Biomedical subjects

Mohamed Amrani

Publications and source records attributed to Mohamed Amrani.

At least 37 records · Page 2Linked to original sources

PubMed2003

Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high-risk patients.

OBJECTIVE: Although there has been some evidence supporting the theoretical and practical advantages of off-pump coronary artery bypass (OPCAB) over the conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB), it has not yet been determined which group of patients would benefit most from it. It has been advocated recently that high-risk patients could benefit most from avoidance of CPB. The aim of this retrospective study is to assess the efficacy of the OPCAB technique in multi-vessel myocardial revascularization in a large series of high-risk patients. METHODS: The records of 1398 consecutive high-risk patients who underwent primary isolated CABG at Harefield Hospital between August 1996 and December 2001 were reviewed retrospectively. Patients were considered as high-risk and included in the study if they had a preoperative EuroSCORE of > or =5. Two hundred and eighty-six patients were operated on using the OPCAB technique while 1112 patients were operated on using the conventional CABG technique with CPB. The OPCAB patients were significantly older than the CPB patients (68.1+/-8.3 vs. 63.7+/-9.9 years, respectively, P<0.001). The OPCAB group included significantly more patients with poor left ventricular (LV) function (ejection fraction (EF) < or =30%) (P<0.001) and more patients with renal problems (P<0.001). RESULTS: There was no significant difference in the number of grafts between the groups. The CPB patients received 2.8+/-1.2 grafts per patient while OPCAB patients received 2.8+/-0.5 grafts per patient (P=1). Twenty-one (7.3%) OPCAB patients had one or more major complications, while 158 (14.2%) CPB patients (P=0.008) developed major complications. Thirty-eight (3.4%) CPB patients developed peri-operative myocardial infarction (MI) while only two (0.7%) OPCAB patients developed peri-operative MI (P=0.024). The intensive therapy unit (ITU) stay for OPCAB patients was 29.3+/-15.4 h while for CPB patients it was 63.6+/-167.1 h (P<0.001). There were ten (3.5%) deaths in the OPCAB patients compared to 78 (7%) deaths in the CPB patients (P=0.041) within 30 days postoperatively. CONCLUSIONS: This retrospective study shows that using the OPCAB technique for multi-vessel myocardial revascularization in high-risk patients significantly reduces the incidence of peri-operative MI and other major complications, ITU stay and mortality. Even though the OPCAB group included a significantly higher proportion of older patients with poor LV function (EF < or =30%) and renal problems, the beneficial effect of OPCAB was evident.

Aged↗

PubMed2003

Age-related changes in the protective effect of chronic administration of L-arginine on post-ischemic recovery of endothelial function.

OBJECTIVE: The aim of this study was to assess the effect of chronic administration of L-arginine (LA) on vascular functions as well as its age-related changes. METHODS: Male Sprague-Dawley rats aged 1, 4, 8 and 16 months were divided into control and LA groups, which were administered LA (4 mg/ml) for 6 weeks. Isolated heart perfusion was performed, followed by cardioplegic arrest for 4h at 4 degrees C and reperfusion. Vascular functions were assessed through observations of pre-/post-ischemic coronary flow response to 5-hydroxytryptamine (5-HT) and glyceryl trinitrate (GTN). Ultrastructure was studied after the same ischemia-reperfusion. RESULTS: A significant improvement of percentage recovery (post-/pre-ischemic value) of response to 5-HT were seen in 4 and 8 months LA group when compared to the control (84.2+/-14.0 vs. 33.9+/-12.5 (P<0.05) and 97.0+/-23.2 vs. 21.5+/-9.7 (P<0.05), respectively). Furthermore, 8 months LA group had better percentage recovery of response to GTN (124.5+/-41.6 vs. 47.7+/-6.3, P<0.05). Ultrastructural study showed no significant differences between the groups in any age. CONCLUSIONS: Chronic oral administration of LA enhanced the post-ischemic recovery of vascular function in the young adult and adult hearts, but not in the infant and elderly.

Aging↗

PubMed2003

Effect of ascorbic acid on endothelium-dependent vasodilatation of human arterial conduits for coronary artery bypass grafting.

