Kidney transplant patients at Ullevål Hospital 1963-83. / Pasienter nyretransplantert ved Ullevål sykehus 1963­83.

BACKGROUND: In the period November 1963 to July 1983, 118 patients received a kidney transplant at Ullevål Hospital. All future kidney transplants were subsequently performed at Oslo University Hospital, Rikshospitalet. The purpose of our study is to present demographic data and show patient and graft survival from the first patient cohort of kidney transplant recipients in Norway. MATERIAL AND METHOD: The patients were identified in surgical protocols from Ullevål Hospital and the Norwegian Renal Registry using follow-up data up to December 2016. We recorded the patients' age and sex, cause of renal failure, donor characteristics, patient and graft survival, number of retransplants and cause of death. RESULTS: 118 patients: 38 women and 80 men, aged 14-67 years, received a transplant during the reference period. The most common indicators for transplantation were chronic glomerulonephritis (n = 61), chronic pyelonephritis (n = 20) and polycystic kidney disease (n = 14). Seventy-two patients (61 %) received a kidney from a deceased donor. After one year, 94 of the patients were still living (80 %), after five years, 66 of the patients (56 %) were still living, and after twenty years, the figure was 34 (29 %). Cardiovascular disease was the most common cause of death. The median graft survival was 3.8 years (quartile range 14.4 years). Thirty-two patients underwent retransplantation. INTERPRETATION: Even in this pioneering era, patient survival rates and the functional life of donated kidneys were acceptable.

The three first liver transplantations in Norway, and the road leading to them.

Although renal transplantation was a therapeutic reality in Norway from 1969, organ transplantation was largely regarded as experimental surgery from its introduction in the early 1950s until the licensing of ciclosporin in 1982. After the first successful renal transplantation in 1954, 13 years elapsed before a liver and a heart were successfully transplanted, both in 1967. Inspired by the pioneers Thomas Starzl in Denver, Colorado, and Roy Yorke Calne in Cambridge, early in 1968 Snorre Aune, Gunnar Schistad and Andreas Skulberg began experimental studies on pigs at Ullevål Hospital to develop a surgical technique for liver transplantation. They collaborated with a team at Rikshospitalet led by Audun Flatmark and performed transplantations there every other week, and every other week at Ullevål. It took over one year of weekly animal experiments before the first transplanted pig survived. The first three transplantations on humans in Norway were performed at Ward 2, Ullevål Hospital in 1969, 1970 and 1972. The first patient died shortly after surgery, the second after 24 days, the third 54 days after transplantation. Snorre Aune, Gunnar Schistad and Andreas Skulberg were awarded the Michael Skielderup gold medal in 1972 for this pioneering work. The article is based on the author's own experience as an assistant surgeon and junior partner in the animal experiments and the first human liver transplantations in Norway, and a survey of relevant publications.

Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial.

Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery. Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO(2)I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20-30% postoperatively (P < 0.05). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO(2)I by 15-20% compared to the PAC group (P < 0.05). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group (P = 0.04). Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO(2)I, and reduces the duration of respiratory support after complex valve surgery.

Pediatric cardiac surgery in Northern Russia. Results from an international cooperative program.

OBJECTIVES: In order to evaluate a Norwegian-Russian clinical cooperation, this study sought to compare the incidence, early mortality and morbidity of surgically treated patients with atrial septum defect (ASD), ventricular septum defect (VSD) and Tetralogy of Fallot (TOF) in Norway and Archangels region in Russia. DESIGN: A retrospective analysis of patient records of all those surgically treated for ASD, VSD and TOF in Norway and from Archangels region from 1 January 2000 to 31 December 2005. RESULTS: The Norwegian cohort consisted of 191 ASDs, 227 VSDs and 126 TOFs. The Russian cohort counted 128 ASDs, 77 VSDs and nine TOFs. Thirty-days mortality was 0.4% in the Norwegian VSD, 1.6% in the Norwegian TOF and 1.3% in the Russian VSD cohort. Postoperative complications in the Norwegian cohorts were 18.3% (ASDs), 15.9% (VSDs) and 34.1% (TOFs). The corresponding findings in Archangels were 4.7%, 11.7% and 0%. CONCLUSION: Surgery for ASDs, VSDs and TOFs can be carried out with minimal early mortality in both countries. The discrepancy in early postoperative morbidity illustrates the challenges in comparative studies between different countries, cultures and health care systems. The establishment of a decentralized surgical facility has increased the access to cardiac surgery to the population in Archangels region.

