Soluble type A substance in fresh-frozen plasma as a function of ABO and Secretor genotypes and Lewis phenotype

Soluble ABO blood group substance (SAS) in fresh-frozen plasma (FFP) and its cognate alloantibody titer reduction capacity (TRC) are not considered when prescribing this product for plasma exchange (PEX) therapy of ABO incompatible transplant recipients. SAS was quantified in 250 single FFPs using ELISA. Total and IgG class-specific anti-A TRCs of FFPs were measured using a microhemagglutination inhibition assay. SAS level depended not only on the A subtype (p < 0.0001) and the Secretor status (p < 0.0001), but also on the expression of ALe(b) in A1 secretors (p < 0.0001). The variation was as great as 137.6 arbitrary units (aU) for 14 A1 Le(a-b-) secretors and 1.2 aU for 6 A2 non-secretors. Homozygous expression of the A1, A2 and Secretor alleles did not increase SAS levels. Only total anti-A TRC, but not IgG class-specific TRC depended on the detected SAS level (r = 0.566, p = 0.0003).

Bovine mesenteric vein graft (ProCol) in critical limb ischaemia with tissue loss and infection

OBJECTIVES

Poor results have been reported following infrainguinal reconstructions using heterogenous grafts. The objective of this study was to assess the use of bovine mesenteric vein (ProCol) graft in patients with critical limb ischaemia (CLI), tissue loss/infection and no autologous vein available for reconstruction.

METHODS

Prospective analysis of 32 patients with CLI and tissue loss/infection, in whom reconstruction with ProCol was undertaken between October 1999 and May 2002.

RESULTS

The primary patency rate was 16% at 1 month. After thrombectomy, the secondary patency rate was 50% at 1 month and 26% at 14 months. No graft infections were seen. Aneurysmal dilatation of the graft occurred in 2 (6%). Limb salvage at 14 months was 47%.

CONCLUSION

In patients with critical limb ischaemia, tissue loss/infection and no available vein, the ProCol graft may be an alternative. However, primary patency is a problem. In situations without tissue loss/infection, where the risk of graft infection is less, prosthetic material may be a better alternative.

The Sorin Pericardial Bioprosthesis: The Stentless Aortic Valve with Excellent Hemodynamic Performance

Fragestellung: Die Sorin PericarbonTM Freedom Stentless Aortenklappe verfügt über eine sehr gute hämodynamische Funktion und eine hohe Widerstandsfähigkeit. In dieser Studie stellen wir die früh- und mittelfristigen Resultate mit dieser Klappenprothese vor. Methodik: 31 konsekutive Patienten (16 Frauen und 15 Männer) wurden nach Implantation einer Sorin PericarbonTM Freedom Stentless Aortenklappe untersucht. Das mittlere Lebensalter betrug 64 +/- 17 Jahre. Präoperativ litten fünf Patienten an einer isolierten Aortenklappenstenose, drei Patienten an einer isolierten Aortenklappeninsuffizienz, ein Patient wies ein kombiniertes Aortenvitium auf. Drei Patienten hatten zusätzlich eine Mitralklappeninsuffizienz, 14 Patienten eine koronare Herzkrankheit und ein Patient eine kongenitale Aortenisthmusstenose. Bei drei Patienten bestand eine akute Aortenklappenendokarditis. 18 Patienten wurden als Hoch-Risiko-Patienten (EuroSCORE 9 +/- 2) klassifiziert. Die mittlere linksventrikuläre Auswurfsfraktion betrug 52.5 +/- 15.0%. Ergebnisse: Alle implantierten Klappenprothesen wurden, bezogen auf die intraoperative Anulusausmessung, um 2mm grösser gewählt. 16 Patienten erhielten isolierte Klappenersatzoperationen. Als Zusatzeingriffe wurden drei Mitralklappenrekonstruktionen, 12 aorto-koronare Bypass-Operationen und eine Resektion einer Aortenisthmusstenose in Kombination mit einem VSD-Verschluss durchgeführt. Drei Eingriffe waren Re-Operationen. Die postoperative Früh-Mortalität war 6.4% (zwei Hoch-Risiko-Patienten). Beide Todesfälle waren nicht klappenbedingt. Vier Patienten entwickelten postoperativ ein Low-Output-Syndrom und erhielten eine intra-aortale Ballon-Pumpe. Die sechs Monate postoperativ durchgeführte Echokardiographie erbrachte tiefe transvalvuläre Mean- und Peak-Gradienten (9.6 +/- 4.4 bzw. 20.6 +/- 5.9mmHg) sowie eine signifikante Regression der linksventrikulären Hypertrophie(linksventrikulärer Massenindex 126.5 +/- 27.3 vs. 189.6 +/- 45.3g/m2, p = 0.0313) und eine Verbesserung der systolischen Auswurfsfraktion (58 +/- 9.8 vs. 52.5 +/- 15.0%, p = 0.9749). Schlussfolgerungen: Die Sorin PericarbonTM Freedom Stentless Aortenklappe zeigte eine hervorragende hemodynamische Funktion, die nach sechs Monaten durch tiefe transvalvulären Gradienten, Regression der linksventrikulären Hypertrophie sowie Anstieg der systolischen Auswurfsfraktion charakterisiert ist. Aussagen bezüglich Lebensdauer und Abnützung des biologischen Gewebes können erst nach Durchführung von Langzeit-Untersuchungen erhoben werden.

