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Malkoc A, Gnanadev R, Shoemaker HB, Alach A, Vo TD, Behseresht J, Tayyarah M, Andacheh I, Hsu JH. The Use of Advanced Three-Dimensional Computed Tomography During Simple and Complex Endovascular Aortic Aneurysm Repairs. Ann Vasc Surg 2024:S0890-5096(24)00202-4. [PMID: 38754579 DOI: 10.1016/j.avsg.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/10/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES Endovascular aneurysm repair (EVAR) success depends on imaging technology both in the planning and operative phases. Endovascular repair requires intravenous contrast and radiation exposure to the patient as well as radiation exposure to the operator. Recent developments in imaging technology attempt to merge preoperative imaging with intraoperative imaging to improve the efficiency and accuracy of EVAR. The Cydar 3D imaging system combines the preoperative and intraoperative imaging during the operation. We aim to investigate the use of the Cydar 3D imaging system during EVAR compared to conventional methods. METHOD Retrospective review of all patients undergoing an EVAR at a single quaternary vascular center from 2019-2023 was collected. This cohort was divided into two groups: (1) Repair using Cydar 3D imaging or (2) Repair without Cydar 3D imaging. Overall, 138 unique patients were identified with 27 operations using Cydar 3D imaging and 111 operations without Cydar 3D imaging. We performed a 1-to-1 propensity score - matched analysis using nearest-neighbor matching for variables including age, case urgency, and if the case was performed in the operative room or interventional radiology room. A match occurred when a patient in the Cydar 3D imaging group had an estimated score within 0.01 standard deviations of a patient in the control group. From this we paired 27 from each cohort for a total of 54 patients. Demographic data included length of stay (LOS) in days, contrast volume (ml), Fluoroscopy time (min), procedure length (mins), mortality, blood loss (ml). Univariate analyses were performed and a p-value less than 0.05 was considered statistically significant. RESULTS A total of 54 vascular patients were analyzed: 27 without the Cydar 3D imaging and 27 with the Cydar 3D imaging. In the univariate analysis there was no statistical difference in the average length of stay (6.4 days ± 11.76 vs. 4.1 ± 6.03, p = 0.372), aneurysm size (5.9 ± 1.4 vs. 5.9 ± 1.2, p=0.88), contrast volume in mL (91.3 ± 47.0 vs. 91.1-33.49, p=9.88), fluoroscopy time in mins (20.2±17.2 vs. 19.5±19.4, p=0.89) , procedure length (299.3±177.9 vs. 353±191.98, p=0.279), blood loss in mL (513.8±791 vs. 353±191.98, p=0.594). There was an increase in reintervention for endoleaks in the group with use of Cydar 3D imaging (0 vs 6, p=0.043). A sub-analysis of patients undergoing physician modified EVARs did show a 15% reduction in the contrast volume used. CONCLUSION The use of 3D imaging technology has the potential to increase the safety of EVAR to both patients and operators. In our study we did not find any difference in standard EVARs however there was a contrast use decrease in physician modified EVARs. Further studies will need to be performed to determine the realized benefit from performing EVARs using this new technology.
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Affiliation(s)
- Aldin Malkoc
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA.
| | - Raja Gnanadev
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA
| | - Hailey B Shoemaker
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Ahmad Alach
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Trung D Vo
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Jason Behseresht
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Majid Tayyarah
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Iden Andacheh
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Jeffrey H Hsu
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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GnanaDev R, Malkoc A, Hsu J, Behseresht J, Tayyarah M, Vo TD, Andacheh I. Use of the GORE Conformable Excluder Device in Highly Angulated Aortic Neck Anatomy: Mid-term Outcomes. Vasc Endovascular Surg 2024:15385744241242183. [PMID: 38527219 DOI: 10.1177/15385744241242183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Patients with complex aortic anatomy require meticulous surgical planning to optimize intraoperative and postoperative outcomes. The GORE Excluder Conformable Abdominal Aortic Aneurysm Endoprosthesis (CEXC Device, WL Gore and Associates, Flagstaff, AZ) allows for endovascular treatment of highly angulated and short proximal neck abdominal aortic aneurysms (AAA). Owing to its recent approval, short-term clinical outcomes of this device remain scarce. REPORT In this report, we present a case series of 3 patients who underwent endovascular aortic repair using the GORE Excluder Conformable device with highly angulated (>70°) aortic neck anatomy. Endografts were deployed in a radiology suite using standard 2D angiography in conjunction with a CYDAR Medical (Wilmington, Delaware) reconstructed 3D overlay. The patients' ages were 85, 67, and 85 years. The mean abdominal aortic aneurysm diameter in these cases was 6.9 cm. The mean proximal neck length was 2.1 cm, proximal mean neck angulation was 83°. The mean operative time, total fluoroscopy time, and contrast used were 208 minutes, 28.3°minutes, and 94.5 milliliters, respectively. No adjunctive procedures, such as proximal cuff or endo-anchors, were performed at the time of index procedure. DISCUSSION Type Ia endoleak was observed in 1 patient post-operatively but after treatment with an aortic cuff there was no evidence of enlarging aneurysm sac. The GORE Excluder Conformable Endoprosthesis expands access to endovascular management of AAAs. Our early experience with this device demonstrated excellent patient and clinical outcomes in a highly angulated neck anatomy.
