Simon Kendall - Academia.edu (original) (raw)
Papers by Simon Kendall
Brit J Radiol, 2006
We report the case of a 68-year-old male in whom an intrathoracic non-Hodgkin's lymphoma ... more We report the case of a 68-year-old male in whom an intrathoracic non-Hodgkin's lymphoma was diagnosed late after he presented with the clinical and radiological features of a descending aortic dissection due to penetrating ulcer. An endovascular stent was implanted in the descending aorta. At follow up, a CT scan showed the presence of a mediastinal mass thought to be a periaortic haematoma as a consequence of the endovascular stent implantation. A further CT scan showed an increase in size of the mediastinal mass encasing the whole descending aorta. A biopsy of the mass was performed which was shown to be non-Hodgkin's lymphoma. This is the first report of a penetrating ulcer of the descending aorta due to lymphoma, which probably caused the dissection.
The Annals of Thoracic Surgery, 1995
Ann Thorac Surg, 1994
We performed a prospective, randomized, double-blind trial of topical aprotinin versus placebo in... more We performed a prospective, randomized, double-blind trial of topical aprotinin versus placebo in 100 patients undergoing cardiac operations with cardiopulmonary bypass. Fifty-five patients received aprotinin. Forty underwent coronary artery bypass grafting (CABG) and 15 valve replacement ± CABG. Of 45 patients in the control group 38 underwent CABG and 7 valve replacement ± CABG. Aprotinin (50 mL; 70 mg) or placebo was applied topically to the heart, pericardium, and mediastinum before sternal closure. There were five reentries for bleeding with a surgical site identified in four. Mean blood loss was significantly less in the aprotinin group (653 versus 903 mL; p =
Journal of Thoracic and Cardiovascular Surgery
The Journal of cardiovascular surgery
Vascular grafts continue to evolve. Recent developments have been aimed at decreasing porosity, i... more Vascular grafts continue to evolve. Recent developments have been aimed at decreasing porosity, increasing strength of prosthesis, increasing ease of handling and suturing and optimising flow characteristics. This study describes results with a recently developed collagen impregnated polyester prosthesis Hemashield Woven Double Velour, which does not require pre-clotting. Between January 1988 and December, 1991 such prostheses were used in 90 patients at Papworth Hospital. Fifty-eight, were used to replace the ascending aorta, 10 for the arch of the aorta and 28 for the descending aorta seven of whom were for coarctation and four for traumatic transections. In 60 cases the underlying disease was a dissected or ruptured aorta requiring emergency operation. There were 66 survivors with X-ray and CT follow-up of 6-52 months. Median blood loss was 630 ml range 380-1800 ml. There was no leakage from any of the grafts during surgery despite full perioperative heparinisation. For emergency/elective operations (N = 60/30) early mortality was 25%/10% (15/3) and late mortality 5%/6.6% (3/2). Of 15 patients who had interposition grafts for Type A dissection CT scans at 5-47 months showed one with chronic dissection proximal to the repair and 11 with persistent distal dissection. There was no evidence of late bleeding, seroma impaired healing or thickened neointima formation. It is concluded that there are no clinical disadvantages associated with collagen impregnation to set against the notable convenience of initial impermeability.
The Journal of Heart and Lung Transplantation
Total orthotopic heart transplantation was recently introduced into clinical practice as an alter... more Total orthotopic heart transplantation was recently introduced into clinical practice as an alternative technique of orthotopic heart transplantation, adding bicaval and left and right pulmonary vein anastomoses to pulmonary artery and ascending aorta connection (total technique). The conventional technique (ventricular transplantation with atrioplasty) is compared with the total technique with particular emphasis on right ventricular performance. Forty-eight mongrel dogs (23 to 31 kg) were used for 12 total and 12 standard orthotopic heart transplantations. Right ventricular (RV) function and atrial systole were analyzed with the use of micromanometry, sonomicrometry, and ultrasonic flow probes (preload-independent RV recruitable stroke work, RVPRSW). Fourier analysis was used to calculate RV power and pulmonary vascular impedance. There was no significant difference in cardiac ischemic and bypass times between the two groups. After transplantation, sinus rhythm was preserved after all total transplantations and after only one standard transplantation; no significant hemodynamic differences were observed. RVPRSW in the total group was conserved after transplantation; however, RVPRSW decreased by 39% (+/-8, p < .05) in the standard group. There was also a significant decrease in the rate of RV filling in the standard group after transplantation, suggesting decreased right atrial function. Pulmonary vascular impedance and RV power output were not significantly different after transplantation between the two groups. Total atrioventricular transplantation is a feasible alternative and conserves normal sinus rhythm. Ischemic and bypass times were not significantly different when the superior vena cava anastomosis is performed last after the release of the aortic cross-clamp. The insignificant decrease in the rate of RV filling with the use of the total technique suggests conserved RV diastolic function after transplantation with less decreased RV function in the total group.