OBJECTIVE: Techniques aimed at improving the performance of arterial conduits will maximize the clinical benefit achievable with coronary artery bypass surgery. Controlling oxidant stress could be a strategy for preventing early graft deterioration. We tested the effect of a free radical scavenger, ascorbic acid (vitamin C), on preserving the endothelium-dependent vasodilatation function in vitro of radial artery and internal thoracic artery. We also tested its effect on the amount of reactive oxygen species (ROS) generated by each graft. METHODS: Radial artery (RA, n=25) and internal thoracic (ITA, n=19) segments were obtained from coronary artery bypass grafting patients. Each segment was divided into 3-4 mm vascular rings and incubated with or without ascorbic acid (10(-3) mol/l) for 1 h or 72 h. Using the organ bath technique, the endothelium-dependent vasodilatation function was tested in vitro by the addition of cumulative concentrations of acetylcholine (10(-9)-10(-5) mol/l) following vasocontraction by endothelin-1 (3 x 10(-8) mol/l). ROS were measured by using chemiluminescence technique at 1-h and after 72 h incubation with or without ascorbic acid. RESULTS: There were no differences in the vasodilatation function between control and ascorbic acid group of both arteries in the 1-hour incubation experiment. However, in the 72 h incubation experiment, ascorbic acid preserved the endothelium-dependent vasodilatation function of RA compared with control group (35.8+/-2.2% vs. 25.9+/-2.1%; P=0.005), but not ITA (39+/-3.5% vs. 40.5+/-9.3%; P=0.438). After 72 h incubation, RA generated significantly more free radicals compared with 1 h (133.7+/-151.5 vs. 16.8+/-16.8 cps/mg x 100; P=0.01); however, AA has no statistically significant effect on decreasing the amount of free radicals generated by both arteries. CONCLUSIONS: In RA, ascorbic acid is able to preserve the endothelium-dependent vasodilatation function after 72 h incubation, but not after 1 h. However, the mechanism of action of AA is not completely understood. This finding could open the door for understanding the role of oxidant stress and antioxidants in preserving the endothelial function of coronary artery bypass grafts.

Aged↗

PubMed2003

Off-pump coronary artery bypass surgery is associated with reduced neutrophil activation as measured by the expression of CD11b: a prospective randomized study.

BACKGROUND: Coronary artery bypass grafting (CABG) surgery is associated with systemic inflammation. Activation of neutrophils is a crucial step in inflammation and results in neutrophil sequestration within the tissues. One of the potential advantages of performing off-pump coronary artery bypass (OPCAB) surgery is the attenuation of the systemic inflammatory response. This prospective randomized study compares neutrophil activation in patients undergoing OPCAB versus those undergoing CABG with cardiopulmonary bypass (CPB). METHODS: Twenty patients undergoing primary isolated CABG were randomly divided prospectively into 2 groups: 1 group underwent CABG with CPB, and the other group underwent OPCAB. Central venous blood samples were obtained before skin incision and at 15 minutes, 60 minutes, 2 hours, 5 hours, and 24 hours following the initiation of CPB or application of the stabilization device. Differential white cell counts were measured with routine laboratory techniques. CD11b surface expression on neutrophils was measured by flow cytometry. Interleukin 8 levels in the plasma were measured by enzyme-linked immunosorbent assays. RESULTS: The 2 groups were matched with respect to preoperative and operative characteristics. White cell and neutrophil counts rose in both groups following the operation but were significantly higher in the OPCAB group at 5 hours (P < .001 and P = .002, respectively). Interleukin 8 concentrations were significantly higher in the CPB group at 5 hours following the initiation of CPB (P = .034). CD11b levels were significantly higher in the CPB group at 60 minutes (P = .002). CONCLUSION: This prospective randomized study demonstrates that the activation of circulating neutrophils as measured by CD11b expression is lower following OPCAB than in CPB. Although OPCAB is associated with significantly higher neutrophil counts, these neutrophils exhibit fewer activation markers. The lower postoperative neutrophil counts occurring in the CPB group may be explained by the activation and consequent sequestration of the neutrophils in the CPB circuit and tissues.

Aged↗

PubMed2002

Conversion to off-pump coronary bypass without increased morbidity or change in practice.

