TUESDAY MORNING, APRIL 20,
1999
7:00 a.m. C.
WALTON LILLEHEI RESIDENT FORUM SESSION
Supported by an unrestricted
educational grant from St. Jude Medical, Inc.
Ballroom, Ernest N. Morial
Convention Center
Moderators: Fred A. Crawford, Jr., M.D.
Timothy J. Gardner, M.D.
L1. Angiogenic
Therapy with Vascular Endothelial Growth Factor Reverses Pulmonary Hypertension
Andrew I. Campbell*, David A.
Latter* and Duncan J. Stewart*, Toronto, Ontario, Canada
Sponsored By: Richard D.
Weisel, Toronto, Ontario, Canada
OBJECTIVE: The role of
angiogenic factors in pulmonary hypertension (PH) is controversial. Increased
VEGF expression associated with plexiform lesions may contribute to the
vasculopathy of this disease, or may represent an incomplete adaptive response
to the loss of vascular channels. We hypothesized that VEGF gene transfer could
reverse PH in the rat monocrotaline model, possibly by inducing the development
of new pulmonary microvessels.
METHODS: 18 animals were
injected with 80 mg/kg of monocrotaline (MCT) and 14 days later were randomized
to receive either 5x105 syngeneic smooth muscle cells (SMC)
transfected with VEGF165 (n=10) or with the control vector pcDNAS.l
(n=8) via the internal jugular vein. At the time of gene transfer, central
venous (CVP) and right ventricular (RV) pressures were measured to confirm the
development of pulmonary hypertension. 28 days following MCT injection, CVP,
RV, and aortic pressures were measured, and right ventricular/left ventricular
weight (RV/LV) ratios obtained.
RESULTS: 14 days following
MCT delivery, RV pressure was increased to 28mm Hg in both groups. 28 days
following MCT injection, RV pressures in control animals were further elevated
to 55±5mm Hg, while in the VEGF transfected animals the rise in RV pressure was
reduced to 37±3mm Hg (p<0.01). CVP was also significantly reduced
from 3±0.5 to 1.5±0.5mm Hg (p=0.05). Systemic arterial pressure was
unaffected by gene transfer in either group. The degree of RV hypertrophy was
also significantly attenuated following VEGF transfer (0.4±0.02 in control vs.
0.28±0.01 in VEGF treated animals, p<0.001).
CONCLUSIONS: VEGF gene
transfer is able to significantly reduce the progression of established
pulmonary hypertension in the monocrotaline model of PH, and supports a significant
therapeutic role for this form of angiogenic gene therapy.
*By Invitation
L2. Transforming Growth Factor Beta-1 Gene
Transfer Ameliorates Acute Lung Allograft Rejection
Bassem N. Mora*, Carlos H. R.
Boasquevisque*, Mariano Boglione*, Jon M. Ritter*, Ronald K. Scheule*, Nelson
S. Yew*, Lisa Debruyne*, Lihui Qin*, Jonathan S. Bromberg* and G. Alexander
Patterson, Ann Arbor, Michigan, Framingham, Massachusetts and St. Louis,
Missouri
OBJECTIVE: We have
previously demonstrated successful ex vivo transfec-tion of rat lung isografts
using reporter genes complexed to liposomes. The aim of the current work was to
study the feasibility of functional gene transfer using the gene encoding for
Transforming Growth Factor b-1 (TGFb-1), a known immunosuppressive cytokine, on
rat lung allograft function in the setting of acute rejection.
METHODS: The rat left lung
transplant technique was used in all experiments, with Brown Norway donor rats
and Fischer recipient rats. Following harvest, left lungs were transfected ex
vivo with either sense or antisense TGFb-1 constructs complexed to cationic
lipids, then implanted into recipients. On postoperative days (POD) 2,5, and 7,
animals were sacrificed, arterial oxygen-ation measured, and acute rejection
graded.