European Journal of Cardio-Thoracic Surgery, 2004
Following cardiac surgery, patients are transferred from the operating theatre to intensive care.... more Following cardiac surgery, patients are transferred from the operating theatre to intensive care. This clinical environment has one nurse per patient and facilities for mechanical ventilation. Patients are kept in this setting until the following day. This practice has been challenged with early extubation of patients. At our institution we have established a fast-track policy including the following features: (1) patient selection; (2) operating list scheduling with fast-track patients first; (3) anaesthetic tailored to early extubation; (4) methodical procedure with warm cardiopulmonary bypass; (5) removal of the arterial line; (6) transfer from intensive care to a separate high dependency unit (&amp;amp;amp;amp;amp;#39;step-down&amp;amp;amp;amp;amp;#39;) on the day of operation, where the ratio of nurse to patient is one to three and there are no ventilatory facilities and no invasive monitoring; or (7) to keep these patients on ICU but decrease the nurse to patient ratio. The case notes of 572 patients who predominantly had myocardial revascularisation, undergoing this process from July 1996 to July 2000 at our institution were reviewed. Mean EUROSCORE for the study group was 1.42. The 30-day mortality rate for the study group was 0.34%, mean intensive care time was 5 h 52 min, mean time to extubation was 3 h 10 min, mean readmission rate to intensive care was 0.34% and mean hospital stay from day of operation (inclusive) was 5.65 days. This process increased our throughput by 14.6% (compared to standard practices). This study demonstrates that transfer of appropriate patients to a high dependency area from intensive care following cardiac surgery is safe. It allows intensive care beds to be used by more than one patient each day and allows significant cost savings by reducing the nursing ratio per patient.
Cardiovascular and Interventional Radiology, 1993
A patient with persistent chronic dissection proximal to an aortic interposition graft for repair... more A patient with persistent chronic dissection proximal to an aortic interposition graft for repair of a type A dissection prompted us to review the computed tomographic (CT) findings in 14 other such patients 5-47 months after surgery. No other case of proximal aortic dissection was identified although dilatation of the aortic root proximal to the graft was present in 8 patients (57%). Persistent dissection distal to the graft in 11 patients (79%) was in keeping with that reported by other workers. Chronic dissection proximal to the surgical repair of a dissection seems a rare although important complication.
British Journal of Surgery, 1991
A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incisi... more A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incision with layered closure (n = 137), a midline incision with mass closure (n = 104) or a midline incision using layered closure (n = 108), endeavouring to close the latter two incisions with a measured suture length to wound length ratio of greater than 4:1. After 18 months follow-up, no patient in the lateral paramedian group had developed an incisional hernia whereas 7 of 104 patients undergoing a midline incision with mass closure and 7 of 108 patients undergoing a midline incision with layered closure had incisional hernias (P less than 0.01). The mean suture length to wound length ratios for the three groups were 2.6 (range 1.3-6.2), 5.0 (range 3.0-8.7) and 3.7 (range 2.0-6.3) respectively (P less than 0.0001). The lateral paramedian incision remains superior to the midline incision closed with the mass technique and its integrity is independent of the suture length to wound length ratio.
The Annals of Thoracic Surgery, 1993
In 1979 we published a report of a patient with primary liposarcoma of the pericardium treated by... more In 1979 we published a report of a patient with primary liposarcoma of the pericardium treated by surgical resection. Since then we have performed a total of seven resections on the same patient for recurrent liposarcoma, which have given excellent symptomatic relief, and her life was prolonged for 14 years. Repeated resection of recurrent liposarcoma of the mediastinum should always be considered as the appropriate management for these patients.