Plasma IL-18 and IL-18BP are altered differently in reverse remodeling following aortic valve replacement.

OBJECTIVES: Patients with aortic stenosis (AS) develop left ventricular remodeling characterized by changes in extracellular matrix (ECM) and cardiomyocyte-hypertrophy. Aortic valve replacement (AVR) reverses this process (reverse remodeling). We examined plasma levels of interleukin-18 (IL-18) and its binding protein (IL-18BP) before and after AVR for AS since these mediators have been shown experimentally to exert effects on myocardial remodeling. DESIGN: Plasma levels of IL-18 and IL-18BP were analyzed in 22 patients with AS undergoing AVR, preoperatively, two days, six and 12 months postoperatively. Echocardiography and functional testing were performed. RESULTS: IL-18BP was significantly increased by 28% and 15% at two days and six months after AVR, compared to preoperative values. In contrast, IL-18 showed a later peak (increased by 24% at 12 months postoperatively) when IL-18BP was normalized. IL-18 correlated positively with deceleration time (R = 0.44) at this time-point which might indicate an association with diastolic function. CONCLUSIONS: We report for the first time that plasma IL-18 and IL-18BP are differentially regulated after AVR for AS with an early increase in IL-18BP postoperatively followed by a later peak in IL-18 at 12 months. Given the known effects of these mediators on myocardial remodeling and function, they might play a role in the reverse and remodeling process associated with AVR.

Alterations in circulating activin A, GDF-15, TGF-beta3 and MMP-2, -3, and -9 during one year of left ventricular reverse remodelling in patients operated for severe aortic stenosis.

BACKGROUND: Patients with aortic stenosis (AS) develop left ventricular remodelling with cardiomyocyte hypertrophy and increased fibrosis. Following aortic valve replacement (AVR) reverse remodelling usually takes place. AIMS: To examine circulating levels of members of the transforming growth factor (TGF) beta superfamily and matrix metalloproteinases (MMP), known to have important effects on hypertrophy and extracellular matrix, in patients operated for AS. METHODS: Circulating levels of activin A, GDF-15, TGF-beta3, MMP-2, -3, and -9 were measured in twenty-two patients undergoing AVR preoperatively, and 2 days, six months and 12 months postoperatively. Echocardiography and a six minute walking test evaluated reverse remodelling and physical performance. RESULTS: Activin A increased at six (1081.00+/-98.05 pg/ml, p<0.05) and twelve months (1263.09+/-141.43 pg/ml, p<0.05) compared to the preoperative value (855.00+/-76.30 pg/ml) and correlated negatively to physical performance. The preoperative value was also increased compared to controls (639.54+/-63.05 pg/ml, p<0.05). GDF-15, MMP-3 and -9 were all increased at two days postoperatively (p<0.05). MMP-3 correlated with left ventricular end diastolic dimension (p<0.05). MMP-2 did not change during the study period. TGF-beta3 was only slightly reduced at six months postoperatively. CONCLUSION: The observed alteration in circulating levels of members of the TGF-beta superfamily and MMPs might play a role in the reverse remodelling process following AVR for AS.

The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-up.

