than medical treatment for the management of ischaemic heart disease. However, patients with single-vessel involvement have been excluded from prospective comparisons of the two methods. We have carried out such a comparison in patients with isolated proximal left anterior descending artery stenosis, conserved left ventricular function, and documented ischaemia. Eligible patients presenting to a single centre were randomly assigned PTCA (68 patients) or left internal mammary grafting (66). The procedures were technically feasible in all cases. The incidence of in-hospital complications was 2% (perioperative myocardial infarction) for CABG and 3% (emergency CABG for acute closure) for PTCA. Clinical and functional status improved similarly in both groups. However, patients in the PTCA group took more antianginal drugs. At median follow-up of 2.5 years, 86% of CABG-treated and 43% of PTCA-treated patients were free from adverse events (p < 0.01; relative risk 2.0 [95% CI 1.7-2.3]). The adverse events that explain this difference were restenosis (32%) requiring subsequent surgical (16%) or percutaneous (15%) revascularisation (1% had medical therapy). Rates of cardiac death and myocardial infarction did not differ between the groups. Both CABG and PTCA improve the clinical status of symptomatic patients with single-vessel coronary artery disease. If patient and physician accept the risk of restenosis and reintervention associated with PTCA, this procedure remains a suitable option and a simpler initial alternative to CABG.

Angioplasty, Balloon, Coronary↗
PubMed1987

[Multiple peripheral emboli resulting from thrombosis of a St. Jude aortic valve prosthesis].

Although thrombosis of St. Jude valve prosthesis is rare, we report a case of multiple thromboembolism in a patient who had stopped anticoagulant therapy. The consequences were very severe since two abdominal operations (colonic resection) were necessary. Since the patient was not compliant with anticoagulant therapy, aortic valve replacement was performed and a biologic valve implanted. The postoperative phase was long but the patient left the hospital after two months' treatment. This case again demonstrates the importance of anticoagulant therapy in patients with a prosthetic heart valve. Addition of dipyridamole diminished the risk of thromboembolic accident and should be added to the anticoagulant regimen.

Anticoagulants↗
PubMed1986

Mechanical emergency recanalization of the left main coronary artery.

Acute occlusion of the left main coronary artery is normally fatal. According to the literature, only a few cases have been treated by intracoronary thrombolysis; the prolonged period of ischemia, however, resulted in severe left ventricular dysfunction and numerous complications. Therefore, effort should be directed to recanalize the left main coronary artery within the shortest possible interval. We followed this approach in a case of acute occlusion of a subtotal stenosis of the left main coronary artery which could be mechanically reopened and dilated within a few minutes. The intervention resulted in immediate reversal of profound cardiogenic shock and complete restoration of normal left ventricular function. At hospital discharge, the patient was asymptomatic with a negative bicycle stress test. Immediate mechanical recanalization and angioplasty appear to be a feasible approach in life-threatening coronary occlusion.

Aged↗
PubMed1985

[Outcome of coronary transluminal angioplasties followed by an occlusion].

Coronary occlusion is the most serious complication of percutaneous transluminal angioplasty. In 440 cases coronary occlusion occurred in 22 patients (5%). Treatment was coronary bypass in 12 cases mechanical recanalization in 7 cases and coronary bypass after unsuccessful mechanical recanalization in 3 cases. One patient died after mechanical recanalization and 9 (41%) had myocardial infarction confirmed by electrocardiography and angiography. The number of coronary occlusions increased initially but decreased with improvements in materials and techniques. It is concluded that coronary occlusion is a severe but rare complication of percutaneous angioplasty. Mechanical recanalization should be attempted, and in case of failure the patient should be referred for surgery. In the large majority of cases the outcome is benign.

Aged↗
PubMed1985

[St Jude's Medical prosthesis in patients over 65].

Between September 1979 and December 1982, 56 St Jude Medical valvular prostheses were implanted in 54 patients over 65 years of age. Surgery consisted in simple aortic valve replacement (35 cases), simple mitral valve replacement (12 cases), double aortic and mitral valve replacement (2 cases), valve replacement and coronary artery bypass surgery (3 cases), aortic valve replacement and replacement of the ascending aorta (1 case) and mitral valve replacement and tricuspid annuloplasty (1 case). The operative mortality (within 30 days of surgery) was 3.5% (2 cases). Patients were assessed by clinical examination, ECG, chest X-ray, echocardiogram and laboratory investigations on average 19 months after surgery. There were 3 late deaths (1 endocarditis, 1 cardiac failure and 1 subdural haematoma). No cases of significant haemolysis were observed. There were no cases of thrombosis of the valve or any deaths directly related to the valve. Four patients had cerebral embolism (4.9% per patient/year). None were fatal and only 1 patient had sequellae. Clinical improvement was very significant; 96% of the patients are now in the NYHA Classes I and II whilst 80% were in Class III or IV before surgery. The cardiothoracic ratio decreased significantly from 0.56 to 0.51 (p less than 0.01). The authors conclude that elderly patients may derive great benefits from valvular cardiac surgery and that age in itself is not a contraindication to this type of surgery. The St Jude Medical prosthesis is an excellent prosthesis but thromboembolism remains a major problem as with other mechanical prostheses. Anticoagulation for life is essential.

Age Factors↗