The Annals of Thoracic Surgery, 1995
Lower RR, Stofer RC, Hurley I, Dong J, Cohn E jr, Shumway NI: Successful homotransplantation of t... more Lower RR, Stofer RC, Hurley I, Dong J, Cohn E jr, Shumway NI: Successful homotransplantation of the canine heart after anoxic preservation for seven hours. Am J Surg 1962;104:302. (37) Magovern JA, Pennock JL, Oaks TE, Campbell DB, Burg JE, Herscy RM: Atrial natriuretic peptide in recipients of human orthotopic heart transplants. J Heart Transplant 1987;6:193. (38) Mc Allister HA: Histologic grading of cardiac allograft rejection: a quantitative approach. J Heart Transplant 19tX);9:277. (39) Milller J, Warnecke H, Spiegelsbcrger S, Schiller S, Voss A, Hetzer R: Distant rejection monitoring by ECG-telephone transmission. J Heart Transplant 1990;9:82. (40) Novitzky D, Cooper DKC, Barnard CN: The surgical technique of heterotopic heart transplantation. Ann Thorac Surg 1983;36:476. (4l) Norwood WI, Lang P, Castaneda AR: Experience with operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 198 I;82:51 I. (42) Oaks TE, Pac WE, Miller CA, Pierce WS: Combined registry for the clinical use of mechanical ventricular assist pumps and the total artificial heart in conjunction with heart transplantation: fifth official report -I(Y-)0. J Heart Lung Transplant 19 ~) I; 10:621. (43) Oyer PE, Stinson EB, Jamieson SW, Hunt SA, Pcrlroth M. Billingham M, Shumway NE: Cyclosporine in cardiac transplantation: a 2 1/2_ year follow-up. Transplant Proc 1983;15:2546. (44) Park JW, Schiller S. Hetzcr R. Flcx:k E.: Wcrtigkeit tines nichtinvasiven Parameters der friihdiastolischen Ventrikelfunktion zur Erkennung tinct Absto-6ungsreaktion nach Herztransplantation. Key-words: Heart-hmg -single hmg and double lung transplantation. Schliisselw6rter: Herz-Lunge -Einfachhmgen-und Doppelhtngentransplantation.
Journal of cardiothoracic surgery, 2016
For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed s... more For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.
The Annals of Thoracic Surgery, Jan 9, 2009
the staged procedure, alternative approaches to the ascending aorta, such as right-sided intercos... more the staged procedure, alternative approaches to the ascending aorta, such as right-sided intercostal or parasternal incisions, could have been considered [2-5]. These incisions do not require a sternotomy; however, they could demand the ligation of the internal mammary artery, compromising even more of the blood supply in the irradiated area. Moreover, this approach would have been very difficult because of the alteration of the mediastinal tissue and pericardium directly at the front of the ascending aorta. This could have even led to serious iatrogenic injuries during preparation. In addition, valve replacement before the treatment of the sternal osteomyelitis could have increased the risk of prosthetic endocarditis. This and the age of the patient were indeed the reasons why the patient was neither considered for transfemoral or apical valve implantation.
We report two cases, which underwent surgery through Median sternotomy. They were on an ACE type ... more We report two cases, which underwent surgery through Median sternotomy. They were on an ACE type I inhibitor pre-operatively. Both of these patients developed persistent dry cough post-operatively, which resulted in sternal wound dehiscence. They had no clinical or bacteriological evidence of sternal wound infection. Although one patient was overweight and had moderately impaired left ventricular function, there were no
We present an unusual complication caused by a dialysis catheter inserted through the internal ju... more We present an unusual complication caused by a dialysis catheter inserted through the internal jugular vein into the central venous system. The 49-year-old male patient developed a right atrial thrombus, which became infected with Staphylococcus aureus, resulting in septic pulmonary embolism and septicemic shock. The thrombus was excised on cardiopulmonary bypass. The patient made an uneventful recovery.
Journal of Cardiothoracic Surgery, 2015
There are certain obstacles which left-handed surgeons can face when training but these are not n... more There are certain obstacles which left-handed surgeons can face when training but these are not necessary and often perpetuated by a lack of knowledge. Most have been encountered and overcome at some point but unless recorded and disseminated they will have to be resolved repeatedly by each trainee and their trainers. This article highlights difficulties that the left-hander may encounter in cardiac surgery and gives practical operative advice for both trainees and their trainers to help overcome them.