BACKGROUND: This article examines the feasibility of complete conversion from conventional coronary artery operation to routine off-pump coronary bypass operation. METHODS: Data on our first 285 off-pump procedures using the Octopus system (Medtronic Inc, Minneapolis, MN) represent our learning curve. This is a complete experience in coronary bypass surgery over 16 months. RESULTS: The cohort was nonselected. All patients had at least two-vessel disease. Eight hundred seven grafts were performed (mean, 2.8 per patient) of which 647 grafts (84%) were arterial (mean, 2.3 per patient). One hundred seventy nine patients (63%) underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications were: mortality, 3 patients (1.5%); renal failure, 24 patients (8%); stroke, 2 patients (< 1%); and atrial fibrillation, 60 patients (21%). The morbidity data and frequency of arterial grafting did not differ from that of 355 patients who underwent coronary bypass operations in a preceding 18-month period. CONCLUSIONS: Complete shift from routine use of cardiopulmonary bypass to nonselective off-pump coronary bypass operation is possible with a low conversion rate and without an apparent increase in morbidity or change in technique. Whereas short-term safety and efficacy seem certain, studies of long-term outcome are necessary before the eventual role of off-pump coronary bypass in myocardial revascularization can be defined.

Aged↗

PubMed2002

Early clinical and angiographic outcome of the pedicled right internal thoracic artery graft to the left anterior descending artery.

BACKGROUND: The left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery became the gold standard graft in coronary surgery. Subsequently, the right internal thoracic artery (RITA) graft was increasingly used. However, there is still some debate about the optimal way of using this conduit. The aim of the present study was to assess our experience in grafting the pedicled RITA graft to LAD in 212 consecutive patients. METHODS: The records of 212 consecutive patients who underwent isolated coronary artery bypass grafting with the pedicled RITA graft to the LAD artery at Harefield Hospital between January 1998 and May 2001 were retrospectively reviewed. We approached the last 35 consecutive patients to obtain an angiographic control group. All 35 patients (16.5%) consented and, before discharge, underwent angiography to look at the quality of anastomoses and the patency of grafts. RESULTS: Successful catheterization and engagement of the RITA grafts was performed in 32 patients. Angiography showed that 32/32 (100%) of the RITA grafts were widely patent with excellent flow. The distal anastomoses of these RITA grafts were also satisfactory. There were no deaths among the study patients. CONCLUSIONS: Our results show that the use of the pedicled RITA graft to the LAD artery provides a good early clinical and angiographic outcome, and suggests that the pedicled RITA graft to the LAD artery is a good alternative to the pedicled LITA graft to the LAD artery.

Adult↗

PubMed2002

Mitral annulus distortion during beating heart surgery: a potential cause for hemodynamic disturbance--a three-dimensional echocardiography reconstruction study.

BACKGROUND: Positioning for access to the coronary arteries leads to hemodynamic instability during off-pump cardiac surgery. External changes have been well described, but a description of the intracardiac structures in humans has not been described. METHODS: With multiplane intraoperative echocardiography, the mitral annulus at end diastole was reconstructed in the different positions and correlated with hemodynamic changes in the right heart and left atrium. RESULTS: Significant distortion of the mitral annulus with enlargement of the left atrium and pulmonary veins was demonstrated, which correlated with high left atrial pressures. CONCLUSIONS: Mitral valve distortion can significantly contribute to hemodynamic instability during positioning for off-pump cardiac surgery.

Blood Pressure↗

PubMed2002

Effects of cerivastatin on vascular function of human radial and left internal thoracic arteries.

