12 results on '"Spyt, T"'
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2. Midterm evaluation of the Tissuemed (Aspire) porcine bioprosthesis: 493 patients, 506 bioprostheses.
- Author
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Goldsmith IR, Spyt TJ, Boehm M, Kendall S, and Rosin MD
- Subjects
- Adult, Aged, Aged, 80 and over, Animals, Aortic Valve surgery, Cause of Death, Female, Follow-Up Studies, Heart Valve Diseases mortality, Humans, Male, Middle Aged, Mitral Valve surgery, Prosthesis Design, Prosthesis Failure, Survival Rate, Swine, Tricuspid Valve surgery, Bioprosthesis, Heart Valve Diseases surgery, Heart Valve Prosthesis
- Abstract
Background: Valve durability has been a major concern with bioprostheses, and the Tissuemed (Aspire) porcine bioprosthesis was designed to provide a solution to structural valve failure. Because bioprostheses tend to fail by 8 years, the aim of our study was to determine its midterm durability and performance., Methods: We reviewed 506 prostheses that were implanted in 493 patients (287 men; mean age 73 +/- 6 years) between 1991 and 1999. Preoperatively 316 (68%) patients were in New York Heart Association class III or IV. There were 417 (85%) aortic, 61 (12%) mitral, 13 (2.6%) aortic and mitral, and two (0.4%) tricuspid procedures. Concomitant procedures were performed in 163 (33%) patients. Follow-up was complete in 488 (98.9%) patients with a total cumulative follow-up of 1,402 patient-years., Results: The 30-day mortality in this elderly population was 10% (95% confidence interval, 8 to 13), with no early valve-related deaths. Patients' survival at 8 years was 46% +/- 7%. This was influenced by the following factors: (1) the patient's age, being worse for those 70 years or older (p = 0.005); (2) those in New York Heart Association functional class III and IV (p = 0.004); (3) those in atrial fibrillation before the operation (p = 0.006); (4) those with poor left ventricular function (p = 0.009); and (5) those who had a previous cardiac operation (p = 0.003). Valve-related complications (expressed as percent per patient-year) were thromboembolism at 0.9%/patient-year; major hemorrhage at 1.4%/patient-year; bacterial endocarditis at 0.4%/patient-year; nonstructural dysfunction at 0.2%/patient-year, and reoperation at 0.2%/patient-year. At 8 years, freedom from thromboembolism was 93% +/- 7%, major hemorrhage, 90% +/- 4%, nonstructural dysfunction, 99% +/- 1%, structural valve failure, 100%, and reoperation, 99% +/- 1%. At follow-up, 98% of survivors were in New York Heart Association class I or II., Conclusions: Our study suggests that at 8 years, the Tissuemed (Aspire) porcine bioprosthesis is durable and has satisfactory performance with low complication rates.
- Published
- 2001
- Full Text
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3. Reliability of Allen's test in selection of patients for radial artery harvest.
- Author
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Jarvis MA, Jarvis CL, Jones PR, and Spyt TJ
- Subjects
- Aged, Blood Flow Velocity physiology, Collateral Circulation physiology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Ultrasonography, Doppler, Coronary Artery Bypass methods, Hand blood supply, Patient Selection, Radial Artery transplantation, Tissue and Organ Harvesting
- Abstract
Background: Allen's test is widely used to assess the ulnar collateral blood supply of the hand before radial artery harvest for coronary bypass surgery. This study was performed to determine the optimum cut-off point for a positive Allen's test and the clinical reliability of Allen's test in this role., Methods: Patients undergoing coronary artery bypass surgery were examined by independent observers using both Allen's test and a Doppler ultrasound test of the ulnar collateral circulation., Results: We examined 93 hands in 47 patients; mean age was 63.6 years. Receiver operating characteristic analysis found that at a conventional cut-off of 6 seconds on Allen's test had a sensitivity of 54.5%, specificity of 91.7%, and diagnostic accuracy of 78.5%. At a cut-off of 5 seconds diagnostic accuracy was maximal (79.6%), with sensitivity of 75.8% and specificity of 81.7%; 100% sensitivity occurred at a cut-off of 3 seconds, with specificity of 27% and diagnostic accuracy of 52%., Conclusions: At no cut-off point does Allen's test perform satisfactorily as a discriminatory test. It should be replaced by more objective tests, such as Doppler ultrasound.