Journal of Cardiothoracic Surgery, 2015
Ann Thorac Surg, 2008
Gamma irradiation played an important role in our decellularization process. The original purpose... more Gamma irradiation played an important role in our decellularization process. The original purpose for use of gamma irradiation was to remove the cell components from the porcine aortic valves in conjunction with polyethylene glycol (PEG). Because the radiation effect can reach the entire tissue evenly, it contributed to complete decellularization of such porcine aortic valves that had complex structures (eg, variety of tissue thickness). Gamma irradiation also brought supplemental benefits to our decellularized tissue, such as elimination of both the DNA sequence of porcine endogenous retrovirus and ␣1.3-galactosyl epitope (ie, they could be the sources of infection or rejection, or both), and the possible reinforcement effect due to polymerization of PEG by gamma irradiation, as described in our article [2]. Therefore, Dohmen and Konertz's [1] comment that "gamma irradiation was not used to decellularize but to sterilize the decellularized scaffold" is definitely incorrect. Although it is true that decellularized tissues get sterilized through our process with 100 kGy gamma irradiation, it is of limited significance in our study. On the other hand, we agree with their comments that we need further studies on hemodynamic functional evaluations and long-term impact of gamma irradiation, which were described as limitations in our article [2]. However, we believe that it was inappropriate to refer the article by Cohen and colleagues [3] to discuss the use of gamma irradiation and its negative effects, because it had a completely different setting from ours (ie, the homograft).
The Annals of Thoracic Surgery, Jun 30, 2008
Methods. Ten-year postsurgery survival was collated on patients undergoing coronary artery bypass... more Methods. Ten-year postsurgery survival was collated on patients undergoing coronary artery bypass grafting from 1994 to 1996, and quality of life was assessed using EQ-5D and a quality-of-life thermometer. We analyzed data from 1,180 patients. Mean age was 61 years, and 79% had triple-vessel disease.
Brit J Radiol, 2006
We report the case of a 68-year-old male in whom an intrathoracic non-Hodgkin's lymphoma ... more We report the case of a 68-year-old male in whom an intrathoracic non-Hodgkin's lymphoma was diagnosed late after he presented with the clinical and radiological features of a descending aortic dissection due to penetrating ulcer. An endovascular stent was implanted in the descending aorta. At follow up, a CT scan showed the presence of a mediastinal mass thought to be a periaortic haematoma as a consequence of the endovascular stent implantation. A further CT scan showed an increase in size of the mediastinal mass encasing the whole descending aorta. A biopsy of the mass was performed which was shown to be non-Hodgkin's lymphoma. This is the first report of a penetrating ulcer of the descending aorta due to lymphoma, which probably caused the dissection.
The Annals of Thoracic Surgery, 1995
Ann Thorac Surg, 1994
We performed a prospective, randomized, double-blind trial of topical aprotinin versus placebo in... more We performed a prospective, randomized, double-blind trial of topical aprotinin versus placebo in 100 patients undergoing cardiac operations with cardiopulmonary bypass. Fifty-five patients received aprotinin. Forty underwent coronary artery bypass grafting (CABG) and 15 valve replacement ± CABG. Of 45 patients in the control group 38 underwent CABG and 7 valve replacement ± CABG. Aprotinin (50 mL; 70 mg) or placebo was applied topically to the heart, pericardium, and mediastinum before sternal closure. There were five reentries for bleeding with a surgical site identified in four. Mean blood loss was significantly less in the aprotinin group (653 versus 903 mL; p =
Journal of Thoracic and Cardiovascular Surgery
The Journal of cardiovascular surgery
Vascular grafts continue to evolve. Recent developments have been aimed at decreasing porosity, i... more Vascular grafts continue to evolve. Recent developments have been aimed at decreasing porosity, increasing strength of prosthesis, increasing ease of handling and suturing and optimising flow characteristics. This study describes results with a recently developed collagen impregnated polyester prosthesis Hemashield Woven Double Velour, which does not require pre-clotting. Between January 1988 and December, 1991 such prostheses were used in 90 patients at Papworth Hospital. Fifty-eight, were used to replace the ascending aorta, 10 for the arch of the aorta and 28 for the descending aorta seven of whom were for coarctation and four for traumatic transections. In 60 cases the underlying disease was a dissected or ruptured aorta requiring emergency operation. There were 66 survivors with X-ray and CT follow-up of 6-52 months. Median blood loss was 630 ml range 380-1800 ml. There was no leakage from any of the grafts during surgery despite full perioperative heparinisation. For emergency/elective operations (N = 60/30) early mortality was 25%/10% (15/3) and late mortality 5%/6.6% (3/2). Of 15 patients who had interposition grafts for Type A dissection CT scans at 5-47 months showed one with chronic dissection proximal to the repair and 11 with persistent distal dissection. There was no evidence of late bleeding, seroma impaired healing or thickened neointima formation. It is concluded that there are no clinical disadvantages associated with collagen impregnation to set against the notable convenience of initial impermeability.
