Search PubMed⌕ Search

Biomedical subjects

W Bircks

Publications and source records attributed to W Bircks.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Complications following heart valve replacement by mechanical and biologic prostheses].

From 1973 to 1985 2394 mechanical valve prostheses (MVP) (follow-up time 110,653 months) and 186 biological valve prostheses (BVP) (follow-up time 5887 months) were implanted. There were only small differences according to the cumulative incidence of prosthetic malfunctions, for reoperations after 10 years: MVP 5.4 +/- 0.4%; BVP 7.7 +/- 0.9%. The total reoperation incidence/100 patient-years was for MVP 1.14, for BVP 2.65. Further complications resulted from anticoagulation therapy (thrombemboli, bleeding), and prosthetic valve endocarditis. The cumulative freedom of any complications after 10 years was 73.1% for Björk-Shiley-AVR, 54.2% for BS-MVR, and only 31.2% for BS AVR + MVR. These results indicate regular controls for all patients postoperatively.

Bioprosthesis↗
PubMed1987

Reoperations for malfunction of heart valve prostheses, especially with endocarditis.

Following the increasing number of patients with heart valve replacement and an extended indication (older age groups, acute infective endocarditis, multivalvular procedures) the indicence of malfunction of valve prostheses is continuously growing. The prognosis of patients with a malfunctioning prosthesis mainly depends on early diagnosis and adequate therapy. In a retrospective study (1970 to 1984) 3,533 implanted heart valve prostheses were followed up and the cases with malfunction (n = 150; 4.2%) were analyzed. During the follow-up period after 1963 mitral valve replacements (MVR) there were 78 cases of malfunction (4.6%), after 1806 aortic valve replacements (AVR) 73 (4.1%), and after 34 tricuspid valve replacements (TVR) 4 malfunctions (11.8%). These malfunctions concerned periprosthetic leakages (n = 65), prosthetic endocarditis (n = 42), prosthetic valve thrombosis (n = 13), mechanical dysfunction including bioprosthetic degeneration (n = 17), valve related hemolysis (n = 3), and unsatisfactory hemodynamics (n = 10). Special attention was turned to the problem of prosthetic endocarditis (1963-1984) found in a total of 71 patients following 3,878 prosthetic valve replacements (1.9%). In 42 reoperated cases (1970-1984) the causing microorganisms were analyzed, demonstrating staphylococci in a leading position. Secondary complications and additional risk factors are discussed. There has been no change concerning the basis and the strategy of management for prosthetic endocarditis for many years: After a short time of conservative management with tested antibiotics, early reoperation and exchange of the prosthesis seems to be the optimal therapy, despite a distinctly high postoperative mortality (17%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1987

Coronary and valvular surgery in elderly patients (greater than 70 years).

During 1949-1964 only 22% of our patients (n = 6807) undergoing cardiac surgery were older than 40 years. Up to 1970 no patients older than 60 years underwent open-heart surgery in our institution. Between 1970 and 1978 an open-heart procedure was performed in 174 patients older than 60 years (4.5%). The hospital mortality was 18.3%. During the following years the operative indication for aged patients became more liberal, and the operative risk decreased distinctly. Already in 1983 the percentage of aged people rose to 24.1% of our extracorporeal circulation group (n = 1111). In a retrospective study (1979 to 1985) a total of 6855 heart procedures using ECC were evaluated. In total 196 patients (2.9%) were 70 years and older. Valvular replacement was performed in 95 cases. (AVR n = 67, MVR n = 13, DVR n = 15) resulting in a hospital mortality of 10.9% (n = 10). Revascularisation for coronary heart disease including resection of ventricular aneurysms was necessary in 64 patients with an early mortality rate of 3.1% (n = 2). The highest risk group consisted of combined coronary and valvular procedures (n = 33) with a mortality rate of 12.1% (n = 4). There was one case each of ASD II, HOCM, left atrial myxoma, and massive pulmonary embolism with cardiogenic shock: only the latter patient died, from cerebral hypoxia postoperatively. Thus the hospital mortality in this age group (n = 196) was 9.1% (n = 17).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1987

Techniques and complications of transaortic subvalvular myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).