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Affiliation(s)
- Raja GnanaDev
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Aldin Malkoc
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Jeffrey Hsu
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Jason Behseresht
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Majid Tayyarah
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Trung D Vo
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
| | - Iden Andacheh
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA
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Lim C, Hsu J, Vo T, Behseresht J, Tayyarah M, Andacheh I. A Comparison of Venaseal Versus Radiofrequency Ablation Outcomes Within a Managed Care Organization. Ann Vasc Surg 2024; 99:75-81. [PMID: 37952570 DOI: 10.1016/j.avsg.2023.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/18/2023] [Accepted: 09/18/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Chronic venous insufficiency is a common medical condition that afflicts over 30 million adults in the United States. Treatment and management have changed dramatically over the past 20 years with the introduction of various endovenous therapies, including radiofrequency ablation (RFA) and cyanoacrylate closure using the Venaseal system. In this study, we explore a direct comparison of outcomes between RFA and VenaSeal conducted by a single surgeon within a managed care organization. METHODS Between May 2020 and December 2021, there were 87 patients undergoing 97 total procedures who were treated with either VenaSeal (n = 55) or RFA (n = 42), conducted by a single surgeon within a managed care organization. Primary outcomes included successful greater saphenous vein (GSV) closure, postoperative deep vein thrombosis (DVT), embolization, saphenofemoral junction (SFJ) thrombosis, skin reaction (allergic or thrombophlebitis), or procedure-related emergency room (ER) and urgent care (UC) visits. Retrospective chart review was conducted to describe patient demographics, indications for treatment, treatment details (number of access sites and indication for treatment), as well as follow-up adjunctive vein procedures (sclerotherapy and stab phlebectomy). RESULTS All patients had postprocedural ultrasound (US) performed within 7 days by the operating surgeon and mean overall patient follow-up from index procedure was 12 months; 2 patients were lost to follow-up due to death. All operations utilized intraoperative US, and SFJ thrombosis was not observed in any patient postprocedure. The average age of VenaSeal and RFA groups was 59.05 and 59.51 years, respectively. The average number of access sites during the procedure for VenaSeal and RFA was 1.56 and 1.20, respectively. Of the 55 VenaSeal treatments, 9.1% of patients reported postoperative skin reactions, and 9.1% of patients underwent subsequent stab phlebectomy (22 stabs on average). Of the 42 RFA treatments, 7.1% of RFA patients reported postoperative skin reactions, and 9.5% underwent subsequent stab phlebectomy (36 stabs on average). The percentage of patients who had postoperative UC or emergency department visits related to the procedure in the VenaSeal and RFA groups was 3.6% and 0%, respectively. CONCLUSIONS Both VenaSeal and RFA demonstrated effective vein closure of the GSV at 12-month follow-up, with VenaSeal demonstrating continued noninferiority to RFA. Based on our data, postoperative skin reactions do not appear to be significantly higher with VenaSeal treatment, as previously reported.
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Affiliation(s)
- Caryssa Lim
- Department of Vascular Surgery, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Jeffrey Hsu
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA
| | - Truong Vo
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA
| | - Jason Behseresht
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA
| | - Majid Tayyarah
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA
| | - Iden Andacheh
- Department of Vascular Surgery, Kaiser Permanente Fontana Medical Center, Fontana, CA.