RESULTS: On POD 2, there
were no differences in acute rejection or lung function between TGFb-1 treated
animals and controls. On POD 5, oxygenation was significantly improved in
grafts transfected with the TGFb-1 sense construct compared to antisense
controls: PaO2 = 434.2 ± 198.1 vs. 102.8 ± 85.4 mm Hg, respectively, p<0.05.
Lung acute rejection scores were also significantly improved, corresponding to
decreases in both vascular and airway rejection scores (vascular rejection
score: 2.00 ± 0.50 vs. 2.79 ± 0.64; airway rejection score: 1.28 ± 0.67 vs.
2.29 ± 0.76, respectively, p<0.05). The amelioration of acute rejection was
temporary and decreased by POD 7.
CONCLUSIONS: The
feasibility of using gene transfer techniques in order to introduce novel
functional genes in the setting of lung transplantation is demonstrated. In
this model of rat lung allograft rejection, TGFb1 gene transfer resulted in
temporary but significant improvements in lung allograft function and acute
rejection scores.
*By Invitation
L3. Mechanical Transmyocardial
Revascularization Induced Angiogenic Response
Victor F. Chu*, Jinqiang Kuang*,
Amy N. Mcginn*, Adel Giaid*, Stephen Korkola* and Ray Cj-Chiu, Montreal,
Quebec, Vancouver, BC, Canada
OBJECTIVE: Although it
remains controversial, increased expression of an-giogenic growth factors has
been proposed as a mechanism of transmyocardial laser revascularization (TMLR).
We assessed the effectiveness of less expensive mechanical transmyocardial
revascularization (TMMR) in a chronically ischemic porcine model by measuring
myocardial angiogenic response.
METHODS: Ameroid
constrictors were implanted around porcine circumflex arteries 6 weeks before
transmyocardial revascularization. Group 1 (n=5) recieved TMMR in the ischemic
zone with an 18 gauge needle and were harvested at 1 week post-TMMR. Group 2
(n=3) is simliar to Group 1 but were harvested at 4 weeks post-TMMR. Group 3
received sternotomy only with no myocardial puncture and serves as control.
Myocardial samples were immunohistochemically stained for VEGF, bFGF, and TGF-b
using specific antibodies. Growth factor expression was quantified using
computer assisted morphometry. Vascular density was assessed by staining for
factor VIII.
RESULTS: Significantly
increased expression of all three factors in TMMR group were found at 1 week
post treatment (VEGF p<0.001, bFGF p<0.001, TGF-b p<0.001). Angiogenic
factor levels were lower at 4 weeks but still significantly higher than the
baseline (VEGF p<0.001, bFGF p=0.156, TGF-b p=0.008)(Fig. l). Vascular density
in TMMR group was significantly higher than control group at 1 week
(p<0.001). This difference persisted at 4 weeks (p<0.001)(Fig. 2).
CONCLUSIONS: Mechanical
transmyocardial revascularization is associated with significantly increased
angiogenic growth factor expression and concomitant neovascularization at up to
4 weeks post treatment. These changes are similar to those observed in TMLR.
Myocardial perfusion and functional studies are needed to establish potential
clinical significance of these findings on angiogenic responses.
*By Invitation
L4. Histologic Abnormalities of the
Ascending Aorta and Pulmonary Artery in Aortic Valve Disease
Mauro P.L. De Sa*, Jagdish
Butany*and Tirone E. David, Toronto, Ontario, Canada
OBJECTIVE:
This study was undertaken to examine the histology of the
ascending aorta (AA) and pulmonary artery (PA) in patients with aortic valve
disease (AVD) in an attempt to clarify dilation of aortic root after the Ross
procedure and dilation of the ascending aorta in patients with bicuspid aortic
valve (BAV).
METHODS:
Histologic examination of the AA and pulmonary artery PA
was performed in 15 patients with BAV, 8 patients with tricuspid AVD, and in 6
normal controls. The specimens were divided into 3 groups according to the patients'
ages: 21 to 40 years, 41 to 60 years and more than 60 years. The arteries were
examined for degenerative changes (cystic medial necrosis, fibrosis, smooth
muscle cell orientation, and elastic fragmentation). Each change was
quantitated by two independent observers and graded from 0 (none) to 3
(severe).