The Journal of Heart and Lung Transplantation
Total orthotopic heart transplantation was recently introduced into clinical practice as an alter... more Total orthotopic heart transplantation was recently introduced into clinical practice as an alternative technique of orthotopic heart transplantation, adding bicaval and left and right pulmonary vein anastomoses to pulmonary artery and ascending aorta connection (total technique). The conventional technique (ventricular transplantation with atrioplasty) is compared with the total technique with particular emphasis on right ventricular performance. Forty-eight mongrel dogs (23 to 31 kg) were used for 12 total and 12 standard orthotopic heart transplantations. Right ventricular (RV) function and atrial systole were analyzed with the use of micromanometry, sonomicrometry, and ultrasonic flow probes (preload-independent RV recruitable stroke work, RVPRSW). Fourier analysis was used to calculate RV power and pulmonary vascular impedance. There was no significant difference in cardiac ischemic and bypass times between the two groups. After transplantation, sinus rhythm was preserved after all total transplantations and after only one standard transplantation; no significant hemodynamic differences were observed. RVPRSW in the total group was conserved after transplantation; however, RVPRSW decreased by 39% (+/-8, p < .05) in the standard group. There was also a significant decrease in the rate of RV filling in the standard group after transplantation, suggesting decreased right atrial function. Pulmonary vascular impedance and RV power output were not significantly different after transplantation between the two groups. Total atrioventricular transplantation is a feasible alternative and conserves normal sinus rhythm. Ischemic and bypass times were not significantly different when the superior vena cava anastomosis is performed last after the release of the aortic cross-clamp. The insignificant decrease in the rate of RV filling with the use of the total technique suggests conserved RV diastolic function after transplantation with less decreased RV function in the total group.
European Journal of Cardio-Thoracic Surgery, 2004
Following cardiac surgery, patients are transferred from the operating theatre to intensive care.... more Following cardiac surgery, patients are transferred from the operating theatre to intensive care. This clinical environment has one nurse per patient and facilities for mechanical ventilation. Patients are kept in this setting until the following day. This practice has been challenged with early extubation of patients. At our institution we have established a fast-track policy including the following features: (1) patient selection; (2) operating list scheduling with fast-track patients first; (3) anaesthetic tailored to early extubation; (4) methodical procedure with warm cardiopulmonary bypass; (5) removal of the arterial line; (6) transfer from intensive care to a separate high dependency unit (&amp;amp;amp;amp;amp;#39;step-down&amp;amp;amp;amp;amp;#39;) on the day of operation, where the ratio of nurse to patient is one to three and there are no ventilatory facilities and no invasive monitoring; or (7) to keep these patients on ICU but decrease the nurse to patient ratio. The case notes of 572 patients who predominantly had myocardial revascularisation, undergoing this process from July 1996 to July 2000 at our institution were reviewed. Mean EUROSCORE for the study group was 1.42. The 30-day mortality rate for the study group was 0.34%, mean intensive care time was 5 h 52 min, mean time to extubation was 3 h 10 min, mean readmission rate to intensive care was 0.34% and mean hospital stay from day of operation (inclusive) was 5.65 days. This process increased our throughput by 14.6% (compared to standard practices). This study demonstrates that transfer of appropriate patients to a high dependency area from intensive care following cardiac surgery is safe. It allows intensive care beds to be used by more than one patient each day and allows significant cost savings by reducing the nursing ratio per patient.