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Yufa A, Mikael A, Gautier G, Yoo J, Vo TD, Tayyarah M, Behseresht D, Hsu J, Andacheh I. Percutaneous Axillary Artery Access for Peripheral and Complex Endovascular Interventions: Clinical Outcomes and Cost Benefits. Ann Vasc Surg 2021; 83:176-183. [PMID: 34954376 DOI: 10.1016/j.avsg.2021.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to determine the safety, efficacy, and applicability of percutaneous axillary artery (pAxA) access in patients requiring upper extremity large sheath access during complex aortic, cardiac, and peripheral endovascular procedures. We also take this opportunity to address the potential cost-benefits offered by pAxA access compared to open upper extremity access. METHODS A total of 26 consecutive patients, between June 2018 and October 2020, underwent endovascular intervention, requiring upper extremity access (UEA). Ultrasound-guided, percutaneous access of the axillary artery was used in all 26 patients with off-label use of pre-close technique with Perclose ProGlide closure devices. Access sites accommodated sheath sizes that ranged from 6 to 14 French (F). End points were technical success and access site-related complications including isolated neuropathies, hematoma, distal embolization, access-site thrombosis, and post-operative bleeding requiring secondary interventions. Technical success was defined as successful arterial closure intraoperatively with no evidence of stenosis, occlusion, or persistent bleeding, requiring additional intervention. RESULTS Of the 26 patients requiring pAxA access, 15 underwent complex endovascular aortic aneurysm repairs (EVAR) with branched, fenestrated, snorkel, or parallel endografts, 6 underwent peripheral vascular interventions, and 5 underwent cardiac interventions. Fifty-three percent accommodated sheath sizes of 12F or higher. Technical success was achieved in 100% of cases with no major perioperative access complications requiring additional open or endovascular procedures. In our series, we had one post-operative mortality secondary to myocardial infarction in a patient with significant coronary artery disease. CONCLUSIONS Our data again demonstrated the proposed safety and efficacy attributable to pAxA access, while extending its application to wide spectrum of endovascular interventions which included peripheral or coronary vascular in addition to complex EVAR.
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Affiliation(s)
- Ann Yufa
- Albert Einstein Medical Center, 5501 Old York Road, Klein 510, PHILADELPHIA, PENNSYLVANIA 19141; University of California, Riverside School of Medicine, 900 University Ave., RIVERSIDE, CALIFORNIA 92521.
| | - Amarseen Mikael
- University of California, Riverside School of Medicine, 900 University Ave., RIVERSIDE, CALIFORNIA 92521; Riverside Community Hospital, 4445 Magnolia Ave., RIVERSIDE, CALIFORNIA 92501
| | - Gloryanne Gautier
- Albert Einstein Medical Center, 5501 Old York Road, Klein 510, PHILADELPHIA, PENNSYLVANIA 19141
| | - Joseph Yoo
- Albert Einstein Medical Center, 5501 Old York Road, Klein 510, PHILADELPHIA, PENNSYLVANIA 19141
| | - Trung Duong Vo
- Kaiser Permanente, Southern California Medical Group, 9961 Sierra Ave., Department of Surgery, FONTANA, CALIFORNIA 92335
| | - Majid Tayyarah
- Kaiser Permanente, Southern California Medical Group, 9961 Sierra Ave., Department of Surgery, FONTANA, CALIFORNIA 92335
| | - Darian Behseresht
- Kaiser Permanente, Southern California Medical Group, 9961 Sierra Ave., Department of Surgery, FONTANA, CALIFORNIA 92335
| | - Jeffrey Hsu
- Kaiser Permanente, Southern California Medical Group, 9961 Sierra Ave., Department of Surgery, FONTANA, CALIFORNIA 92335
| | - Iden Andacheh
- University of California, Riverside School of Medicine, 900 University Ave., RIVERSIDE, CALIFORNIA 92521; Kaiser Permanente, Southern California Medical Group, 9961 Sierra Ave., Department of Surgery, FONTANA, CALIFORNIA 92335
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Ali AM, Khan S, Tayyarah M. Creation of a Successful Transposed Antecubital Radiocephalic Arteriovenous Fistula in Patient with Known Ipsilateral Modified Radical Mastectomy, Postoperative Radiation, and Proximal Central Venous Occlusion. Ann Vasc Surg 2016; 32:128.e15-7. [PMID: 26802298 DOI: 10.1016/j.avsg.2015.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
Native arteriovenous fistula (AVF) placement in patients with ipsilateral mastectomy and radiation has been avoided because of concerns regarding central venous outflow obstruction. To our knowledge, only 3 such cases have been reported. We present a patient with bilateral mastectomies and right-sided radiation therapy presenting for vascular access in the setting of multiple failed AVF in her left upper extremity and infected-groin catheter, central catheters, and axillary loop graft. We created and superficialized a radiocephalic AVF in her right upper extremity in the setting of central vein occlusion and robust collaterals which remains patent and has been cannulated successfully.
