Search PubMed⌕ Search

Biomedical subjects

M I Turina

Publications and source records attributed to M I Turina.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Post-infarction septal rupture. Surgical management and evolution].

BACKGROUND: The occurrence of a ventricular septal rupture abruptly worsens the prognosis of the patients who initially survived a myocardial infarction and imposes a surgical correction to reverse the evolving hemodynamic shock. This study reports our experience in the management of post-infarction septal defects. PATIENTS: 54 consecutive patients with a post-infarct ventricular septal defect were reviewed. The rupture was located in the antero-apical septum in 24 patients and in the postero-basal septum in 30. 26 patients presented with a one-vessel disease (the infarct-related artery), 19 with a two- and 9 with a three-vessel disease. 25 patients were in shock preoperatively. The septal rupture was approached through a left ventriculotomy in 53 patients and through a right atriotomy in 1 patient and was closed with a patch of pericardium or synthetic tissue. Aorto-coronary bypasses using vein grafts were performed on the coronary arteries that presented significant stenosis. RESULTS: 14 patients died peroperatively (2 pts) or postoperatively (12 pts) (mortality rate: 26%) mostly due to cardiac failure or cardiac complications: 25 patients among the 40 survivors suffered significant morbidity post-operatively. During follow-up (median time: 48 months), 19 patients died, again mostly from cardiac causes. Survival rate at 5 and 10 years was 70 and 40 percent, respectively. The necessity to operate within a short delay (less than 36 hours after occurrence of septal rupture) turned to be a significant predictor for increased post-operative mortality (p = 0.03). Pre-operative shock showed only a trend for an increased post-operative mortality (p = 0.13). CONCLUSION: The mortality and morbidity after surgical correction of post-infarction ventricular septal rupture remains significant. Early closure of the septal rupture seems, however, indicated in view of the gravity and evolution of the underlying disorder.

Heart Rupture, Post-Infarction↗
PubMed1998

Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984-1996.

The outcomes of cardiovascular operations during pregnancy, at delivery, and post partum were reviewed from published material in the period 1984-1996. Surgery during pregnancy resulted in fetal-neonatal morbidity and mortality of 9% and 30%, respectively, and in maternal morbidity and mortality of 24% and 6%, respectively. Duration of pregnancy at surgery and duration and temperature of cardiopulmonary bypass did not influence fetal-neonatal outcome. Maternal complications and mortality of surgery immediately after delivery were 29% and 12%, respectively, and for surgery performed with a postpartum interval the respective rates were 38% and 14%. Hospitalization after week 27 of gestation and extreme emergency contributed significantly to poor maternal outcome. Maternal deaths were reported in 9% of valvular procedures and in 22% of aortic or arterial dissection repairs and pulmonary embolectomies. Fetal-neonatal risks of maternal surgery during pregnancy are high and unpredictable. Maternal risks of cardiovascular procedures during pregnancy are moderate, significantly increase if an operation is performed at or after delivery, and, overall, should be considered as higher than those in nonpregnant cardiovascular surgical patients.

Cardiopulmonary Bypass↗
PubMed1998

Late outcome of coronary artery bypass grafting in young versus older patients.

BACKGROUND: We compared long-term results of coronary artery bypass grafting between 1976 and 1988 in 176 patients 40 years old or younger with a matched control group of 176 patients 25 to 30 years older. METHODS: Mean age was 37.4 +/- 2.7 years (+/- standard deviation) in the study group and 64.2 +/- 2.9 years in the control group. Matching criteria were age, sex, left ventricular ejection fraction, number of bypass grafts, and year of operation. RESULTS: The study group had more smokers (p = 0.000) and more patients with hypercholesterolemia (p = 0.026), unstable angina (p = 0.003), and preoperative myocardial infarction (p = 0.009); fewer patients had hypertension (p = 0.000) and diabetes (p = 0.005) in this group than in the control group. The internal mammary artery was used in 31% of the study patients and in 30% of the controls. The actuarial survival rates after 5, 10, and 15 years were 92%, 86%, and 72% in the study group and 92%, 86%, and 66% in the control group (p = 0.202). Young age was a predictor of cardiac reoperation. CONCLUSIONS: Late survival is similar for young and older patients, but the reintervention rate is higher in the younger group. The absence of unstable angina, a left ventricular ejection fraction greater than 0.45, and the use of internal mammary artery grafts increase survival in all patients.

Adult↗
PubMed1998

Inflammatory aneurysm of the ascending aorta.