BACKGROUND: Statins may enhance vascular function independently of effects on cholesterol. This study investigated the ability of statins to modulate the vascular recovery of arteries used as coronary bypass grafts. METHODS: Specimens of radial artery and left internal thoracic artery were obtained during coronary artery bypass grafting. The specimens were divided into vascular rings, which were incubated in the absence or presence of cerivastatin (10(-6) mol/L) for either 2 or 24 hours. Using an organ bath technique, endothelial function was examined using acetylcholine (10(-9) to 10(-5) mol/L) after contraction by 3x10(-8) mol/L of endothelin-1. RESULTS: Time-related endothelial dysfunction was shown in the control group of radial artery but not in the cerivastatin group: maximal endothelium-dependent vasodilation in the control and cerivastatin groups were 56.8% +/- 10.2% and 65.9% +/- 10.1% at 2 hours and 39.4% +/- 4.7% and 68.4% +/- 5.0% (p < 0.01, vs control) at 24 hours, respectively. On the other hand, in the left internal thoracic artery, those in the control and cerivastatin groups were 38.3% +/- 8.2% and 45.0% +/- 5.5% at 2 hours and 38.1% +/- 8.2% and 56.5% +/- 8.8% at 24 hours, respectively (NS). CONCLUSIONS: In radial artery, cerivastatin significantly preserved endothelium-dependent vasodilation, which diminished with time in the control group. This could have very important implications in the clinical practice of coronary artery bypass grafting.

Adult↗

PubMed2002

Use of radial artery graft reduces the morbidity of coronary artery bypass graft surgery in patients aged 65 years and older.

BACKGROUND: The use of the radial artery graft in patients aged 65 years and older could prevent the occurrence of leg wound infection, which is known to increase the morbidity of coronary artery bypass grafting surgery. METHODS: We reviewed, retrospectively, 261 patients aged 65 years and older (age range 65 to 93 years), who underwent coronary artery bypass grafting surgery between February 1998 and August 2001. All the patients received at least one radial artery graft in addition to either a left internal thoracic artery, right internal thoracic artery, or saphenous vein graft as required. Saphenous vein grafts were used in 141 (54.1%) patients (group 1), and these were compared to 120 (45.9%) patients (group 2) who received only arterial conduits. Angiography was performed on 26 consecutive patients. The aim of the study was to review the clinical and angiographic outcomes in this population. RESULTS: The mean number of distal anastomoses performed was 2.98. Mean global operating time was 204 minutes. This time dropped to 201 minutes in group 1 versus 231 minutes in group 2; p = 0.009. Sixteen (11.3%) patients receiving saphenous vein grafts had leg wound infection whereas only 1 (0.3%) patient of the global population had a forearm infection. The mean global hospital stay was 9.81 days; this duration increased to 13 days when leg wound infection occurred versus 9.1 days when infection did not occur; p = 0.008. Twenty-six (10%) patients underwent an early angiographic study. Twenty-four (92.3%) radial artery grafts were patent. CONCLUSIONS: The routine use of radial artery grafts in patients aged 65 years and older is feasible, safe, and does not increase mortality, morbidity, or the complexity of coronary artery bypass grafting surgery.

Aged↗

PubMed2002

The effect of chronic L-arginine administration on vascular recovery following cold cardioplegic arrest in rats.

OBJECTIVE: Acute administration of L-arginine (LA), the physiological substrate of nitric oxide, has been used as a strategy for myocardial protection during ischemia-reperfusion. The aim of this study was to assess the effects of chronic oral LA administration on vascular functions and morphology after prolonged cold cardioplegic arrest. METHODS: Adult male Sprague-Dawley rats (600-650 g) were divided into control and LA groups, which received LA (4 mg/ml) for 6 weeks. Two experimental protocols were carried out. (1) Isolated rat heart perfusion was performed and hearts were subjected to ischemia for 4 h at 4 degrees C using cold crystalloid cardioplegia (n=8 in LA, n=7 in control). Endothelial and vascular smooth muscle functions were assessed through observations of pre- and post-ischemic coronary flow response to 5-hydroxytryptamine (5-HT) and glyceryl trinitrate (GTN) (%5-HT and %GTN, respectively). (2) Semi-quantitative assessment of tissue morphology was conducted after the same ischemia-reperfusion protocol (n=4 in each group). RESULTS: The LA group showed significantly better recovery (post-/pre-ischemic value) of %5-HT (97.0+/-65.6 versus 21.5+/-25.7%, P=0.015) and %GTN (124.5+/-117.6 versus 47.7+/-16.6%, P=0.021). The histological assessment showed no significant differences between the two groups. CONCLUSIONS: Chronic oral administration of LA significantly ameliorated the postischemic recovery of endothelial and vascular smooth muscle functions after cold cardioplegic arrest in rats.

