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Emery R.W.,Cardiovascular Surgery | Solien E.,Kips Bay Medical | Jamieson S.W.,University of California at San Diego
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery | Year: 2012

The eSVS Mesh (Kipps Bay Medical, Minneapolis, MN USA) Mesh (Kipps Bay Medical, Minneapolis, MN USA) is a new concept in improving saphenous vein graft patency for coronary bypass grafting. This is a nitinol-based external support device that maintains external support of the graft and prevents detrimental expansion when exposed to arterial pressure. The implanting technique is critical to outcomes and is described in this article. Clinical testing in the United States is pending. Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery. Source

Morin J.,Cardiovascular Surgery
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery | Year: 2012

Autotransplantation of a solitary kidney provides an excellent opportunity to study the immediate and long-term consequences of intra-operative renal ischaemia. The purpose of this report is to describe a series of nine patients who underwent ex vivo repair and autotransplantation on solitary kidneys. The series included six females and three males with a mean age of 36 years. Seven of the nine patients were hypertensive (mean number of anti-hypertensive agents: 3). Two patients had chronic renal failure (serum creatinine levels: 192 and 205 μmol l(-1)). All arteries except one with Takayasu disease were affected by dysplastic aneurysm or fibrodysplasia lesion. There was no atherosclerotic lesion. The mean number of renal artery branches repaired was 3.1 per patient. Mean duration of ischaemia was 161 min. Creatinaemia increased in all patients following the procedure. Creatinaemia and clearance returned to preoperative values between the 3rd and 10th postoperative days. One kidney was lost due to renal vein thrombosis. Late findings indicated that renal function was stable and there was no deterioration in the function of the autotransplanted kidneys after a follow-up period of 89 months. Preoperative versus postoperative creatinaemia and clearance levels were respectively 111 vs. 105 μmol l(-1) and 66.9 vs. 62.0 ml min(-1) (ns). During the same time, the mean number of anti-hypertensive agents decreased slightly from 3 to 2.5. In this small series of patients who underwent ex vivo repair and autotransplantation on solitary kidneys, intra-operative renal ischaemia had no detrimental effect on renal function. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. Source

Gaemperli O.,University of Zurich | Biaggi P.,Cardiovascular Center | Gugelmann R.,University of Zurich | Osranek M.,University of Zurich | And 6 more authors.
Circulation | Year: 2013

Background-: Percutaneous mitral valve repair with the MitraClip device has emerged as an alternative to surgery for treating severe mitral regurgitation. However, its effects on left ventricular loading conditions and contractility have not been investigated yet. Methods and Results-: Pressure-volume loops were recorded throughout the MitraClip procedure using conductance catheter in 33 patients (mean age, 78±10 years) with functional (45%), degenerative (48%), or mixed (6%) mitral regurgitation. Percutaneous mitral valve repair increased end-systolic wall stress (WSES; from [median] 184 mm Hg [interquartile range (IQR), 140-200 mm Hg] to 209 mm Hg [IQR, 176-232 mm Hg]; P=0.001) and decreased end-diastolic WS (WSED; from 48 mm Hg [IQR, 28-58 mm Hg] to 34 mm Hg [IQR, 21-46 mm Hg]; P=0.005), whereas the end-systolic pressure-volume relationship was not significantly affected. Conversely, cardiac index increased (from 2.6 L·min·m [IQR, 2.2-3.0 L·min·m] to 3.2 L·min·m [IQR, 2.6-3.8 L·min·m]; P<0.001) and mean pulmonary capillary wedge pressure decreased (from 15 mm Hg [IQR, 12-20 mm Hg] to 12 mm Hg [IQR, 10-13 mm Hg]; P<0.001). Although changes in WSES were not correlated with changes in cardiac index, changes in WSED correlated significantly with changes in mean pulmonary capillary wedge pressure (r=0.63, P<0.001). Total mechanical energy assessed by the pressure-volume area remained unchanged, resulting in a more favorable index of forward output (cardiac index) to mechanical energy (pressure-volume area) after mitral valve repair. On follow-up (153±94 days), New York Heart Association functional class was reduced from 2.9±0.6 to 1.9±0.5 (P<0.001) at 3 months, and echocardiographic follow-up documented a stepwise reduction in end-diastolic volume (from 147 mL [IQR, 95-191 mL] to 127 mL [IQR, 82-202 mL]; P=0.036). Conclusions-: Percutaneous mitral valve repair improves hemodynamic profiles and induces reverse left ventricular remodeling by reducing left ventricular preload while preserving contractility. In nonsurgical candidates with compromised left ventricular function, MitraClip therapy could be considered an alternative to surgical mitral valve repair. © 2013 American Heart Association, Inc. Source

Martis R.J.,Indian Institute of Technology Kharagpur | Acharya U.R.,Ngee Ann Polytechnic | Mandana K.M.,Cardiovascular Surgery | Ray A.K.,Indian Institute of Technology Kharagpur | Chakraborty C.,Indian Institute of Technology Kharagpur
Expert Systems with Applications | Year: 2012

Electrocardiogram (ECG) is the P, QRS, T wave indicating the electrical activity of the heart. The subtle changes in amplitude and duration of ECG cannot be deciphered precisely by the naked eye, hence imposing the need for a computer assisted diagnosis tool. In this paper we have automatically classified five types of ECG beats of MIT-BIH arrhythmia database. The five types of beats are Normal (N), Right Bundle Branch Block (RBBB), Left Bundle Branch Block (LBBB), Atrial Premature Contraction (APC) and Ventricular Premature Contraction (VPC). In this work, we have compared the performances of three approaches. The first approach uses principal components of segmented ECG beats, the second approach uses principal components of error signals of linear prediction model, whereas the third approach uses principal components of Discrete Wavelet Transform (DWT) coefficients as features. These features from three approaches were independently classified using feed forward neural network (NN) and Least Square-Support Vector Machine (LS-SVM). We have obtained the highest accuracy using the first approach using principal components of segmented ECG beats with average sensitivity of 99.90%, specificity of 99.10%, PPV of 99.61% and classification accuracy of 98.11%. The system developed is clinically ready to deploy for mass screening programs. © 2012 Published by Elsevier Ltd. All rights reserved. Source

Stewart G.C.,Brigham and Womens Hospital | Mayer J.E.,Cardiovascular Surgery
Heart Failure Clinics | Year: 2014

Heart transplantation has become an increasingly common and effective therapy for adults with end-stage congenital heart disease (CHD) because of advances in patient selection and surgical technique. Indications for transplantation in CHD are similar to other forms of heart failure. Pretransplant assessment of CHD patients emphasizes evaluation of cardiac anatomy, pulmonary vascular disease, allosensitization, hepatic dysfunction, and neuropsychiatric status. CHD patients experience longer waitlist times and higher waitlist mortality than other transplant candidates. Adult CHD patients undergoing transplantation carry an early hazard for mortality compared with non-CHD recipients, but by 10years posttransplant, CHD patients have a slight actuarial survival advantage. © 2014 Elsevier Inc. Source

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