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Affiliation(s)
- Aamna Mahnoor Ali
- General Surgery, Kaiser Permanente-Arrowhead Regional Medical Center, Fontana, CA.
| | - Sadia Khan
- Breast and Oncologic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Majid Tayyarah
- Vascular Surgeon, Department of Surgery, Kaiser Permanente Foundation Hospital, Fontana, CA
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Vo T, Tumbaga G, Aka P, Hsu J, Behseresht J, Tayyarah M. VESS9. Surgical Aneurysmorrhaphy to Preserve Autogenous Arteriovenous Fistula (aAVF) With Aneurysm-Related Complications. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sarmiento JM, Wisniewski PJ, Do NT, Slezak JM, Tayyarah M, Aka PK, Vo TD, Hsu JH. The Kaiser Permanente Experience With Ultrasound-Guided Percutaneous Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2012; 26:906-12. [DOI: 10.1016/j.avsg.2011.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 09/18/2011] [Accepted: 09/26/2011] [Indexed: 12/17/2022]
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Sarmiento JM, Wisniewski PJ, Do NT, Slezak JM, Tayyarah M, Aka PK, Vo TD, Hsu JH. PS158. Use of Ultrasound for Percutaneous Endovascular Aortic Aneurysm Repair (PEVAR) Reduces Rate of Conversion to Femoral Cutdown. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Do N, Wisniewski P, Sarmiento J, Vo T, Aka PK, Hsu JH, Tayyarah M. Retrograde superior mesenteric artery stenting for acute mesenteric arterial thrombosis. Vasc Endovascular Surg 2010; 44:468-71. [PMID: 20484067 DOI: 10.1177/1538574410366168] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Retrograde superior mesenteric artery stenting (ROMS) represents a significant development in the treatment of acute mesenteric ischemia. Compared to traditional surgical mesenteric bypass, ROMS is a less invasive technique that avoids many complications associated with emergent mesenteric bypass. This case report illustrates that retrograde superior mesenteric artery (SMA) stenting is an option for the treatment of acute mesenteric ischemia for patients in extremis.
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Affiliation(s)
- Natalie Do
- Kaiser Permanente Fontana Medical Center, Department of Vascular Surgery, Fontana, CA 92335, USA
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Abstract
OBJECTIVE Our purpose was to examine the impact of the introduction of endovascular treatment on the early outcomes of ruptured abdominal aortic aneurysms (AAAs) during 2 consecutive time periods at a single institution. METHODS The hospital records of a single tertiary care center from 1997 to 2004 were retrospectively reviewed, and 36 consecutive patients who underwent treatment for acute ruptured AAA were identified. They were divided into 19 (53%) patients who were all treated with conventional open surgery from 1997 to 2001 (early) and 17 (47%) patients who were treated either with open (n = 4, 24%) or endovascular (n = 13, 76%) methods from 2002 to 2004 (late). All endovascular repairs were performed with commercially available bifurcated devices. Outcome measures included death, major complications, disposition at discharge (home or extended care facility), procedure time, blood loss, and hospital length of stay. RESULTS Age, sex, and AAA size were similar between the 2 groups. Perioperative mortality in the early and late periods were 37% versus 12%, respectively (P =.13); rates of major complications were 84% versus 65%, respectively (P =.26); and discharge to home rather than extended care facility was 32% versus 59%, respectively (P =.18). Median procedure times (275 vs 149 minutes, P <.01), blood loss (3800 vs 138 mL, P <.0001), and length of stay (18 vs 6 days, P <.05) were all higher during the early period than in the late period. CONCLUSIONS This preliminary study suggests that introduction of endovascular therapies may be potentially beneficial in the overall treatment scheme of patients with ruptured AAAs. However, longer follow-up and larger cohorts are needed to better establish its feasibility and efficacy compared with conventional open surgical repair.
