This extensive morphological study (macroscopy, x-ray, histology, histochemistry and electron microscopy) compares two types of bioprosthetic valves, porcine aortic (PAV) and bovine pericardial (BPV) of various models, both unimplanted (five) and explanted (229). There were 197 PAV and 32 BPV explanted from the mitral, aortic and tricuspid positions, with a mean duration of implantation of 70.3 and 13.5 months, respectively. Within that material, a smaller, rather homogeneous, series of 11 Carpentier-Edwards PAV (CE) and 11 Ionescu-Shiley BPV (IS) explants (mean implantation period 53 and 49, mean patient-age 45 and 47 years) made the comparison of clinical and macroscopic features more valid. In the total series, the leading causes of failure were cuspal tear/perforation with calcification in the PAV group (64 per cent); non-calcified leaflet rupture (27 per cent) and infective endocarditis (27 per cent) in the BPV group. In the small series of CE PAV and IS PAV, the characteristic modes of failure were calcified juxta-commissural cusp rupture for CE and non-calcified leaflet rupture at the suture for IS. The most characteristic x-ray features were calcification of fibrous cords irradiating from the commissures and calcific nodules in the centre in PAV and large plaques extending from the commissures and leaflet base in all directions in BPV. The main microscopic features of leaflet degradation were: the soaked sponge phenomenon (loosening and plasma and fat insudation) and the nodular, protein-rich calcification, both centred in the spongiosa, in PAV explants; important macrophagic activity and destruction of collagenous structures at the outflow layer and along the suture of the leaflets, with preservation of the middle layer, and the intrinsic calcification of the deep collagenous bundles, in BPV explants. Those alterations and other features are discussed with reference to leaflet structure and design, haemodynamics and possible causal mechanisms.
Biocompatibility is redefined as the quality of being mutually tolerant with life. In so far as this represents a quality which is as likely to be achieved as is the alchemist's dream of turning lead into gold, a compromise approach is recommended. It is suggested that all extracorporeal or body invasive procedures stimulate the inflammatory defence mechanism of the body by stimulating the monocyte to produce a family of polypeptides currently known collectively as Interleukin-1 (IL-1). So far two dissimilar gene products have been cloned and there are probably more. The IL-1 group of polypeptides possess hormonal functions which orchestrate nearly every instrument of the body's defence system. Inducers of IL-1 are present in dialysate and induce bacterial pyrogen and acetate. In addition bacterial cell wall glycoprotein may be cleaved into muramyl peptides by the release of granulocyte lysozyme at the membrane interface. Muramyl dipeptides have been found in CAPD drain fluid and are more potent inducers of IL-1 than endotoxin. Membrane activation of the fifth component of the complement with the release of C5a will also induce monocytes to produce IL-1. The consequences of repeated stimulation of the acute phase response are undesirable and may include muscle wasting, osteopenia and bone cysts (Shrinking man syndrome), fibrosis of scapulo-humeral joints and the carpal-tunnel syndrome. These latter lesions are often associated with deposition of amyloid fibrils related to beta 2-microglobulin. Efforts to reduce these complications are urgently required.(ABSTRACT TRUNCATED AT 250 WORDS)
The combination of an ultrafiltration device with an exchanger whose semipermeable hollow fibres are covered with renal epithelial cells is proposed as a design for a bioartificial kidney. We first demonstrated that continuous ultrafiltration can be maintained for relatively long periods in the absence of anticoagulation. As a second step, we report here the feasibility of attaching and growing two lines of kidney epithelial cells (MDCK and LLC-PK1) on two different semipermeable materials, an acrylic copolymer and a polysulphone. Cells seeded on acrylic copolymer hollow fibres reach confluence within three weeks. Depending on the chemical and/or physical properties of the polymer, the cells show distinct differentiated morphology, which may influence their ability to perform specialized tasks.
Glutaraldehyde stabilizes pericardial tissue in prosthetic heart valves by forming covalent cross-links between collagen molecules. If the cross-linking is nonuniform owing to variable penetration of the glutaraldehyde, areas of the tissue may become sites for enzymatic attack or become potentially antigenic. Cross-linking can be easily assessed by measuring the shrinkage (thermal denaturation) temperature of the tissue. We used differential scanning calorimetry to perform a stratigraphic analysis of the shrinkage temperature of glutaraldehyde-treated pericardium. In the fixation conditions used (0.25 per cent glutaraldehyde for 28, seven and two days and for 2 hours), no variation was found in the shrinkage temperature measurement throughout the thickness of the tissue. This indicates uniform penetration of fixative and cross-linking throughout the tissue.