The gold standard to clarify an acute pathology of the ascending aorta is transesophageal echocardiography or contrast-enhanced computed tomography. Neither of these methods led to the correct finding in our case of an inflammatory aneurysm of the ascending aorta. Both assessments resulted in the diagnosis of an acute dissection of the ascending aorta.

Aortic Dissection↗
PubMed1998

Long-term follow-up in hypertrophic obstructive cardiomyopathy after septal myectomy.

BACKGROUND: Controversy exists about the choice of treatment for patients with hypertrophic obstructive cardiomyopathy. The purpose of this study was to evaluate clinical and echocardiographic long-term results in patients with hypertrophic obstructive cardiomyopathy after septal myectomy and to determine predictors of event-free survival in these patients. METHODS: Between 1965 and 1995, 110 consecutive patients 2 to 66 years old (mean age, 37 +/- 15 years) with an invasively measured left ventricular outflow tract gradient of 86 +/- 39 mm Hg (81 +/- 42 mm Hg by Doppler echocardiography) underwent either septal myectomy only (n = 87) or myectomy combined with additional procedures (n = 23). Mean follow-up was 11.7 +/- 7.5 years. Predictors of late events were calculated using multivariate Cox regression analysis. RESULTS: The perioperative mortality rate was 3.6% (n = 4). The cumulative survival rate at 5, 10, and 15 years was 93%, 80%, and 72%, respectively, and symptom-free survival, 77%, 50%, and 33%, respectively. Predictors of late death were New York Heart Association class III or IV (p < 0.05), congestive heart failure (p < 0.05) and additional procedures (p < 0.05). The left ventricular outflow tract gradient was nearly eliminated in all patients, the left atrial dimension decreased significantly during the early years, and left ventricular dilatation occurred late in 17 patients. CONCLUSIONS: Septal myectomy is associated with a low perioperative mortality and a high late survival rate (72% at 15 years' follow-up). Septal myectomy is still an excellent modality in the treatment strategy for symptomatic patients with hypertrophic obstructive cardiomyopathy.

Adolescent↗
PubMed1998

Aprotinin in pediatric cardiac operations: a benefit in complex malformations and with high-dose regimen only.

BACKGROUND: The benefits and the current indications of aprotinin in congenital operations are not well defined. At present there are only a few studies available that have investigated a small number of patients in several heterogeneous groups of malformations. METHODS: We investigated efficacy and safety of aprotinin in three groups of children < 15 kg, presenting with isolated ventricular septum defect (n = 60), tetralogy of Fallot (n = 52), and transposition of the great arteries (n = 56). Low-dose aprotinin regimen A1 (500,000 KIU in pump prime only) and high-dose aprotinin A2 (50,000 KIU/kg during induction of anesthesia, 50,000 KIU/kg in pump prime, and 20,000 KIU/h continuous infusion) were compared to a control group A0 (without aprotinin) regarding perioperative blood loss, transfusion requirements, and effects on the coagulation system. RESULTS: The most common coagulation tests of aprotinin-treated patients and the platelet numbers were comparable with those of control patients preoperatively and 15 minutes after protamine administration. A significant dose-dependent reduction in fibrin-fibrinogen split products was observed at the end of cardiopulmonary bypass in the majority of aprotinin-treated patients with transposition. In patients with ventricular septum defect and Fallot, no significant difference in blood loss and transfusion requirements could be observed between patients with or without aprotinin and no difference was observed between low- and high-dose regimen. In transposition of the great arteries, high-dose aprotinin led to significant reduction of blood loss (p = 0.02) and postoperative blood transfusion (p = 0.003). Severe side effects as a result of administration of aprotinin were not observed. CONCLUSIONS: High-dose aprotinin reduces blood loss and transfusion requirement only in complex congenital cardiac operations; therefore aprotinin cannot be recommended as a blood conservation agent in routine pediatric operations.

Anesthesia, General↗
PubMed1998

Improved exposure of the pulmonary arteries for thromboendarterectomy.

Pulmonary thromboendarterectomy is a surgical technique for treating pulmonary hypertension caused by unresolved pulmonary embolism. It has been recommended to perform this procedure under deep hypothermic circulatory arrest. Here we describe two technical modifications: (1) improved exposure to the right pulmonary artery by division of the superior caval vein and (2) thromboendarterectomy in normothermic cardiopulmonary bypass, with beating heart or electrically induced ventricular fibrillation. These modifications allow complete endarterectomy of both pulmonary arteries under normothermic conditions, thus avoiding hypothermic circulatory arrest, which results in short cardiopulmonary bypass times and reduces the morbidity and mortality of this procedure.

Cardiopulmonary Bypass↗
PubMed1998

Fluorescence activated cell sorting: a reliable method in tissue engineering of a bioprosthetic heart valve.