Administration, Oral↗

PubMed2002

Differential effects of endothelin-1 on isolated working rat hearts before and after ischaemia and reperfusion.

Endothelin (ET) may have both detrimental (reduced coronary flow) and beneficial effects (positive inotrope, reduced arrhythmogenesis) following ischaemia. We examined the effects of ET on cardiac function during reperfusion following prolonged hypothermic cardioplegic arrest in a protocol mimicking cardiac transplantation. Isolated working rat hearts were perfused with Krebs buffer to which increasing concentrations of ET-1 or sarafotoxin S6c had been added. Identical experiments were performed after 4 h of cardioplegic arrest at 4 degrees C. Under pre-ischaemic conditions ET-1 caused a dose-dependent decrease in cardiac function compared with controls. In contrast, following ischaemia low doses of ET-1 (10(-10) M) caused a significant and beneficial increase in cardiac output (109.1% versus 81.3%), dP/dt i.e. the rate of change of pressure with time (94.7% versus 75.6%) and stroke volume (100.3% versus 77.5%) compared with controls (P<0.05). At higher doses of ET-1 there was a detrimental effect on cardiac output, dP/dt and stroke volume similar to that seen prior to ischaemia. Sarafotoxin S6c had no significant effect pre or post ischaemia on any of the parameters measured compared with controls (P=not significant). ET-1 at low concentrations during reperfusion can improve the recovery of cardiac function mediated via ET(A) receptors. ET may play an important physiological role in the recovery of cardiac function following prolonged ischaemia.

Analysis of Variance↗

PubMed2002

Up-regulation of endothelin-converting-enzyme mRNA expression following cardioplegic arrest.

Endothelin-1 (ET-1) is believed to play an important role in cardiac ischaemia/reperfusion injury. ET-1 is synthesized from preproET-1 by the action of ET-converting enzyme (ECE). It is unclear to what extent the ET system is activated following prolonged ischaemia. In this study we used a model mimicking the conditions of the donor heart during transplantation. Isolated rat hearts perfused with Krebs-Henseleit buffer were subjected to 30 min of normothermic perfusion, then 4 h of cardioplegic arrest at 4 degrees C with St Thomas' Hospital solution, followed by reperfusion for 2 h. Hearts were freeze-clamped at different time points during the protocol. Using quantitative reverse transcription-PCR, relative levels of ET-1 and ECE mRNA expression were measured and compared with a housekeeping gene (ribosomal protein L32). During reperfusion there was a consistent decrease in coronary flow to approx. 85-90% of pre-ischaemic flow. There was no significant alteration in preproET-1 mRNA expression during 2 h of reperfusion. However, ECE mRNA expression was increased by 77.5% at 1 h and by 74.6% at 2 h following ischaemia compared with pre-ischaemic values (P<0.05). Thus we conclude that ECE mRNA expression is increased following prolonged hypothermic cardioplegic arrest. Elevations in the expression of this enzyme may help to explain the role of the ET system in the pathogenesis of ischaemia/reperfusion injury following cardiac surgery and transplantation.

Animals↗

PubMed2002

The early clinical and angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique.

OBJECTIVE: The emergence of the off-pump coronary artery bypass technique has made surgeons consider combining it with other techniques developed and learned with conventional coronary artery bypass grafting with cardiopulmonary bypass. One of these techniques is the construction of a sequential graft to bypass more than one coronary vessel. The purpose of this study is to review the outcome of combining sequential coronary artery bypass grafting with off-pump techniques. METHODS: We retrospectively reviewed the records of 45 consecutive patients who underwent isolated coronary bypass surgery with off-pump and sequential grafting techniques at Harefield Hospital (Harefield, UK) between July 1999 and December 2000. The registry database, medical notes and charts were studied for preoperative and postoperative data of the patients. Ten patients consented and underwent early postoperative angiography to check the quality of the grafts and anastomoses. RESULTS: There were no deaths among the study patients. Morbidity consisted of atrial fibrillation in 6 patients (13.3%), leg wound infection in 2 patients (4.4%), and pleural effusion in 1 patient (2.2%). Early angiography of the 10 consenting patients revealed 10 patent sequential grafts (100%) with 20 satisfactory end-to-side and side-to-side anastomoses (100%). CONCLUSION: The combination of sequential grafting and off-pump techniques is feasible, is safe, and provides good early clinical and angiographic outcomes.

