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Biomedical subjects

J Bergsland

Publications and source records attributed to J Bergsland.

98 records · Page 6Linked to original sources
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On-pump and off-pump coronary artery bypass grafting in the elderly: predictors of adverse outcome.

OBJECTIVE: To establish the role that coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) may have in improving perioperative outcomes of patients 70 years of age and older. BACKGROUND: Coronary revascularization in elderly patients is associated with morbidity and mortality rates higher than those observed in younger patients. The impact of CABG without CPB on perioperative outcomes has not been clearly established. METHODS: This retrospective, nonrandomized study consisted of 1,872 CABG patients. Of these, 1389 underwent CABG with CPB (CPB group) and 483 patients underwent CABG without CPB (off-pump group). Preoperative variables and outcomes were compared between the two groups. Multivariate logistic regression analysis was used to identify independent predictors of mortality, stroke, and adverse outcome. RESULTS: Demographics, Canadian Cardiovascular Society staging, operative priority, and other preoperative variables were comparable between the two groups. The prevalence of previous myocardial infarction was higher in the CPB group (62.6% vs 56.7%; p < 0.005), whereas the prevalence of calcified aorta and preoperative renal failure were higher in the off-pump group (5.4% vs 9.5%; p = 0.04 and 1.7% vs 3.3%; p = 0.04, respectively). Although the graft/patient ratio was higher in the CPB group (3.4 vs 1.9), these patients displayed more extensive coronary artery involvement. At univariate analysis, patients in the off-pump group had a higher rate of freedom from complications (88.2% vs 81.3%; p < 0.005) and a lower incidence of stroke (2.1% vs 4.2%; p = 0.034) than patients in the CPB group. Although there was a trend for a higher actual mortality in the off-pump group (4.8% vs 3.7%; p = ns), the risk adjusted mortality in this group was lower (1.9% vs 2.1%). Multivariate analysis showed that while the use of CPB correlated independently with an increased risk of overall complications, it was not associated with a higher probability of death or stroke. CONCLUSIONS: This investigation suggests that elderly patients undergoing CABG may benefit from off-pump revascularization, as the use of CPB correlated independently with an increased risk of overall complications. However, CPB did not emerge as an independent predictor of death or stroke at multivariate analysis.

Aged↗
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Use of the "single suture" technique to expose the anterior surface of the heart.

The "single suture" technique, which consists of placing a suture in the oblique sinus of the posterior pericardium and connecting it to a vaginal tape, is commonly adopted in off-pump coronary artery revascularization to obtain elevation of the heart and coronary artery exposure. This report describes the use of this technique to expose the anterior wall of the heart in the setting of ventricular aneurysm repair.

Heart Aneurysm↗
PubMedDate not supplied

Coronary blood flow and thallium 201 uptake in rejecting rat heart transplantations.

The effects of rejection on coronary flow (CAF) in heart allografts are unclear, although previous evidence with cardiac imaging agents indicates impaired flow during advanced rejection. The purpose of this study was to measure CAF in heterotopically placed heart grafts. Lewis rats (LEW) received grafts from either syngeneic Lewis rats (LEW/LEW group) or allogeneic ACI rats (ACI/LEW group). CAF was measured in both the transplanted and native hearts with radiolabeled microspheres. Rejection was measured histologically (grades 0 [absent] to 4+ [severe]). In addition systemic blood pressure and cardiac outputs of the native hearts were determined with microspheres. Different animals were studied during relatively early (4 days) and late (6 days) rejection. Among the 4-day animals a cyclosporine-treated group was included (ACI/LEW CyA). In 6-day rats CAF in allografts was lower (0.56 +/- .06 ml/gm/min) compared with syngeneic grafts (1.72 +/- 0.4 ml/gm/min) (p less than 0.05). The CAF in the native hearts did not differ significantly but was higher than in the grafts in both groups. Heart rates were reduced in allografts (p less than 0.05). It is interesting that arterial pressure and cardiac output were significantly lower in animals bearing allogeneic than syngeneic grafts. In rats studied at 4 days graft CAF was lower than in the native heart in both the LEW/LEW and ACI/LEW groups, but there was no significant difference in behavior between groups. The same was true for a cyclosporine-treated group. Graft heart rates were similar in all 4-day rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Uptake of myocardial imaging agents by rejected hearts.