BACKGROUND: Techniques of tissue engineering are used to seed human autologous cells in vitro on degradable mesh to create new functional tissue like a bioprosthetic heart valve. A precondition is subsequent seeding of native-valve-analogous pure endothelial and myofibroblast cell lines. The aim of this study is to find a safe method of isolating viable cell lines out of tissues from the operating room. METHODS: Mixed cells from ascending aorta obtained from the operating room were incubated with an endothelial-specific fluorescent marker. The labeled cells were activated and sorted by flow cytometry. Isolated cell lines were cultured and thereafter square sheets of polymeric scaffold were seeded with myofibroblasts, followed by endothelial cells. The created tissue was stained with hematoxylin and eosin, van Gieson stain, and stains for factor VIII and CD34. RESULTS: Control culture samples (n = 25) revealed vital uncontaminated endothelial and myofibroblast cell lines. Microscopy of the seeded meshes (n = 16) demonstrated a tissue-like structure. Van Gieson stain showed production of collagen. Endothelial cells formed a superficial monolayer, demonstrated by factor VIII and CD34; no invasive formation of capillaries was detectable. CONCLUSIONS: These results demonstrate that fluorescence activated cell sorting is a reliable and safe method to gain pure vital autologous cell lines out of human mixed cells for subsequent seeding on degradable mesh and that those cells are active to form new tissue.

Aorta↗
PubMed1998

Disadvantages of local repair in acute type A aortic dissection.

BACKGROUND: In acute type A dissection of the aorta, local repair with glue-aortoplasty was compared with aortic replacement. METHODS: Between 1992 and 1996, 106 consecutive patients (mean age, 59 years; 84 men) were operated on average 14.5 hours after onset of dissection. A local repair (gelatin-resorcine-formaldehyde/glutaraldehyde glue, Trigon AG, Monchengladbach, Germany) without graft replacement was performed in 21 patients. Graft replacement and reinforcement of aortic stumps with gelatin-resorcine-formaldehyde/glutaraldehyde glue was performed in 85 patients (supracoronary graft, 68; aortic root replacement, 17). RESULTS: Survival was 79% after 30 days and 69% after 2 years. There was no difference in early mortality (p = 0.2240) and survival (p = 0.07649). Risk factors for early mortality were preoperative shock, neurologic disorder, duration of crossclamp, and extracorporeal circulation. The rate of reoperation on the proximal aorta was 31.6% (6 of 19) after local repair and 9% (6 of 64) after aortic replacement (p = 0.0157). Local repair was a significant predictor for reoperation (p = 0.0087), with decreased reoperation-free survival (p = 0.01164). In all reinterventions (four supracoronary grafts, including two valve replacements; two composite grafts; two arch replacements) breakdown of the aortoplasty was confirmed. CONCLUSION: Local repair has satisfactory early results but an increased incidence of reoperations due to a breakdown of the glue-aortoplasty. Indications for local repair should be restricted to high-risk patients requiring a minimal emergency surgical procedure.

Acute Disease↗
PubMed1998

Cryopreserved arterial allografts in the treatment of major vascular infection: a comparison with conventional surgical techniques.

OBJECTIVE: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infections. METHODS: Seventy-two patients with mycotic aneurysms (n = 29) or infected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal aorta (n = 46) were treated with in situ repair and extra-anatomic reconstruction using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34). Disease-related survival and survival free of reoperation were assessed. Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up. RESULTS: The use of cryopreserved arterial allografts was superior to conventional surgery in terms of disease-related survival (P =.008), disease-related survival free of reoperation (P =.0001), duration of intensive care per year of follow-up (median 1 vs 11 days; range 1 to 42 vs 2 to 120 days; P =.001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P =.002), duration of postoperative antibiotic therapy (21 vs 40 days; range 21 to 90 vs 60 to 365 days; P =.002), incidence of complications (24% vs 63%; P =.005), and elimination of infection (91% vs 53%; P =.001). In addition, costs were 40% lower in the group treated by allografts (P =.005). CONCLUSIONS: The use of cryopreserved arterial allografts is a more effective treatment for mycotic aneurysms and infected vascular prostheses than conventional surgical techniques.

Adult↗
PubMed1998

Preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction.