Adult↗

PubMed2002

Transvalvular velocities after full aortic root replacement: results from a prospective randomized trial between the homograft and the Medtronic Freestyle bioprosthesis.

BACKGROUND AND AIM OF THE STUDY: Unstented bioprostheses offer better hemodynamics after aortic valve replacement. It has been reported recently that subcoronary implantation of the Freestyle valve may result in increased transvalvular velocities. In a prospective randomized trial, transvalvular velocities were investigated after implantation of a homograft or a Medtronic Freestyle bioprosthesis as a full root. METHODS: A total of 137 patients was randomized to receive either a homograft (group H, n = 64) or a Freestyle (group F, n = 73) root replacement. Echocardiographic investigations were performed at six weeks, six months, and then yearly after surgery. Transvalvular and subvalvular velocities were recorded from each echocardiogram. RESULTS: At follow up, none of the patients showed high transvalvular or subvalvular velocities (>2 m/s). At six weeks after surgery the transvalvular velocity was 1.5+/-0.3 m/s in group H (n = 51) and 1.7+/-0.3 m/s in group F (n = 56) (p = NS), while subvalvular velocities were 0.9+/-0.3 and 1.0+/-0.3 m/s, respectively (p = NS). These findings remained constant up to the three-year follow up, when transvalvular velocity was 1.6+/-0.4 m/s in group H (n = 10) and 1.6+/-0.2 m/s in group F (n = 15) (p = NS). Subvalvular velocities were 0.9+/-0.1 and 0.9+/-0.1 m/s, respectively (p = NS). CONCLUSION: Full aortic root replacement and reimplantation of the coronary arteries either with the Medtronic Freestyle or the homograft valve produces near-normal transvalvular velocities less than were reported for the Freestyle in the subcoronary implantation.

Adult↗

PubMed2002

Evaluation of left ventricular function and mass after Medtronic Freestyle versus homograft aortic root replacement using cardiovascular magnetic resonance.

BACKGROUND AND AIM OF THE STUDY: Regression of left ventricular hypertrophy (LVH) after aortic valve replacement has traditionally been measured by echocardiography. However, cardiovascular magnetic resonance (CMR) can be used to measure left ventricular function and mass more accurately and reproducibly. This translates into fewer patients being needed to demonstrate significant changes. The study aim was to demonstrate the feasibility of using CMR to measure left ventricular mass index (LVMI) and function in patients from a prospective randomized trial, and to compare homografts with the Medtronic Freestyle root replacement. METHODS: Among 23 patients recruited, 17 had LVMI and function (end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF)) measured pre- and postoperatively using CMR (eight homograft, nine Freestyle). RESULTS: Significant regression of LVH was seen in both groups one year postoperatively (homograft LVMI 145+/-44 g/m2 preoperative versus 83+/-23 g/m2 one year postoperatively; Freestyle LVMI 140+/-28 g/m2 versus 93+/-21 g/m2, respectively). At six months there was significant regression in the xenograft group (from 140+/-28 to 106+/-22 g/m2; p <0.05) and a trend towards regression in the homograft group (from 145+/-44 to 103+/-25 g/m2; p = NS). There was also a trend towards a reduction in EDV, ESV and SV, and an increase in EF over one year in both groups. CONCLUSION: Regression of LVH was measured using CMR in patients after aortic root replacement and coronary implantation with the homograft and Medtronic Freestyle root replacement. Despite the small number of patients studied, it was possible to demonstrate the extent and pattern of regression of left ventricular mass in the two groups.

Aged↗

PubMed2002

Aortic distensibility after aortic root replacement assessed with cardiovascular magnetic resonance.