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Affiliation(s)
- W Anthony Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, 32610-0286, USA.
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Grossi EA, Kallenbach K, Chau S, Derivaux CC, Aguinaga MG, Steinberg BM, Kim D, Iyer S, Tayyarah M, Artman M, Galloway AC, Colvin SB. Impact of heparin bonding on pediatric cardiopulmonary bypass: a prospective randomized study. Ann Thorac Surg 2000; 70:191-6. [PMID: 10921707 DOI: 10.1016/s0003-4975(00)01319-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass in adult patients; however, little is known about its effects in the pediatric population. Two studies were performed to assess this technology's impact on inflammation and clinical outcomes. METHODS In a pilot study, complement and interleukins were measured in 19 patients who had either uncoated cardiopulmonary bypass circuits or heparin-bonded circuits. Subsequently, 23 additional patients were studied in a randomized fashion. Respiratory function and blood product utilization were recorded. RESULTS In the pilot study, heparin-bonded circuit patients had less complement 3a (p < 0.001) and interleukin-8 (p < 0.05) compared with uncoated cardiopulmonary bypass circuit patients. The randomized study revealed that the heparin-bonded circuit was associated with reduced complement 3a (p = 0.02). Multiple variable analysis revealed that the following postoperative variables were increased with bypass time (p = 0.01) and diminished with heparin-bonded circuits: interleukins (p = 0.01), peak airway pressures (p = 0.05), and prothrombin time (p = 0.03). CONCLUSIONS Heparin-bonded circuits significantly reduce cytokines and complement during cardiopulmonary bypass and lower interleukin levels postbypass; they were also associated with improved pulmonary and coagulation function. Heparin-bonded circuits ameliorate the systemic inflammatory response in pediatric patients from cardiopulmonary bypass.
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Affiliation(s)
- E A Grossi
- Division of Cardiothoracic Surgery, New York University School of Medicine, New York, USA.
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Schwartz JD, Shamamian P, Grossi EA, Schwartz DS, Marcus SG, Steiner F, Jacobs CE, Tayyarah M, Eng K, Colvin SB, Galloway AC. Lexipafant inhibits platelet activating factor enhanced neutrophil functions. J Surg Res 1997; 69:240-8. [PMID: 9224389 DOI: 10.1006/jsre.1997.5008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Platelet activating factor (PAF) enhances polymorphonuclear leukocyte (PMN) superoxide (.O2-) production, CD11b expression, and elastase release, all essential components in the pathophysiology of multiple-organ failure. This study was designed to determine the effects of Lexipafant, a PAF receptor antagonist, on PAF-mediated PMN functions. PMNs from 10 healthy volunteers were isolated and pretreated with various concentrations of Lexipafant (0-100 microM). PMNs were then incubated for 5 min with 200 nM PAF for .O2- detection or 2000 nM PAF for elastase measurement and activated with 1 microM N-formylmethionylleucylphenylalanine. The mean rate of .O2- production was determined by a cytochrome c reduction assay (nmole .O2-/min/1.33 x 10(5) PMN +/- SEM). Elastase release was measured by the cleavage of the synthetic elastase substrate Meo-Suc-Ala-Ala-Pro-Val-pNA (mean elastolytic activity +/- SEM). In parallel experiments, PMNs were incubated with 200 nM PAF for 30 min following pre-treatment with Lexipafant and CD11b expression was determined by flow cytometry (mean fluorescence intensity +/- SEM). Statistical analysis was performed using repeated-measures ANOVA (P < 0.05). Lexipafant inhibited PAF-enhanced PMN .O2- generation, CD11b expression and elastase release in a dose dependent fashion. The IC50 of Lexipafant for .O2- production, CD11b expression, and elastase release was 0.046, 0.285, and 0.05 microM, respectively. Lexipafant attenuated the PAF-mediated upregulation of PMN .O2- production, CD11b expression, and elastase release in a dose dependent fashion. These data support the hypothesis that Lexipafant may reduce the severity of the inflammatory response to injury produced by PAF-enhanced activation of PMNs.
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Affiliation(s)
- J D Schwartz
- New York University School of Medicine, Department of Surgery, S. Arthur Localio, Surgical Research Laboratory, New York 10016, USA
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