Left ostial stenosis surgical angioplasty.

BACKGROUND: Left main coronary stenosis, including ostial lesions, is conventionally treated by coronary bypass surgery. This approach, however, restores a less physiological retrograde perfusion to part of the myocardium and may contribute to a competition of flows in non-occluded coronaries. Direct surgical reconstruction of the LMCA has been described and theoretically avoids these potential drawbacks. METHODS: From May 1995 until December 2005, 25 patients with ostial left main stenosis underwent surgical angioplasty in our unit. Patients were all followed up clinically and with transesophageal echocardiography. RESULTS: Mean age of the patients was 59.7 years (range, 33 - 73 years). The male to female ratio was 14 : 11. The left main coronary stem was approached anteriorly in all patients. The onlay patch consisted of saphenous vein and was extended across the aortotomy suture line. There were no early deaths or perioperative myocardial infarctions. All patients underwent follow-up clinical examination and transesophageal (TOE) echocardiography as well as other investigations when required. TOE demonstrated a wide open left main coronary artery normal flow pattern, and no aneurysmal dilatation or calcification of the onlay patch in 24 patients. After a mean follow-up of 8 years, the all-cause survival was 88 %, while event-free survival was 80 % with 21 pts remaining in CCS I. CONCLUSION: Surgical reconstruction of the LMCA is a safe and effective treatment for left main stenosis. Re-institution of normal blood flow through the left main coronary artery possibly confers advantages over bypass surgery.

Extended ganciclovir prophylaxis in lung transplantation.

BACKGROUND: Positive cytomegaloviral status of the donor or of the recipient adversely affects survival and enhances the development of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. The role of ganciclovir prophylaxis in cytomegalovirus infection in respect to obliterative bronchiolitis or to BOS development is not known. METHODS: From the Papworth transplant database, we identified 146 patients who received organs from cytomegalovirus-positive donors. We classified patients into 3 groups as follows: Group 1 consisted of 42 patients who underwent transplantation between 1990 and 1992 when no prophylaxis was given; Group 2 consisted of 49 patients who underwent transplantation between 1992 and 1995 when 4 weeks of IV ganciclovir was given as prophylaxis; and Group 3 consisted of 55 patients who underwent transplantation between 1995 and 1998 when cytomegalovirus prophylaxis consisted of IV (1 week) followed by oral ganciclovir for a total of 3 months. Donor management, recipient management during and after surgery, and pharmacotherapy were uniform during the study period. We used survival and regression methods to compare these groups, adjusting for the transplantation type (single lung, double lung, or heart-lung) and for HLA typing. RESULTS: We found a significant difference among all 3 groups in numbers of cytomegaloviral disease episodes in the 1st year after transplantation. The number of rejection episodes in the 3 groups during the 1st post-transplant year gradually decreased from Group 1 to Group 3. We identified no statistically significant benefit in the time to BOS occurrence or in actuarial survival. CONCLUSION: Extended prophylaxis with IV and oral ganciclovir practically abolishes cytomegaloviral disease and is related to a decreased incidence of rejection episodes. However, ganciclovir prophylaxis is not related to a decreased incidence or progression of BOS or survival.