Cardiovascular and Interventional Radiology, 1993
A patient with persistent chronic dissection proximal to an aortic interposition graft for repair... more A patient with persistent chronic dissection proximal to an aortic interposition graft for repair of a type A dissection prompted us to review the computed tomographic (CT) findings in 14 other such patients 5-47 months after surgery. No other case of proximal aortic dissection was identified although dilatation of the aortic root proximal to the graft was present in 8 patients (57%). Persistent dissection distal to the graft in 11 patients (79%) was in keeping with that reported by other workers. Chronic dissection proximal to the surgical repair of a dissection seems a rare although important complication.
British Journal of Surgery, 1991
A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incisi... more A total of 349 patients were randomized to undergo laparotomy through a lateral paramedian incision with layered closure (n = 137), a midline incision with mass closure (n = 104) or a midline incision using layered closure (n = 108), endeavouring to close the latter two incisions with a measured suture length to wound length ratio of greater than 4:1. After 18 months follow-up, no patient in the lateral paramedian group had developed an incisional hernia whereas 7 of 104 patients undergoing a midline incision with mass closure and 7 of 108 patients undergoing a midline incision with layered closure had incisional hernias (P less than 0.01). The mean suture length to wound length ratios for the three groups were 2.6 (range 1.3-6.2), 5.0 (range 3.0-8.7) and 3.7 (range 2.0-6.3) respectively (P less than 0.0001). The lateral paramedian incision remains superior to the midline incision closed with the mass technique and its integrity is independent of the suture length to wound length ratio.
The Annals of Thoracic Surgery, 1993
In 1979 we published a report of a patient with primary liposarcoma of the pericardium treated by... more In 1979 we published a report of a patient with primary liposarcoma of the pericardium treated by surgical resection. Since then we have performed a total of seven resections on the same patient for recurrent liposarcoma, which have given excellent symptomatic relief, and her life was prolonged for 14 years. Repeated resection of recurrent liposarcoma of the mediastinum should always be considered as the appropriate management for these patients.
The Annals of Thoracic Surgery, 1995
Lower RR, Stofer RC, Hurley I, Dong J, Cohn E jr, Shumway NI: Successful homotransplantation of t... more Lower RR, Stofer RC, Hurley I, Dong J, Cohn E jr, Shumway NI: Successful homotransplantation of the canine heart after anoxic preservation for seven hours. Am J Surg 1962;104:302. (37) Magovern JA, Pennock JL, Oaks TE, Campbell DB, Burg JE, Herscy RM: Atrial natriuretic peptide in recipients of human orthotopic heart transplants. J Heart Transplant 1987;6:193. (38) Mc Allister HA: Histologic grading of cardiac allograft rejection: a quantitative approach. J Heart Transplant 19tX);9:277. (39) Milller J, Warnecke H, Spiegelsbcrger S, Schiller S, Voss A, Hetzer R: Distant rejection monitoring by ECG-telephone transmission. J Heart Transplant 1990;9:82. (40) Novitzky D, Cooper DKC, Barnard CN: The surgical technique of heterotopic heart transplantation. Ann Thorac Surg 1983;36:476. (4l) Norwood WI, Lang P, Castaneda AR: Experience with operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 198 I;82:51 I. (42) Oaks TE, Pac WE, Miller CA, Pierce WS: Combined registry for the clinical use of mechanical ventricular assist pumps and the total artificial heart in conjunction with heart transplantation: fifth official report -I(Y-)0. J Heart Lung Transplant 19 ~) I; 10:621. (43) Oyer PE, Stinson EB, Jamieson SW, Hunt SA, Pcrlroth M. Billingham M, Shumway NE: Cyclosporine in cardiac transplantation: a 2 1/2_ year follow-up. Transplant Proc 1983;15:2546. (44) Park JW, Schiller S. Hetzcr R. Flcx:k E.: Wcrtigkeit tines nichtinvasiven Parameters der friihdiastolischen Ventrikelfunktion zur Erkennung tinct Absto-6ungsreaktion nach Herztransplantation. Key-words: Heart-hmg -single hmg and double lung transplantation. Schliisselw6rter: Herz-Lunge -Einfachhmgen-und Doppelhtngentransplantation.