RESULTS:
All 15 pts with BAV displayed various degrees of
degenerative changes in the media of the aorta and 7 pts in all age groups had
severe changes (cystic medial necrosis and elastic fragmentation). Of the 8
patients with tricuspid AVD, only 2 had severe degenerative changes. None of
the controls had more than mild changes in the media of the AA. Severe
degenerative change sin the PA were present in all pts with BAV, and in older
patients with and without AVD.
CONCLUSIONS:
Degenerative changes in the media of the AA and PA are
part of the aging process but patients with BAV have premature degeneration.
The PA of young patients with BAV have severe degenerative changes similar to
those of older patients with or without AVD. This finding explains the late
dilation of the aortic root that may occur after the Ross procedure.
*By Invitation
L5. A Comparison of Three Fetal Cell
Types for Transplantation into a Myocardial Scar To Improve Heart Function.
Tetsuro Sakai*, Ren-ke Li*,
Richard D. Weisel, Donald A. G. Mickle*, Zhi-qiang Jia*, Shinji Tomita* and
Eung-joong Kim*, Toronto, Ontario, Canada
OBJECTIVE: We previously
demonstrated that fetal cardiomyocyte transplantation into the myocardial scar
improved heart function. The mechanism, however, has not been ellucidated. This
study compares cardiac function after cell transplantation with three different
fetal cell types: cardiomyocytes (with contractile proteins and gap junction),
smooth muscle cells (with contractile proteins, but without gap junction), and
fibroblasts (no contractile proteins).
METHODS: A left
ventricular scar was created by cryoinjury in adult rats. Four weeks after the
injury, the rats received an injection into the cardiac scar of cultured fetal
cardiomyocytes (CM, n=13), smooth muscle cells (SM, n=10), fibroblasts (FB,
n=10), or culture medium (Control). All rats received cyclosporin. Four weeks
after injection, cardiac function was examined with an intraventricular
balloon, during Langendorff perfusion.
RESULTS: All transplanted
cells formed a tissue in the cardiac scar. Developed pressure was significantly
greater with CM (at a diastolic volume of 0.2 mL, improvement over control was
134±20% for CM; 108±14% for SM; and 106±17% for FB, p<0.01). The maximum
rate of pressure rise was significantly higher with CM (at 0.2 mL, the
improvement was 119±37% for CM; 98±18% for SM; and 92±11% for FB, p<0.01).
The maximum rate of pressure fall was significantly greater with CM (at 0.2 mL,
the improvement was 126±29% for CM; 108±19% for SM; and 99±16% for FB,
p<0.01).
CONCLUSIONS: Fetal
cardiomyocytes transplanted into cardiac scar provided better systolic
function, contractility and relaxation than smooth muscle cells or fibroblasts.
The contractile and elastic properties of cardiomyocytes contributed to the
functional improvement.
*By Invitation
L6. Delayed Myocardial Preconditioning by
Alphal-Adrenoceptors Involves Inhibition of Apoptosis
Kourosh Baghelai*, Laura J.
Graham*, Andrew S. Wechsler and Emma R. Jakoi*, Philadelphia, Pennsylvania and
Richmond, Virginia
OBJECTIVE: Previous
studies have demonstrated that αl-adrenoceptor activation increases
myocardial resistance to ischemic injury 24 hours later. Here we test the
hypothesis that phenylephrine induced delayed cardioprotection is associated
with limited infarction, decreased apoptosis, and involves altered expression
of the anti-apoptotic BCLx and pro-apoptotic BAX proteins.
METHODS: Rabbits were
treated with phenylephrine (50 mg/kg, I.V., n=6) or an equivalent volume of
saline (vehicle, n=6). Twenty four hours after pre-treatment, isolated hearts
were perfused with a bovine erythrocyte suspension in modified Krebs solution,
subjected to 45 minutes of normothermic global ischemia and reperfused for 120
minutes. Infarct size was determined by triphenyl tetrazolium chloride
staining. Apoptosis was quantified by the deoxynucleotidyl transferase mediated
dUTP nick end labeling and confocal microscopy. Left ventricular tissue from
separate groups of animals (n=5 per group), 24 hours after pretreatment with
phenylephrine or vehicle but without ischemia and reperfusion, was analyzed by
Western blotting for the content of BCLx and BAX proteins.