The natural history of hypertrophic obstructive cardiomyopathy (HOCM) is usually characterized by development of mitral insufficiency, congestive heart failure (CHF) and sudden death. In patients (pts) belonging to at least clinical class III (NYHA) after failed medical therapy (beta-blocking agents and calcium-antagonists) surgery should be considered (by means of transaortic subvalvular myectomy). The history and development of different surgical techniques and procedures has been described in detail since 1958, when Cleland performed the first transaortic subvalvular myotomy. Our surgical series (1963-May 31, 1986) consists of 212 pts (mean age 40 years, range 6-73 years) with typical and atypical HOCM. The total hospital mortality rate was 6.6% (n = 14), which was reduced to 3.8% (n = 6), if only transaortic subvalvular myectomy (TSM) was performed (n = 160). In the group of 52 pts with additional surgical procedures the mortality rate was 15.4% (n = 8). The main problems occurred in pts with additional mitral valve replacement (MVR) (n = 15, three deaths). The rate of HOCM-related complications (secondary VSD, total AV-block, cerebral embolism, intraoperative re-myectomy) and those related to surgery (bleeding, pulmonary embolism, wound dehiscence, septicemia) was low. Therefore TSM for HOCM is a low-risk surgical procedure with a good long-term prognosis. However, in pts with a need for additional surgical procedures, the risk is considerably increased. Subjective impression of the pts and hemodynamic data indicate a clear clinical improvement postoperatively. Concerning long-term survival and reduction of the sudden death rate, our data do not allow a final judgement at the moment.

Adolescent↗
PubMed1987

[Surgical treatment of patients with Wolff-Parkinson-White syndrome].

Patients with supraventricular reciprocating tachycardias or atrial fibrillation with rapid ventricular response mediated over an accessory pathway may be difficult to treat. In cases of medically refractory arrhythmias, or in patients requiring operations for other cardiac abnormalities, surgical division of an accessory pathway was attempted in 18 consecutive patients. The major indication for operation was drug refractory tachyarrhythmias in 13 patients, whereas 5 patients were operated upon primarily because of either aortic or mitral or tricuspid valve replacement. After careful preoperative and intraoperative electrophysiological evaluation, all patients revealed only one bypass tract. The location of the accessory pathways were as follows: 16 left free-wall and 2 right free-wall. Surgical division was attempted using the "Sealy-Technique". 14 accessory pathways were divided successfully and in 2 patients they were made responsive to previous ineffective medical therapy. In one patient operation was unsuccessful. In 3 patients reoperations were necessary because of the reappearance of accessory pathway conduction. One patient with associated Ebstein's anomaly died intraoperatively. During a follow-up of 26 +/- 21 months, 14 patients were free of tachyarrhythmias without antiarrhythmic medication, whereas 2 patients responded to previously ineffective therapy. Another patient undergoing unsuccessful surgical ablation was treated with amiodarone. These results indicate that by employing the Sealy-Technique accessory pathways could be successfully divided in 14 of 18 patients (78%) and additionally made responsive to previously ineffective antiarrhythmic therapy in 2 patients (11%) (total success = 89%).

Adolescent↗
PubMed1986

The use of synthetic absorbable suture materials (polyglycolic acid and polydioxanone) in the low pressure circulatory system of growing organisms.

Synthetic absorbable sutures were used for surgery in the cardiovascular low pressure system of growing beagle dogs. Right atrial incisions were closed with this material in 20 dogs. In another 20 dogs caval anastomoses were performed in continuous suture technique. Repeated angiographies and histological examination were performed after observation periods between 5 and 180 days. No clinical complications occurred. Postoperatively patent anastomoses grew with the surrounding tissue, while stenotic anastomoses attained normal luminal diameter after suture absorption. Synthetic absorbable suture materials are recommended for use in the cardiovascular low pressure system, especially in the correction of congenital anomalies.

Animals↗
PubMed1986

Surgical treatment of hypertrophic cardiomyopathy (Düsseldorf experience).

Surgical treatment appears to be the therapy of choice in hypertrophic, obstructive cardiomyopathy, at least in patients who are in the advanced stage of the disease and refractory to medical treatment. In addition, strong evidence has been obtained that surgical treatment improved the prognosis at least in patients who required only a myectomy via a transaortic approach.

Cardiomyopathy, Hypertrophic↗
PubMed1986

[Hemolytic anemia as a result of hemodynamically-insignificant paravalvular dehiscence of St. Jude-Medical aortic valve prosthesis].