BACKGROUND AND AIM OF THE STUDY: The changes in geometry of the aortic root during the cardiac cycle are thought to be essential for optimal valve function, both in terms of leaflet stress and dynamic behavior. Using cardiac magnetic resonance (CMR), the study aim was to determine aortic root distensibility of the homograft (group H) and the Medtronic Freestyle xenograft (group F) after aortic root replacement, from a prospective randomized trial. METHODS: CMR was performed in 15 patients (six homografts, nine Freestyle) at six months and one year after surgery. Percentage change in aortic radius (PCR) and pressure strain elastic modulus (PSEM) were measured as indices of distensibility, and results related to left ventricular mass (LVM). RESULTS: At six months after surgery, mean PCR was 12+/-2.5 in group H and 12.9+/-6.1 in group F (p = NS), and PSEM was 428.5+/-69.8 and 493.5+/-72.7 g/cm2, respectively (p = NS). PCR was reduced to 10+/-1.7% in group H, and by 8.5+/-2.8% in group F (p = NS), while PSEM was increased to 520.5+/-87.3 and 825+/-420.4, respectively (p = NS) at the one-year follow up. Regression analysis showed a correlation between PCR and LVM (r = 0.52, p = 0.08) and LVM index (r = 0.46, p = 0.14), respectively. In addition, there was a relationship between PSEM, LVM and LVM index, suggesting that the stiffer the root wall, the higher the postoperative LVM. CONCLUSION: Up to one year after aortic root replacement, the wall of both the allogenic and xenogenic valves retained near-normal distensibility. For the first time, a correlation was demonstrated between the elastic properties of the aortic root and LVM. The longer-term behavior and clinical implications of these findings require further investigation.

Aged↗

PubMedDate not supplied

Multivessel off-pump coronary artery bypass grafting can be taught to trainee surgeons.

BACKGROUND: Although Off-Pump Coronary Artery Bypass (OPCAB) surgery is being increasingly explored and practised in many cardiac units worldwide, there have been only few reports documenting the training of surgeons in this new technique. The purpose of this study was to address the reproducibility of the OPCAB in a unit where this technique is used extensively. METHODS: Registry data, notes, and charts of 64 patients who were operated on by four trainee cardiac surgeons over a period of thirteen months at Harefield Hospital, were reviewed retrospectively. These trainees were part of an accredited training program for cardiothoracic training and were trained by a single consultant trainer in a cardiac unit after it had an established recent experience in performing nonselective OPCAB for all in-coming patients. Five (7.8%) patients (with 17 distal anastomoses) consented and underwent early postoperative angiography to check the quality of the grafts and anastomoses. RESULTS: The mean age of the study patients was 65.6 and the mean Parsonnet score was 9.4. There was a mean of 2.9 grafts per patient and circumflex territory anastomoses were performed in 48 (75%) patients. No operation required conversion to Cardiopulmonary Bypass (CPB). Angiography of the five patients revealed 17 satisfactory (100%) distal anastomoses. CONCLUSION: With appropriate training, it is possible for trainees to learn OPCAB and perform multivessel revascularization in relatively high-risk patients with good results.

Adult↗

PubMedDate not supplied

The clinical outcome and quality of life following minimally invasive direct coronary artery bypass surgery.

BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) through a limited anterior small thoracotomy has been shown to be a promising technique of surgical treatment for single or double vessel disease. Little is known about the Health-Related Quality Of Life (HRQOL) in this group of patients. METHODS: The records of 75 consecutive patients who underwent MIDCAB procedure at Harefield Hospital between April 2000 and January 2002 were reviewed retrospectively. HRQOL assessment was planned in a cross-sectional design. Patients were contacted by telephone to conduct a semi-structured interview and were sent two questionnaires: the Short Form health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: There was no in-hospital death. Patients stayed in the Intensive Therapy Unit (ITU) for 11.56 +/- 4.55 hours and stayed in hospital for 3 +/- 2.34 days. None of the study patients had perioperative myocardial infarction (MI) or neurological complications including permanent and transient strokes. We were able to contact all the 75 patients by telephone and they also completed the SF-36 and HADS. The SF-36 scores were compared to an age-matched group of normal British people. The MIDCAB group had an excellent general health perception compared to the normal group (p < 0.001), but similar scores otherwise. The HADS scores showed that only 1 patient (1.3%) had mild depression, 5 patients (6.7%) had mild anxiety, and 2 patients (2.6%) had moderate anxiety. CONCLUSION: MIDCAB is a safe surgical treatment and provides excellent clinical and HRQOL outcomes.

Age Distribution↗