The role of transapical cannulation in the operative management of acute aortic dissection.

OBJECTIVES: The aim of the study was to investigate the usefulness of transapical cannulation as the routine cannulation site in patients with acute aortic dissection and to compare it with other cannulation methods. METHODS: Between January 2010 and December 2013, emergency surgery was performed in 111 consecutive patients with acute type A aortic dissection. Patients were divided into two groups: transapical cannulation group and other cannulation sites group (including femoral and axillary artery cannulation). Pre-, intra- and postoperative data were compared between these two groups of patients. RESULTS: Transapical cannulation was the most frequent cannulation site (78 patients, 70.3%), the femoral artery was selected in 24 patients (21.6%) and the axillary artery in 9 patients (8.1%). The mortality rate in the transapical group was 16.7% and 18.2% when other cannulation sites were chosen (p=0.85). No difference in postoperative stroke rate (6.4% vs 9.1%, p=0.62, transapical vs other cannulation sites group, respectively), myocardial infarction (6.4% vs 6.1%, p=0.94) and postoperative acute renal insufficiency incidence (9% vs 6.1%, p=0.61) was found. CONCLUSIONS: Routine transapical cannulation in patients with acute type A aortic dissection is a fast and safe way to establish cardiopulmonary bypass. There is no difference in major operative outcomes after transapical cannulation when compared to the other cannulation sites.

[Cardiac neoplasms: results of the surgical treatment between 2000. and 2008].

INTRODUCTION: The goal of this study was to show early and midterm results of surgical treatment of cardiac neoplasma. METHODS: Between 2000. and 2008., sixty-seven patients with a cardiac tumor or a subdiaphragmatic neoplasma with right atrial extension were operated in our institution. In 22 patients (32.8%), not only a simple extirpation of neoplasma, but an additional surgical procedure was done. RESULTS: A patient reoperated for a recurence of biatrial myxoma died early after operation (1.5% mortality rate). During follow-up period of 3.3 years, two patients (3.4%) out of 58 that were contacted died because of the neoplasma (Methastasis of adenocarcinoma, Carcinoma renis). CONCLUSION: Surgical treatment of cardic tumors resulted in low early mortality and an excellent survival rate after a follow-up period of 3.3 years.

Perfect angiographic patency of the arterial coronary-coronary conduit five years following surgery.

Five years ago, the left internal thoracic artery free segment was used as a coronary-coronary bypass over a single, distal lesion of the large left anterior descending coronary artery in a patient with triple vessel disease. The patient has recently been readmitted, complaining of chest discomfort. Although he was scheduled for percutaneous coronary intervention due to disease progression on the circumflex coronary artery, the perfect angiographic patency of the arterial coronary-coronary conduit has been confirmed.

Coronary-coronary bypass to reconstruct coronary artery bed following removal of a guidewire entrapped in a stent.

Cardiac surgeons are treating an increasing number of patients after different sorts of complications occurring during various percutaneous procedures. Wire entrapment has been described in the literature and numerous maneuvers have been developed to solve this complication. If they fail, surgical management is absolutely indicated. In such cases the operation can be very demanding. After hardware removal the artery quality is usually unsatisfactory and endarterectomy with adjacent revascularization is mandatory. We report a case in which we used a termino-terminal interposition of the greater saphenous vein to restore a disintegrated part of the coronary artery.

Immunoglobulin G3 antibodies specific for the 19-kilodalton carboxyl-terminal fragment of Plasmodium yoelii merozoite surface protein 1 transfer protection to mice deficient in Fc-gammaRI receptors.

Merozoite surface protein 1 (MSP-1(19)) is a leading malaria vaccine candidate. Specific antibodies contribute to immunity; binding to macrophages is believed to represent the main action of malaria antibodies. We show that an MSP-1(19)-specific immunoglobulin G3 (IgG3) monoclonal antibody can passively transfer protection to mice deficient in the alpha chain of Fc-gammaRI whose macrophages cannot bind IgG3.

Absolute requirement for an active immune response involving B cells and Th cells in immunity to Plasmodium yoelii passively acquired with antibodies to the 19-kDa carboxyl-terminal fragment of merozoite surface protein-1.

Vaccination of mice with the leading malaria vaccine candidate homologue, the 19-kDa carboxyl terminus of merozoite surface protein-1 (MSP119), results in sterile immunity to Plasmodium yoelii, with no parasites detected in blood. Although such immunity depends upon high titer Abs at challenge, high doses of immune sera transferred into naive mice reduce parasitemia (and protect from death) but do not result in a similar degree of protection (with most mice experiencing high peak parasitemias); this finding suggests that ongoing parasite-specific immune responses postchallenge are essential. We analyzed this postchallenge response by transferring Abs into manipulated but malaria-naive mice and observed that Abs cannot protect SCID, nude, CD4+ T cell-depleted, or B cell knockout mice, with all mice dying. Thus, in addition to the Abs that develop following MSP119 vaccination, a continuing active immune response postchallenge is required for protection. MSP119-specific Abs can adoptively transfer protection to strains of mice that are not protected following vaccination with MSP119, suggesting that the Ags targeted by the immune response postchallenge include Ags apart from MSP119. These data have important implications for the development of a human malaria vaccine.