The course of a patient with aortic valve replacement is reported in whom increased intravascular hemolysis and auscultatory findings were suspicious of paravalvular dehiscence although other non-invasive examinations did not reveal pathological findings. Heart catheterization showed nearly normal pressures and angiocardiography minimal diastolic transaortic regurgitation. Nevertheless the patient had to be reoperated due to severe hemolytic anemia. Successful closure of the periprosthetic leakage resulted in prompt normalisation of laboratory findings of hemolysis.

Adult↗
PubMed1986

[Benefits of endocarditis prevention in patients with prosthetic heart valves].

The beneficial effect of prophylaxis for IE was studied in 229 patients with prosthetic heart valves in whom 287 diagnostic or therapeutic interventions were performed. The prevention used was similar to that recommended by the American Heart Association. Prosthetic valve endocarditis was not observed in any of these patients. This result was compared with that of 304 patients with prosthetic heart valves, in whom without any prevention 390 similar interventions were performed during the same observation period. The incidence of prosthetic valve endocarditis occurring within 14 days after the intervention was 1.5/100 interventions (n = 6). All patients had to be reoperated. One patient died perioperatively. Two more patients developed prosthetic valve endocarditis 8 and 13 weeks, respectively, after the initial intervention. This retrospective study documents the benefit of the prophylaxis for IE used.

Anti-Bacterial Agents↗
PubMed1985

[Causes and importance of mitral valve insufficiency in the surgical treatment of hypertrophic obstructive cardiomyopathy].

In hypertrophic obstructive cardiomyopathy (HOCM) mitral incompetence is a frequent additional lesion. Echocardiography shows a SAM-phenomenon and the mitral suspension apparatus is transponed. In such cases myoectomy at typical spots alone or in combination with removal of the hypertrophied myocardium on the posterior wall of the left ventricle can influence the outflow tract positively. From 1963 to 1985 183 patients were operated with such lesions, 119 of them had preoperative mitral insufficiency of different degrees. In 9 patients mitral valve replacement was necessary. Hospital mortality was high in cases with mitral valve replacement. The decision whether the valve has to be replaced can be made after myocardectomy during the operation, but it should be done immediately, if mitral insufficiency persists.

Adolescent↗
PubMed1985

[Surgical treatment of heart valve diseases and coronary diseases in the elderly].

The results of the operative treatment of valvular and coronary heart disease in large groups of elderly patients demonstrate that age per se is no contraindication for cardiac surgery. Age holds only the sixth place in the ranking list of risk factors, at least for coronary revascularization. One has to be aware that the operative risk in patients well over 60 years of age is somewhat higher than in younger individuals. However, there is no clearly identifiable age-related measure for indication or contraindication in the particular case. Surgery should be considered in an elderly patient if he or she had been leading a normal active life before the onset of limiting symptoms caused by the underlying valvular or coronary heart disease. These patients should have a strong motivation to improve their lifestyle postoperatively. Severe additional disease should be considered as a potential reason for renunciation.

Age Factors↗
PubMed1985

Early and late results after resection and end-to-end anastomosis of coarctation of the thoracic aorta in early infancy.

Over a 9 year period, 55 infants underwent resection and end-to-end anastomosis for symptomatic coarctation of the thoracic aorta during their first 120 days of life (mean age 47 days; mean weight 3.7 kg). Forty-two had preductal coarctation and 13, postductal. Additional cardiac lesions were found in 48 patients. Ventricular septal defect, either isolated or associated with other malformations, was the most frequent finding (37 patients). Simultaneous banding of the pulmonary artery was performed in 14 infants because of nonrestrictive ventricular septal defects. The hospital mortality was 3.6% (two patients). There were no late deaths. All survivors have been reinvestigated, and 27 have been recatheterized. In the group as a whole, after an average follow-up of 4.5 years, the mean pressure gradient (arm/leg) was 7 mm Hg (range 0 to 45 mm Hg). In the recatheterized infants, the average systolic pressure gradient at the anastomotic site was 16 mm Hg (range 2 to 62 mm Hg), whereas the mean pressure gradient in this group was 7 mm Hg (range 0 to 33); only three of them had systolic pressure gradients of more than 20 mm Hg. One reoperation is scheduled. Our data suggest, that resection and end-to-end anastomosis for symptomatic coarctation in the first 3 months of life can be performed with very low operative mortality and excellent long-term results.

Aorta, Thoracic↗