Technetium 99 m pyrophosphate, Gallium 67 and Thallium 201 uptakes were measured in heterotopically transplanted rat hearts. Five days after transplantation, Technetium 99 m pyrophosphate, and Gallium 67 uptakes were significantly higher in allogeneic grafts than in syngeneic grafts. At an early stage of rejection (three days after transplantation), only Technetium 99 m pyrophosphate uptake in the left ventricle of allogeneic grafts showed a significant difference (p less than 0.04). At five days, Thallium 201 uptake was significantly lower in allo- than syngeneic grafts. There was a positive correlation between radionuclide uptake and histologic degree of rejection for Technetium 99 m pyrophosphate and Gallium 67 while Thallium 201 uptake correlated negatively. Analysis of variance revealed that hearts with no or minimal rejection had statistically different uptakes than hearts with mild to moderate rejection. These results suggest that uptake of imaging agents might be useful in the diagnosis of rejection of the transplanted heart.

Animals↗
PubMedDate not supplied

Physiologic constraints in autoperfused heart-lung preservation.

The lungs usually deteriorate earlier than the heart in the autoperfused heart-lung preservation technique for transplantation; however, precise lung function during preservation has not yet been examined. The present study evaluated the physiologic changes in the autoperfused heart-lung preparation. Four dogs were tested with a conventional model, however, it was difficult to measure physiologic changes in the lungs. Seven preparations therefore were studied with a modified model in which the preload was kept constant. Stable hemodynamics could then be maintained throughout the experiment. Although pH and PaCO2 could be kept within normal range during preservation by adjusting the ventilator rate, PaO2 during 100% oxygen ventilation decreased significantly after 6 hours. Pulmonary vascular resistance increased transiently after the harvest; thereafter it normalized and remained constant for several hours but again increased markedly after 8 hours. Pulmonary compliance decreased after 7 hours. Complement activation occurred during preservation. There was a significant transpulmonary leukosequestration in the earlier phase of preservation. Platelet aggregation appeared to occur simultaneously, but counts recovered to some extent. In conclusion, autoperfused heart-lung preparation showed good viability up to 5 hours by present techniques. Lung deterioration is multifactorial and includes complement activation, trapping of leukocytes, and platelet aggregation.

Animals↗
PubMedDate not supplied

Beneficial effects of prostaglandin E1 on autoperfused heart-lung preservation.

In an autoperfused heart-lung preservation the lungs usually deteriorate earlier than the heart. This study examines the effect of prostaglandin E1 on the lungs in a newly designed autoperfusion model for heart-lung preservation. This model provided constant preload and afterload with stable hemodynamic parameters so that precise changes of lung function could be measured. Lung function was evaluated by the changes of arterial blood gas, pulmonary vascular resistance, pulmonary compliance, and serial biopsies. Eighteen mongrel dogs were divided into two groups. Seven control dogs received no prostaglandin E1. The study group consisted of seven dogs that received continuous infusion of prostaglandin E1 (1, 10, and 40 ng/kg/min) through the pulmonary artery. Attempts to infuse larger concentrations of prostaglandin E1 at 10 to 40 ng/kg/min resulted in ventricular fibrillation in four animals not included in the analysis. In the control group lung function showed good viability up to 5 hours; however, the lungs deteriorated, and lung edema occurred in all experiments after 9 hours. A lower dosage of prostaglandin E1 (1 ng/kg/min) infusion was effective in seven dogs, which prevented lung deterioration, and five of the seven lungs were well preserved for 10 hours with stable arterial oxygen tension, pulmonary vascular resistance, and pulmonary compliance. Ventricular fibrillation occurred at dosages of 10 to 40 ng/kg/min of prostaglandin E1 in four dogs. These dogs therefore were excluded from the analysis. In conclusion, prostaglandin E1 appears to have a beneficial effect on autoperfused heart-lung preparation.

Alprostadil↗
PubMedDate not supplied

Allopurinol in prevention of reperfusion injury of hypoxically stored rat hearts.

We have studied the effect of the xanthine-oxidase inhibitor allopurinol on the performance of hypoxically stored rat hearts to evaluate the drugs' potential value in heart transplantation. Hearts were stored for 2 hours at 15 degrees C after potassium chloride cardioplegia. Hemodynamics were measured before hypoxia and after reperfusion. Hearts were treated with allopurinol in the cardioplegia, at the time of reperfusion, or with superoxide dismutase (SOD) and catalase (CAT) and compared with control hearts that received no treatment. Hemodynamic performance after hypoxia was significantly improved in the SOD/CAT group compared with the control group. Allopurinol-treated hearts were also significantly improved, especially when the drug was given in the reperfusion phase. Our results demonstrate the importance of free radicals during reperfusion of hypoxically stored hearts. Allopurinol and SOD/CAT may be of value in reducing such damage after heart transplantation.

Allopurinol↗