- Published
- 2000
- Full Text
- View/download PDF
4. Intraoperative and laboratory evaluation of skeletonized versus pedicled internal thoracic artery.
- Author
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Deja MA, Woś S, Gołba KS, Zurek P, Domaradzki W, Bachowski R, and Spyt TJ
- Subjects
- Acetylcholine pharmacology, Blood Flow Velocity, Dose-Response Relationship, Drug, Female, Humans, In Vitro Techniques, Male, Mammary Arteries drug effects, Mammary Arteries physiology, Mammary Arteries transplantation, Middle Aged, Postoperative Complications, Prospective Studies, Reoperation, Vasoconstriction drug effects, Vasodilation drug effects, Vasodilator Agents pharmacology, Internal Mammary-Coronary Artery Anastomosis methods, Tissue and Organ Harvesting methods
- Abstract
Background: The skeletonization of internal thoracic artery is postulated to improve graft length, early blood flow, sternal blood supply, and postoperative respiratory function. Concern exists that skeletonization may injure internal thoracic artery, precluding good results of surgery. Reports on endothelial function of skeletonized internal thoracic artery are lacking., Methods: A prospective assessment of early clinical outcomes of 357 consecutive patients undergoing coronary artery bypass grafting was performed: 287 patients with nonskeletonized and 70 with skeletonized left internal thoracic artery (LITA). The lengths of LITA and of its discarded distal segment, as well as free LITA blood flow, were measured. The dose-effect relationship for relaxation to acetylcholine was studied in the organ bath., Results: Apart from a higher incidence of breaching the pleura with nonskeletonized LITA the clinical outcomes were comparable. The length of skeletonized LITA was 17.8+/-1.14 cm versus 20.3+/-0.52 cm skeletonized (p = 0.11). The length of discarded LITA was shorter in nonskeletonized artery (0.8+/-0.28 cm versus 2.6+/-0.49 cm; p = 0.022). The free LITA blood flow was 66.3+/-7.42 mL/min in nonskeletonized vessel versus 100.3+/-14.84 mL/min in skeletonized (p = 0.048). The acetylcholine-induced relaxation was similar in both groups (maximal relaxation, 80.7%+/-5.95% in nonskeletonized versus 72.9%+/-9.11% in skeletonized; not significant; negative logarithm of half-maximal effect, 7.43+/-0.18 versus 7.1+/-0.10, respectively; p = 0.063)., Conclusions: Skeletonization does not damage the endothelial function of the LITA. Higher free blood flow and available LITA length should encourage the use of skeletonized LITA in clinical practice.
- Published
- 1999
- Full Text
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5. An unexplained cluster of thrombosed bileaflet mechanical heart valve prostheses.
- Author
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Chaudhuri N, Hickey MS, and Spyt TJ
- Subjects
- Adult, Cluster Analysis, Female, Humans, Male, Middle Aged, Prosthesis Design, Prosthesis Failure, Heart Valve Prosthesis Implantation, Thrombosis etiology
- Published
- 1999
- Full Text
- View/download PDF
6. Haemo-glyde coated chest drainage tubes.
- Author
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Kolvekar SK, Finch G, Mummery JA, Taub N, and Spyt TJ
- Subjects
- Cardiac Surgical Procedures, Drainage instrumentation, Humans, Pericardial Effusion therapy, Postoperative Care, Chest Tubes, Polyethylene Glycols
- Published
- 1998
- Full Text
- View/download PDF
7. An alternative airway in cardiac surgery?
- Author
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Ghosh S, West K, and Spyt TJ
- Subjects
- Adult, Aortic Valve Insufficiency complications, Humans, Intraoperative Care, Intubation, Intratracheal, Male, Aortic Valve Insufficiency surgery, Heart Valve Prosthesis, Laryngeal Masks
- Published
- 1997
- Full Text
- View/download PDF
8. Use of expandable wire stents for malignant airway obstruction.
- Author
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de Souza AC, Keal R, Hudson NM, Leverment JN, and Spyt TJ
- Subjects
- Adult, Aged, Aged, 80 and over, Bronchial Diseases etiology, Bronchial Diseases therapy, Bronchoscopy, Constriction, Pathologic etiology, Constriction, Pathologic therapy, Dyspnea etiology, Dyspnea therapy, Equipment Design, Female, Follow-Up Studies, Humans, Male, Middle Aged, Palliative Care, Respiratory Sounds etiology, Stainless Steel, Survival Rate, Tracheal Stenosis etiology, Tracheal Stenosis therapy, Airway Obstruction etiology, Airway Obstruction therapy, Bronchial Neoplasms complications, Stents
- Abstract
The symptoms of progressive dyspnea and stridor in the setting of malignant airway obstruction are severe and distressing. Conservative nebulizer and oxygen therapy offer little relief, and conventional stenting with T tubes requires a tracheostomy. In this article, we describe our experience with stenting in the treatment of malignant mediastinal disease using the Gianturco expanding metal-wire stents. The technique of placement is simple and the procedure was successful in all 21 cases. Relief of stridor was immediate and the dyspnea usually abated. These benefits continued through the mean survival period after stenting of 134 days (range, 2 to 799 days). The patients required only brief hospitalization (2.83 days) before returning home or to the referring institution. It appears that expandable wire stents may offer a simple yet effective intervention in the palliative treatment of mediastinal malignancy.