Journal of cardiothoracic surgery, 2016
For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed s... more For ease of use and to aid precision, left-handed instruments are invaluable to the left-handed surgeon. Although they exist, they are not available in many surgical centres. As a result, most operating theatre staff (including many left-handers) have little knowledge of their value or even application. With specific reference to cardiac surgery, this article addresses the ways in which they differ, why they are needed and what is required - with tips on use.
The Annals of Thoracic Surgery, Jan 9, 2009
the staged procedure, alternative approaches to the ascending aorta, such as right-sided intercos... more the staged procedure, alternative approaches to the ascending aorta, such as right-sided intercostal or parasternal incisions, could have been considered [2-5]. These incisions do not require a sternotomy; however, they could demand the ligation of the internal mammary artery, compromising even more of the blood supply in the irradiated area. Moreover, this approach would have been very difficult because of the alteration of the mediastinal tissue and pericardium directly at the front of the ascending aorta. This could have even led to serious iatrogenic injuries during preparation. In addition, valve replacement before the treatment of the sternal osteomyelitis could have increased the risk of prosthetic endocarditis. This and the age of the patient were indeed the reasons why the patient was neither considered for transfemoral or apical valve implantation.
We report two cases, which underwent surgery through Median sternotomy. They were on an ACE type ... more We report two cases, which underwent surgery through Median sternotomy. They were on an ACE type I inhibitor pre-operatively. Both of these patients developed persistent dry cough post-operatively, which resulted in sternal wound dehiscence. They had no clinical or bacteriological evidence of sternal wound infection. Although one patient was overweight and had moderately impaired left ventricular function, there were no
We present an unusual complication caused by a dialysis catheter inserted through the internal ju... more We present an unusual complication caused by a dialysis catheter inserted through the internal jugular vein into the central venous system. The 49-year-old male patient developed a right atrial thrombus, which became infected with Staphylococcus aureus, resulting in septic pulmonary embolism and septicemic shock. The thrombus was excised on cardiopulmonary bypass. The patient made an uneventful recovery.
Journal of Cardiothoracic Surgery, 2015
There are certain obstacles which left-handed surgeons can face when training but these are not n... more There are certain obstacles which left-handed surgeons can face when training but these are not necessary and often perpetuated by a lack of knowledge. Most have been encountered and overcome at some point but unless recorded and disseminated they will have to be resolved repeatedly by each trainee and their trainers. This article highlights difficulties that the left-hander may encounter in cardiac surgery and gives practical operative advice for both trainees and their trainers to help overcome them.
Journal of Cardiothoracic Surgery, 2015
Ann Thorac Surg, 2008
Gamma irradiation played an important role in our decellularization process. The original purpose... more Gamma irradiation played an important role in our decellularization process. The original purpose for use of gamma irradiation was to remove the cell components from the porcine aortic valves in conjunction with polyethylene glycol (PEG). Because the radiation effect can reach the entire tissue evenly, it contributed to complete decellularization of such porcine aortic valves that had complex structures (eg, variety of tissue thickness). Gamma irradiation also brought supplemental benefits to our decellularized tissue, such as elimination of both the DNA sequence of porcine endogenous retrovirus and ␣1.3-galactosyl epitope (ie, they could be the sources of infection or rejection, or both), and the possible reinforcement effect due to polymerization of PEG by gamma irradiation, as described in our article [2]. Therefore, Dohmen and Konertz's [1] comment that "gamma irradiation was not used to decellularize but to sterilize the decellularized scaffold" is definitely incorrect. Although it is true that decellularized tissues get sterilized through our process with 100 kGy gamma irradiation, it is of limited significance in our study. On the other hand, we agree with their comments that we need further studies on hemodynamic functional evaluations and long-term impact of gamma irradiation, which were described as limitations in our article [2]. However, we believe that it was inappropriate to refer the article by Cohen and colleagues [3] to discuss the use of gamma irradiation and its negative effects, because it had a completely different setting from ours (ie, the homograft).
The Annals of Thoracic Surgery, Jun 30, 2008
Methods. Ten-year postsurgery survival was collated on patients undergoing coronary artery bypass... more Methods. Ten-year postsurgery survival was collated on patients undergoing coronary artery bypass grafting from 1994 to 1996, and quality of life was assessed using EQ-5D and a quality-of-life thermometer. We analyzed data from 1,180 patients. Mean age was 61 years, and 79% had triple-vessel disease.