RESULTS: Hearts pretreated
with phenylephrine 24 hours prior showed improved end-reperfusion diastolic
recovery (26.7 ± 4.5 vs. 42.3 ± 5.0 mmHg, p=0.04) and developed pressures (56.8
± 4.9 vs. 36.2 ± 3.9 mmHg, p=0.008), reduced infarct size (9.9 ± 2.4 vs. 42.6 ±
6.3 %, p=0.002) and decreased number of apoptotic nuclei (24.0 ± 4.8 vs. 51.0 ±
4.6 per HPF, p= 0.038). Analysis by Western blotting showed the ratio of BCLx
to BAX protein significantly increased in phenylephrine pretreated hearts (2.65
± 0.5 vs. 1.00 ± 0.1, p=0.008).
CONCLUSIONS: Delayed myocardial
protection induced by al-adrenoceptor activation involves an increased BCLx to
BAX ratio, thereby limiting apoptotic cell death.
*By Invitation
L7. Collagen Impregnated Dacron Grafts
Resist Infection as Well as Cryopreserved Allografts in the Thoracic Aortic
Position
Norman M. Rowe*, Joshua H.
Burack*, Nuria M. Lawson*, Paul Impellizzeri*, Yoon D. Kim*, Marcel Sierra*,
Peter Homel*, Anthony J. Acinapura and Joseph N. Cunningham, Brooklyn, New York
OBJECTIVE: The purpose of
this study was to study various graft materials response to placement in the
proximal thoracic aorta in the presence of severe intraoperative or
postoperative bacteremia.
METHODS: Thirteen immature
Yorkshire pigs underwent a transverse thoracotomy and were randomized to receive
either placement of collagen impregnated dacron grafts (CIDG; n=6) or
cryopreserved (CPA; n=7) patch grafts in the ascending aorta. All animals were
infused with a control strain of Staphylococcus aureus 18-24 hours after
surgery. Animals were sacrificed 8 weeks later, the grafts were explanted and
analyzed via a combination of microbio-logic culture and a histologic grading
scale for evidence of infection using the Binomial test with significance set
at p<0.05.
RESULTS: The overall
mortality rate was 7.7% (1/13) with one animal dying of overwhelming sepsis in
the CPA group. The overall infection rate was 38.5% (5/13) with 80% (4/5) of
these occurring in the CPA group. The infection rate in the CPA group was 57.2%
(4/7) and only 16.7% (1/6) in the CIDG group (see table).
CONCLUSIONS: This study
demonstrates for the first time that a prosthetic graft in the proximal
thoracic aortic position is as effective (*p<0.0079) and approaching
statistical significance for being superior to allograft in resisting bacterial
inoculation. This newly developed model is currently being utilized for
controlled investigation of cytokine markers of graft infection.
Results of Graft Infections
|
|
|
CIDG
|
CPA
|
TOTAL
|
Infected Grafts
|
1
|
4
|
5
|
|
Non-Infected Grafts
|
5
|
3
|
8
|
*By Invitation
L8. Impact of Body Mass Index and Albumin
on Cardiac Surgery Morbidity and Mortality
Daniel T. Engelman*, Robert J.
Rizzo*, John G. Byrne*, Gregory S. Couper*,Sari F. Aranki*, John J. Collins and
*David H. Adams*, Boston, Massachusetts
OBJECTIVE: Extremely thin
and overly obese patients may not tolerate cardiac surgery as well as other
patients. A retrospective study was conducted to determine whether the extremes
of body mass index (BMI) [weight/height2 (kg/m2)] and/or
cachexia increased the morbidity and mortality associated with cardiac surgery.