OBJECTIVE: Late outcome after mitral valve repair was examined to define preoperative predictors of recurrent atrial fibrillation late after successful mitral valve reconstruction. METHODS: One hundred and eighty-nine patients, 112 with preoperative sinus rhythm and 72 with preoperative chronic or intermittent atrial fibrillation, were followed for 12.2 +/- 10 years after valve repair. Clinic, hemodynamic end echocardiographic data were entered into Cox-regression and Kaplan-Meyer analysis to assess predictors for recurrent atrial fibrillation late after successful mitral valve repair. RESULTS: Univariate and multivariate predictors for recurrent atrial fibrillation late after successful mitral valve reconstruction were preoperative atrial fibrillation (P = 0.0001), preoperative antiarrhythmic drug treatment (P = 0.005), heart rate (P = 0.01), left ventricular ejection fraction (P = 0.01) and increased left ventricular posterior wall thickness (P = 0.05). Patients > 57.5 years with a mean pulmonary artery pressure > or =23 mm Hg and a history of preoperative antiarrhythmic drug treatment had an odds ratio of 53.33 (95% confidence limits 6.12-464.54) for atrial fibrillation late after successful mitral valve repair. CONCLUSION: Older patients with a history of atrial fibrillation, antiarrhythmic treatment or an elevated pulmonary artery pressure may present atrial fibrillation late after successful mitral valve repair. They could be considered for combined mitral valve reconstruction and surgery for atrial fibrillation even though sinus rhythm is present preoperatively.

Adult↗
PubMed1998

[Aortic valve replacement: technique and outcome with artificial heart valves and allografts].

Prosthetic aortic valve replacement has become a highly effective surgical treatment for aortic valve stenosis and aortic valve incompetence. After a properly timed aortic valve replacement, age- and gender-related actuarial survival can be similar to those of a normal healthy population, if serious late valve-related complications do not occur. The perioperative risk of isolated aortic valve replacement approaches 1% to 2% mainly influenced by valve- and patient-related factors such as age, left ventricular function, New York Heart Association class, preoperative hemodynamic and time of operation. Despite a number of various mechanical, bioprosthetic and biological heart valve prostheses, aortic valve replacement remains a palliative surgical treatment. Life-long anticoagulation is required by patients with mechanical heart valve prostheses, and, degeneration and subsequent reoperation is inherent in all bioprosthetic devices. The availability of cryopreserved allograft is limited and the Ross-operation is a technically demanding procedure with a somewhat higher perioperative mortality. Perioperative morbidity after isolated aortic valve replacement is low. A fatal neurological event, the most dreaded complication after aortic valve replacement, is found in about 0.5% of patients. Post-operatively, left ventricular hypertrophy decreases and cardiac dysfunction, reflected by the left-ventricular ejection rate is reversed in most patients, associated with an excellent clinical outcome and an age- and sex-specific normal long-term survival. To offer the most appropriate valve substitute to the individual patient, the debate focus on the question of whether patients benefit from durable mechanical heart valves or a primary anticoagulation-free bioprosthesis. However, there is no difference found between the prostheses types with regard to serious valve related complications such as major thromboembolism and hemorrhage, fatal reoperation and valve-related mortality. The search for an ideal permanent substitute for the aortic valve continues. To date, proper indication, optimal timing of the operation and careful analysis of the late results may help to improve the long-term survival of patients with after isolated aortic valve replacement.

Aortic Valve↗
PubMed1997

[Is hemofiltration following acute kidney failure in elderly cardiovascular surgery patients justified?].

In a retrospective study, 47 patients with acute renal failure following cardiovascular surgery were evaluated in the Cardiovascular Surgery ICU of the University Hospital, Zurich, from 1991 to 1994. The object of the study was to investigate the contribution of hemofiltration for acute renal failure following cardiovascular surgery. The aim was further to identify risk factors which impair survival. We found that overall mortality was 70.2%, but was influenced by the patients' age. In patients under 60 (n = 9) the mortality rate was 55.6%; in patients from 60 to 69 (n = 19) the mortality rate was 57.9%. However, in patients aged 70 and over (n = 19), there was an increase in mortality to 89.5%. Specifically, the outcome was tested in a stepwise logistic regression and we found that recovery of renal function following hemofiltration was the most important factor favoring survival (p < 0.001). Further statistical analysis revealed that age 70 years or over was one of the main risk factors leading to death (p < 0.03), whereas preoperative renal insufficiency had no influence on postoperative outcome (p < 0.29). We conclude that postoperative renal function represents the crucial factor in survival. Although hemofiltration achieved adequate results in all groups, the patients of 70 years and more experienced a significantly higher mortality rate. This suggests that the increased mortality of the elderly was not due to renal failure in itself but rather was related to polymorbidity. Hence we propose that in the latter group of elderly patients candidates for hemofiltration are to be very carefully selected, particularly if they have additional complications.

Acute Kidney Injury↗