BACKGROUND: B-type natriuretic peptide (BNP) is synthesized in cardiac tissue in response to increased wall stress and myocardial hypertrophy. AIMS: In patients with severe aortic stenosis (AS) we examined the effect of aortic valve replacement (AVR) on plasma BNP and association between BNP and left ventricular mass index (LVMI) preoperatively and in the reverse-remodeling phase twelve months postoperatively. We also examined the correlation between BNP and NYHA-class and between BNP and age. METHODS AND RESULTS: Plasma BNP analyses and echocardiographic measurements were performed preoperatively, before discharge after AVR, and at twelve months in twenty-two patients. BNP was additionally measured at six months. Preoperatively, BNP was 283+/-45 pg/ml (mean+/-SEM). Following an immediate postoperative increase (441+/-38 pg/ml), BNP values decreased towards normal values at six and twelve months (139+/-25 and 130+/-18 pg/ml, respectively). LVMI was 206.5+/-15.8 g/m(2) preoperatively and decreased to 119.7+/-7.2 g/m(2) at twelve months with a correlation between LVMI and BNP preoperatively only (r=0.45, p<0.05). There was no correlation between BNP and NYHA-class, whereas BNP correlated to age both pre- and post-operatively. CONCLUSION: We report an increase in plasma BNP in patients with AS. Following a further transient increase postoperatively, BNP levels decreased at six and twelve months after AVR. BNP correlated with LVMI preoperatively, and with age both preoperatively and at twelve months.

Randomized comparison of stentless versus stented valves for aortic stenosis: effects on left ventricular mass.

BACKGROUND: Aortic valve replacement (AVR) is the established treatment for severe aortic stenosis. In response to the long-term results of aortic homografts, stentless porcine valves were introduced as an alternative low-resistance valve. We conducted a randomized trial comparing a stentless with a stented porcine valve in adults with severe aortic stenosis. METHODS AND RESULTS: The primary outcome was change in left ventricular mass index (LVMI) measured by transthoracic echocardiography and, in a subset, by cardiovascular MR. Measurements were taken before valve replacement and at 6 and 12 months. Patients undergoing AVR with an aortic annulus < or =25 mm in diameter were randomly allocated to a stentless (n=93) or a stented supra-annular (n=97) valve. There were no significant differences in mean LVMI between the stentless versus stented groups at baseline (176+/-62 and 182+/-63 g/m2, respectively) or at 6 months (142+/-49 and 131+/-45 g/m2, respectively), although within-group changes from baseline to 6 months were highly significant. Changes in LVMI measured by cardiovascular MR (n=38) were consistent with the echo findings. There was a greater reduction in peak aortic velocity (P<0.001) and a greater increase in indexed effective orifice area (P<0.001) in the stentless group than in the stented group. There were no differences in clinical outcomes between the 2 valve groups. CONCLUSIONS: Despite significant differences in indexed effective orifice area and peak flow velocity in favor of the stentless valve, there were similar reductions in left ventricular mass at 6 months with both stented and stentless valves, which persisted at 12 months.

[Long-term results with the left internal mammary artery as coronary bypass]. / Langtidsresultater med a. mammaria interna sinistra som koronar bypass.

BACKGROUND: From 1986 we have routinely used the left internal mammary artery instead of autologous vein as bypass to the left anterior descending coronary artery. MATERIAL AND METHODS: A cohort of 52 patients has been followed up for up to 12 years. Six years postoperatively, 40 patients were evaluated by clinical examination, exercise testing and serum lipid assessment. Of these, 38 underwent angiography of the native coronary arteries and of all grafts, which represented 47 left internal mammary artery, 90 saphenous vein, and 3 right internal mammary artery bypasses. Information regarding angina recurrence and the need for repeated revascularisation was obtained from hospital records. Twelve-year mortality data were provided by public registers. RESULTS: Fifty patients were discharged alive. Two serious complications, of which one was fatal, were directly related to the use of the left internal mammary artery. After six years, all the re-examined patients had improved their exercise tolerance; 25 (63%) were angina-free. 44 (94%) left internal mammary artery and 67 (74%) saphenous vein bypasses were patent. Tobacco consumption was considerably reduced over the first six years postoperatively while mean triglyceride and cholesterol levels remained moderately elevated. After 12 years, 18 patients were deceased, half of them from coronary heart disease. INTERPRETATION: Our results are in accordance with large, international studies.