METHODS: BMI was used to
objectively measure thinness (BMI <20)and heaviness (BMI >30);
preoperative serum albumin was used to quantify nutritional status and
underlying disease. Data were gathered between 1993-1997 from 5168 consecutive
patients undergoing coronary artery bypass and/or valve surgery.
RESULTS: There was no
correlation between BMI and albumin. Low BMI (<20) and low albumin (<2.5)
were each associated with increased mortality. Patients with high BMI's
(>30) had significantly increased mortality only when associated with low
albumin (<2.5). Multivariate analysis demonstrated that a low albumin or low
BMI was independently associated with increased reoperation for bleeding,
postoperative renal failure, and prolonged ventilation, ICU stay, and total
length of stay. High BMI was associated with increased sternal wound infection
and saphenous vein harvest site infection.
Percentage Mortality by BMI
and Preoperative Serum Albumin
|
|
|
BMI <20
|
BMI 20-30
|
BMI >30
|
all patients
|
Albumin <2.5
|
16 (n=49)
|
7 (n=589)
|
8 (n=130)
|
7 (n=768)
|
|
Albumin 2.5-3.5
|
9 (n=81)
|
3 (n=1365)
|
5 (n=464)
|
4 (n=1910)
|
|
Albumin >3.5
|
7 (n=107)
|
3 (n=1777)
|
3 (n=606)
|
3 (n=2490)
|
|
all patients
|
10 (n=237)
|
3 (n=3731)
|
4 (n=1200)
|
4 (n=5168)
|
CONCLUSIONS: Hypoalbuminemia and low BMI each
independently increase morbidity and mortality following cardiac surgery.
1992-94 AATS Research Scholar
*By Invitation
9:00 a.m. SCIENTIFIC SESSION
Ballroom, Ernest N. Morial
Convention Center
Moderators: Lawrence H. Cohn, M.D.
Tirone E. David, M.D.
BASIC SCIENCE LECTURE
Ballroom, Ernest N. Morial
Convention Center
Gene Therapy Strategies for
Research Revascularization
Victor Dzau,M.D.
Hersey Professor of the Theory
and Practice of Physic Medicine Harvard Medical School, Chairman, Department of
Medicine, Brigham and Women's Hospital, Boston, Massachusetts
33. A Clinical Trial Combining Donor Bone
Marrow Infusion and Heart Transplantation: Intermediate-Term Results
Si M. Pham*, Abdul S. Rao*,
Adriana Zeevi*, Kenneth R. McCurry*, Robert L. Kormos, Paulo Fontes*, Brack G.
Hattler*, John J. Fung*, Thomas E .Starzl* and Bartley P. Griffith, Miami,
Florida and Pittsburgh, Pennsylvania
Discussant: Verdi J. DiSesa,
M.D., Chicago, IL
OBJECTIVE: We have
demonstrated that donor cell microchimerism is augmented by the infusion of
donor bone marrow at the time of solid organ transplantation. We report herein
the intermediate-term results of a trial combining donor bone marrow (BM)
insusion and heart transplantation.
METHODS: From 9/93 to
9/97, 29 patients receiving concurrent heart transplant and infusion of
unmodified donor donor bone marrow (3.6 x 108 cells/ kg). During
that period, 24 heart recipients who did not received bone marrow (because a
lack of consent for bone marrow donation) served as comptemporaneous controls.
Initial immunosuppression regimen consisted of two drugs: tacrolimus and
steroids. A third drug (azathioprine or mycophenolic mofatil) was added as
needed (for rejection or sparing renal toxicity). The mean follow-up were 844 ±
506 and 824 ± 327 days for the BM, and control groups, respectively.
