Early and 1 year angiographic evaluation of graft patency in off-pump coronary bypass surgery via sternotomy.

The goal of this study was to evaluate the early and 1 year postoperative angiographic results in patients who underwent coronary revascularisation for multivessel disease on beating heart via sternotomy. One hundred eleven consecutive patients receiving 272 grafts, operated by the same surgeon were studied (2.5 grafts/patient). The quality of the graft and the anastomoses was systematically evaluated by coronary angiography between 1 and 15 days after surgery. Eighty-seven patients (209 grafts) of the initial cohort (78.3%) were repeatedly controlled by angiography between 5 and 24 months. Angiographic findings were studied and classified according to Fitzgibbon classification. Overall early graft patency was 96.4%. Arterial graft patency was 96.4% and vein graft patency was 96.3% (P=1). Of the grafts (88.7%) were Grade A, 21 grafts (7.7%) Grade B and 10 grafts (3.6%) were occluded (Grade O). The second angiographic control revealed a patency rate of 94.8%, arterial graft patency was 95.4% and vein graft patency was 93.8% (P=0.9): 91.5% of patent grafts were graded (A), 3.3% graded (B) and 5.2% graded (O). A comparison between early and late angiograms revealed: two-stenosis de novo, three-occlusion de novo and decrease or disappearance of the stenosis in 13/21 graft, 11 arterial and two vein grafts (61.9%). In this study, the early and 1 year postoperative patency rate seems to be equivalent to coronary bypass with pump, however, a randomised study is needed to compare both approaches. Most of the stenosis detected at the early coronary angiography could decrease or disappear, especially in arterial grafts.

[Cure of superacute eosinophilic myocarditis treated by temporary circulatory assistance]. / Guérison d'une myocardite suraiguë à éosinophiles traitée par assistance circulatoire temporaire.

The authors report the case of a 31 year old woman, admitted as an emergency for acute myopericarditis, in cardiogenic shock. Echocardiography showed severe left ventricular dysfunction associated with concentric biventricular hypertrophy with increased echogenicity of the myocardial walls. Poor response to treatment with intravenous inotropic drugs led to referral for biventricular circulatory assistance with a Biomedicus pump, which was withdrawn on the 9th day after recovery of normal left ventricular function. Myocardial biopsies showed massive interstitial inflammation with a predominance of eosinophilic cells suggesting a hypersensitivity reaction. Steroid therapy was prescribed when the results of biopsy were known and stopped after 6 months. This case emphasises the value of echocardiography and myocardial biopsy in diagnosis and treatment of acute myocarditis with cardiogenic shock.

Cadaveric renal transplantation after 60 years of age. A single center experience.

We report the outcome of 121 cadaveric renal transplants performed in our institution between September 1985 and April 1992 in 117 patients, aged 60-71 years (mean 63 years) at the time of transplantation. Compared to 640 patients 20-59 years of age transplanted during the same study period, a nonstatistically significant difference was observed in the 5-year actuarial patient (80% and 90%, respectively, in recipients over and under 60 years of age) and transplant (80% and 72%, respectively, in recipients over and under 60 years of age) survival rates. However, elderly patients had significantly lower survival than recipients 20-29 years of age (P < 0.009). Fourteen patients died (all but one with a functioning graft) due to cardiovascular diseases (5%; 42.8% of total deaths), infections (3%; 28.6% of total deaths), and gastrointestinal complications (3%; 28.6% of total deaths). Younger patients showed a similar and nonsignificantly different incidence of cardiovascular- (35%) and infectious-(30%) related deaths. The incidence of acute rejection episodes and cytomegalovirus (CMV) infectious episodes was 27% and 24%, respectively, during the 1st post-transplant year. Ongoing acute rejection and CMV infectious episodes were significantly higher in patients who died than in those still alive (P < 0.002 and P < 0.02, respectively). Cyclosporin maintenance therapy was well tolerated in all patients but one, and 64% of the patients could be maintained without steroids. These data indicate that cadaveric renal transplantation is a safe and effective procedure in the management of chronic renal failure of selected patients 60 years of age or older.