- Published
- 1994
- Full Text
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9. Release of vasoactive substances during cardiopulmonary bypass.
- Author
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De Souza AC and Spyt TJ
- Subjects
- Animals, Hemoglobins analysis, Hemoglobins physiology, Humans, Hypertension etiology, Hypertension physiopathology, In Vitro Techniques, Cardiopulmonary Bypass adverse effects, Nitric Oxide metabolism
- Published
- 1993
- Full Text
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10. Contraction and relaxation of human internal mammary artery after intraluminal administration of papaverine.
- Author
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Hillier C, Watt PA, Spyt TJ, and Thurston H
- Subjects
- Acetylcholine pharmacology, Aged, Bradykinin pharmacology, Dose-Response Relationship, Drug, Endothelium, Vascular drug effects, Endothelium, Vascular physiology, Female, Humans, In Vitro Techniques, Male, Mammary Arteries physiology, Middle Aged, Nitroprusside pharmacology, Papaverine administration & dosage, Vasoconstriction drug effects, Vasodilation drug effects, Mammary Arteries drug effects, Papaverine pharmacology
- Abstract
The internal mammary artery has become the conduit of choice for coronary artery bypass grafting. Intraluminal papaverine treatment during operation reduces vasospasm and facilitates anastomosis. However, it has been suggested that papaverine may cause intimal damage, and accordingly we have investigated endothelial damage by comparing the responsiveness of internal mammary arteries before and after intraluminal exposure to papaverine (15 mg/mL). Control and papaverine-treated segments of internal mammary artery were obtained from 13 patients undergoing coronary artery bypass grafting and mounted as ring preparations in an organ bath. Cumulative dose contractions to noradrenaline were performed, and the dose producing a half maximal response was determined. Relaxation studies of submaximally contracted arteries were performed using the endothelium-dependent vasodilators acetylcholine and bradykinin and the endothelium-independent vasodilator sodium nitroprusside. In the human internal mammary artery the use of intraluminal papaverine increased the lumen size by 20% (p less than 0.05), and the contractions elicited by noradrenaline were significantly less in the papaverine group than in the control group (p less than 0.05). Endothelium-dependent relaxation to acetylcholine or bradykinin was not affected by papaverine treatment. Endothelium-independent relaxation was the same in both groups, with almost 100% relaxation achieved by sodium nitroprusside. These results indicate that intraluminal papaverine treatment during coronary artery bypass grafting causes a reduction of smooth muscle contraction and does not impair endothelium-dependent relaxation.
- Published
- 1992
- Full Text
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11. Comparative study of the hydrodynamic function of the CarboMedics valve.
- Author
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Butterfield M, Fisher J, Davies GA, and Spyt TJ
- Subjects
- Aortic Valve physiology, Biomechanical Phenomena, Humans, In Vitro Techniques, Mitral Valve physiology, Models, Structural, Pulsatile Flow, Heart Valve Prosthesis, Hemodynamics
- Abstract
The hydrodynamic function of each size of the CarboMedics valve was assessed in a pulsatile flow simulator. The mean pressure difference with respect to forward flow, regurgitant volumes, and total energy loss across each valve were analyzed. The results for the 23-mm aortic and 29-mm mitral CarboMedics valves were compared with those for the St. Jude Medical and Björk-Shiley Monostrut valves. Results showed good hydrodynamic function for each CarboMedics valve, although the pressure difference and total energy loss across the 19-mm aortic valve was high. The hydrodynamic function of the CarboMedics valve was comparable with that of the St. Jude Medical valve. Both valves showed similar leakage volumes, which were significantly larger than that for the Björk-Shiley Monostrut valve. On account of this the total energy loss in the Björk-Shiley valve was significantly less than that for the bileaflet valves in the aortic position. Concern remains for the continuing presence of high closed-valve regurgitation in the bileaflet valves.
- Published
- 1991
- Full Text
- View/download PDF
12. Harvesting of lesser saphenous vein.
- Author
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Spyt TJ and Reece IJ
- Subjects
- Humans, Methods, Saphenous Vein transplantation
- Published
- 1987
- Full Text
- View/download PDF
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