This extensive morphological study (macroscopy, x-ray, histology, histochemistry and electron microscopy) compares two types of bioprosthetic valves, porcine aortic (PAV) and bovine pericardial (BPV) of various models, both unimplanted (five) and explanted (229). There were 197 PAV and 32 BPV explanted from the mitral, aortic and tricuspid positions, with a mean duration of implantation of 70.3 and 13.5 months, respectively. Within that material, a smaller, rather homogeneous, series of 11 Carpentier-Edwards PAV (CE) and 11 Ionescu-Shiley BPV (IS) explants (mean implantation period 53 and 49, mean patient-age 45 and 47 years) made the comparison of clinical and macroscopic features more valid. In the total series, the leading causes of failure were cuspal tear/perforation with calcification in the PAV group (64 per cent); non-calcified leaflet rupture (27 per cent) and infective endocarditis (27 per cent) in the BPV group. In the small series of CE PAV and IS PAV, the characteristic modes of failure were calcified juxta-commissural cusp rupture for CE and non-calcified leaflet rupture at the suture for IS. The most characteristic x-ray features were calcification of fibrous cords irradiating from the commissures and calcific nodules in the centre in PAV and large plaques extending from the commissures and leaflet base in all directions in BPV. The main microscopic features of leaflet degradation were: the soaked sponge phenomenon (loosening and plasma and fat insudation) and the nodular, protein-rich calcification, both centred in the spongiosa, in PAV explants; important macrophagic activity and destruction of collagenous structures at the outflow layer and along the suture of the leaflets, with preservation of the middle layer, and the intrinsic calcification of the deep collagenous bundles, in BPV explants. Those alterations and other features are discussed with reference to leaflet structure and design, haemodynamics and possible causal mechanisms.
This study discusses the surgical aspects of permanent cardiac pacemakers with reference to a ten-year review involving 628 procedures. The most suitable route for electrode placement was found to be subclavian vein puncture, access being achieved in 97% of cases. This method was however, associated with a small incidence of pneumothorax (1.4%) and haemothorax (0.9%). The commonest late complication is infection in spite of sterile technique and antibiotic prophylaxis. Experience with infected pacemakers suggest that the best line of management is complete removal of the system followed by delayed replacement once the infection has been eradicated. Pacemaker technology is constantly improving, providing both patient and physician with increasingly elaborate tools. In order to reap the benefit of these pacemakers, the data from this review demonstrates the need for meticulous technique in their insertion and an ability to deal with any complication promptly and adequately.
We report here an experimental investigation of the effects of inlet blood pressure and rotation speed on the performance of a rotating membrane device for plasmapheresis commercialized by Hemascience. The good performance of this device can be explained by a combination of high shear rate, centrifugation of red cells and platelets away from the membrane and large secondary flows.
Prognostic factors of Low Output Syndrome (LOS) requiring operative circulatory support by intra-aortic balloon-pumping (IABP) counterpulsation, were analysed in a population of 841 patients who underwent heart valve replacement surgery between June 1977 and May 1985. The incidence of IABP circulatory support was 6.8%. Mean survival time of patients who needed IABP was 2.35 years +/- 0.425 vs 6.30 years +/- 0.103 for patients who didn't have this complication. A multivariate analysis using the logistic model was done to pinpoint factors predictive of IABP support. The prognostic factors were pre-operative functional class, presence of prior valve replacement, presence of concomitant surgery and presence of endocarditic etiology. The subgroup of 58 patients undergoing balloon counterpulsation was analysed for factors predictive of survival using a multivariate analysis of the Cox' model. Presence of aortic or mitral regurgitation was found to be the independent risk factor of mortality. Using a combination of prognostic factors, we pinpointed groups of patients at high risk of needing post-operative balloon pump counterpulsation support. The necessity of an alternative procedure for the mechanical support of the failing circulation is underlined.
It has been demonstrated in our laboratory that blood flow pulsations enhance plasma filtration rate by 30-60 per cent. The increase in plasmafiltration over the steady flow value is found to be a function of the parameter F. delta V'/QB where F denotes the pulsation frequency, delta V' the volume amplitude of pulsed blood in the filter and QB is the time mean blood flow. The increment in plasma filtration may be related to the increase in time-mean absolute value of shear rate.
1. The new pericardial valves tested showed better hydrodynamic performance than the porcine and the St. Jude Medical mechanical valves. 2. The Ionescu-Shiley III valve exhibited the best hydrodynamic performance, with the least transvalvular energy loss. 3. Transvalvular energy loss shows that the major loss across the 19 mm valves occurs during the forward-flow phase. 4. Our data compares well with data from other in vitro tests performed using different test apparatus. 5. The pericardial bioprostheses, in particular, function well in the 19 mm size and therefore offer an alternative to the increased operative risk associated with valve over-sizing or orifice enlarging procedures. 6. The performance of the two porcine valves tested were comparable with each other.
To facilitate patients' movement, we developed a simplified portable haemodialysis system, using a sorbent cartridge (Organon Teknika) for regeneration of the dialysate. The whole system is in two parts: (1) a compact disposable container for dialysate recirculation with dialyser and blood and dialysate lines; (2) a dual functions circulatory assistance monitor. The pack system is easy to use: single-use; no water processing; no formalin processing; reliable for temporary use (because of its aluminium), providing excellent purification; compact and portable, it permits greater freedom for the patient, and with adequate dialysis.
Cell coating with human embryonal fibroblasts was examined on solid (Plathurane UM 8300) and microporous (Tecoflex 80 A) polyurethane. Using measurements of cellular growth kinetics and adhesion strength it was found that the onset of cellular growth on the microporous material was delayed but that the vitality and adhesion strength of the cells were better than for the solid material.
The development of a tracheal prosthesis was evaluated using in vivo data on mechanical loads in the natural organ. The application of in vivo loads to the explanted organ in a laboratory tester was shown to give information on the natural reaction forces of the organ. It is therefore possible to perform in vitro tests on various prosthesis prototypes under near-natural stress conditions and to adapt the prostheses accordingly before implantation.