RESULTS: The overall
survival rates for the BM and control groups were 90% (26/29) and 88% (21/24),
respectively. No complication or death was associated with bone marrow
infusion. Of those patients who had been followed for ≥ 1 years, 72%
(18/25) of the BM group never experienced an episode of moderate to severe
acute rejection (grade ≥3A) during the 1st year as compared
with 32% (6/19) in the control group (p< 0.05). There was no difference in
the rate of donor-specific immunomodulation between two groups by mixed
lymphocyte reaction assay (18% in BM group vs 15% in controls). However there
is a trend toward less lymphocyte growth from heart biopsies in the BM group (28/150
biopsies {18%} in BM group versus 27/102 {26%}in controls)
CONCLUSIONS: Infusion of
donor bone marrow at the time of heart transplantation appears to reduce the
acute rejection rate. Its impact on coronary allograft vasculopathy is yet to
be determined.
*By Invitation
34. Autologous Cardiomyocyte
Transplantation Improved Porcine Heart Function after a Myocardial Infarction.
§Ren-ke Li*, §Richard
D. Weisel, §Donald A.G. Mickle*, Terrence M. Yau*, Robert Burns*,
Robert J. Cusimano*, Leonard Schwartz*, Eung-ioong Kim*, Tetsuro Sakai*, Shinji
Tomita*, Patty Boylen* and Zhi-qiang Jia*, Toronto, Ontario, Canada
Discussant: Chu-Jeng (Ray)
Chiu, M.D., Montreal, Quebec, Canada
OBJECTIVE: We previously
demonstrated that fetal cardiomyocyte transplantation into a cardiac scar
improved heart function. However, the allograft was rejected despite
cyclosporin therapy. Therefore, we evaluated autologous cardiomyocyte
transplantation in adult swine.
METHODS: In 19 adult pigs
a myocardial infarction was created by occlusion of the distal LAD with an
inrraluminal coil. Four weeks after infarction, ECHO showed a dyskinetic
anterorapical region and a SPECT MIDI scan showed minimal perfusion and very
few viable myocytes in the infarcted region. The ejection fraction was 26±4%.
Cardiomyocytes were isolated and cultured from the right ventricular septum at
the time of infarction and the number of cells was expanded in vitro for
4 weeks. Through a left thoracotomy either cells (N=12) or culture medium (N=7)
were injected into the infarcted region.
RESULTS: Eight weeks after
transplantation, SPECT MIDI scans demonstrated improved perfusion, motion and
thickening of the infarcted region in the transplanted group and no improvement
in the control group. Ejection fraction increased in the transplant
group(38±6%) but not in the control group (28±5%, p<0.05). Conductance and
intravenrricular pressure catheters revealed better preload recruitable stroke
work and end-systolic elastance in the transplanted hearts (p<0.05). Histological
studies revealed transplanted cardiomyocytes within the infarcted region in the
transplanted group but not the control group. The transplanted pigs were more
active and gained more weight (p<0.01) than control pigs. The clinical
benefit of autologous cell transplantation was dramatic.
CONCLUSIONS: Autologous
cardiomyocyte transplantation may improve perfusion and restore heart function
after an extensive myocardial infarction.
10:10 a.m. INTERMISSION - VISIT EXHIBITS
§Authors have a relationship with Genzyme,
Corp.
*By Invitation
10:55 a.m. SCIENTIFIC SESSION
Ballroom, Ernest N. Morial
Convention Center
Moderators: Lawrence H. Cohn, M.D.
Tirone E. David, M.D.
C. WALTON LILLEHEI
RESIDENT FORUM
AWARD PRESENTATION
35. Human Factors and Surgical Outcomes. A
Multicentre Study
Marc R. De Leval, Jane
Carthey*, David J. Wright*, Vernon T. Farewell* and James Reason*, London,
England
Discussant: John J. Lamberti,
M.D., San Diego, CA
OBJECTIVE:
Surgical failures could be analysed as accidents in
complex socio-technical systems (eg aviation) in which human factors (HF) play
a determinant role. This was tested on the arterial switch operation.
METHODS:
All 230 arterial switch operations performed in the UK
over 18 months were studied. As well as clinical data, individual, team,
situational and organisation HF data were collected: these included
questionnaires and lists of negative events (NE) with lists of human
compensations (HC). Outcomes (OC) were divided into: OC1 extubated within 72
hrs; OC2 delayed extubation; OC3 serious complications; OC4 death. HF data were
added to baseline logistic regression analyses of clinical data.
RESULTS:
Mortality was 6.5%. A subset of coronary patterns (CP)
was the most determinant risk factor of death (p<0.001). Here, surgeon
awareness of CP carried a risk of 8.3% against 30.4% in misdiagnosed cases.
There were 155 NE; but no deaths occurred with HC against 39.4% mortality
without HC. Without HC the estimated odds of death increased by a factor of 5
per NE (95% CL 2-12). OC4 and OC3 combined occurred in 25.2% of cases. They
include 87.9% of NE without HC. Without HC the estimated odds of OC4 and OC3
per NE increased by a factor of 37 (95% CL 9-44).
CONCLUSIONS:
HF influence OC, particularly in high-risk cases. HC can
prevent NE becoming serious failures. Applying accident theories to surgery, a
novel form of audit, could improve safety and results, and help understand
individual and institutional differences.
1973-74 AATS Graham Fellow
*By Invitation
36. Lung Transplantation for Pulmonary
Fibrosis: A Ten Year Institutional Experience
Bryan F. Meyers*, John P. Lynch*,
Elbert P. Trulock*, Joel D. Cooper, and G. Alexander Patterson, St. Louis,
Missouri
Discussant: R. Morton Bolman, III, M.D.,
Minneapolis, MN
OBJECTIVE(s): Between 7/88
and 7/98 we performed 433 lung transplants, including 48 transplants in 47
patients for pulmonary fibrosis (PF). The operations for PF include 15
bilateral sequential lung transplants (BLT) and 33 single lung transplants
(SLT). Our objective of this study is to retrospectively review this experience
and compare the suitability of SLT versus BLT for pulmonary fibrosis.
METHODS: A retrospective
review including inpatient hospital charts, outpatient clinic records and
telephone contact to patients to verify current health status.
RESULTS: All recipients
had severe restrictive lung disease and required continuous supplemental oxygen
pre-transplant. Peri-operative mortality was 4 patients (8.5 percent). One
patient underwent unsuccessful redo BLT for irreversible reperfusion injury and
graft failure after an initial SLT. The median hospitalization, intensive care
unit stay, and time on mechanical ventilation were 22 days, 5 days, and 4 days.
Actuarial survival for these 47 patients at 1, 2, and 5
years was 75.4 percent, 72.7 percent, and 49.9 percent, slightly poorer than
our institutional survival for recipients of all diagnoses: 82 percent, 76
percent, and 53 percent. Eighteen of 43 operative survivors have died. Late
causes of death include obliterative bronchiolitis with progressive respiratory
failure (9), malignancy (3), and CMV pneumonitis (2).
Hospital mortality was 3/33 (9.1 percent) after SLT and
1/14 (7.1 percent) after BLT. There have been 12/30 (40 percent) late deaths
after SLT with a mean time to death of 1115 days. After BLT, there have been
6/13 (46 percent) late deaths with a mean time to death of 592 days. There was
no difference between SLT and BLT with regard to median hospital stay, ICU
stay, or intubation. Four of the 33 (12 percent) SLT patients required
tracheostomy while 3 of 14 (21 percent) BLT recipients required tracheostomy.
CONCLUSIONS: We conclude
that either SLT or BLT offer viable surgical therapy for patients with
end-stage pulmonary fibrosis. We can demonstrate no benefit conferred by BLT
over SLT for patients with this diagnosis.
PRESENTATION OF SCIENTIFIC
ACHIEVEMENT AWARD
Michael E. DeBakey, M.D., Houston,
TX
11:45 a.m. ADDRESS BY HONORED SPEAKER
Ballroom, Ernest N. Morial
Convention Center
Experimental and Clinical
Application of Angiogenesis Research
Judah Folkman, M.D.
Andrus Professor of
Pediatric Surgery, Professor of Cell Biology Harvard Medical School, Senior
Associate in Surgery, Children's Hospital, Boston, Massachusetts
ADJOURN FOR LUNCH - VISIT EXHIBITS
*By Invitation