Association of ABO histo-blood group B allele with myocardial infarction

To investigate a possible association of ABO blood group alleles with myocardial infarction, a case-control study comprising 177 patients (median age 57.0 years; range 32-72 years) and 89 controls was performed. The distributions of the ABO blood-genotype O1, O2, A1, A2 and B alleles were assessed by analysis of genomic DNA, using the sequence-specific primer-polymerase chain reaction (PCR-SSP) technique to investigate exons VI and VII on chromosome 9. The prevalence of the B allele was 2.5 times higher amongst patients with a history of myocardial infarction than amongst controls (16.3 vs. 6.7%; P = 0.034, Fisher's exact test). There was an association between patients carrying the B allele and myocardial infarction, with an odds ratio (OR) of 2.7 (95% confidence interval 1.1-6.8). The B allele remained an independent risk factor for myocardial infarction (P = 0.038) when classical risk factors were adjusted for by unconditional logistic regression. In conclusion, the ABO blood group B allele was found to be an independent risk factor for myocardial infarction.

Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery

OBJECTIVE

Effects of aprotinin in off-pump coronary artery bypass (OPCAB) surgery have not yet been described. This study analyses hemostasiologic changes and potential benefit in OPCAB patients treated with aprotinin.

METHODS

In a prospective, double-blind, randomized study 47 patients undergoing OPCAB surgery were investigated. Patients received either aprotinin (2 x 10(6) KIU loading dose and 0.5 x 10(6) KIU/h during surgery, n=22) or saline solution (control, n=25). Activated clotting time was adjusted to a target of 250 s intraoperatively. Blood samples were taken up to 18h postoperatively: complete hematologic and hemostasiologic parameters including fibrinopeptide A (FPA) and D-dimer in a subgroup of 31 patients were analyzed. Blood loss, blood transfusion and other clinical data were collected.

RESULTS

Both groups showed comparable demographic and intraoperative variables. Forty-one (87%) patients of the whole study group received aspirin within 7 days prior to surgery. Number of grafts per patient were comparable (2.9+/-1.0 [mean+/-SD] in the aprotinin group and 2.8+/-1.2 in control, P=0.83). Blood loss during the first 18 h in intensive care unit was significantly reduced in patients treated with aprotinin (median [25th-75th percentiles]: 500 [395-755] ml vs. 930 [800-1170] ml, P<0.001). Postoperatively only two patients (10%) in the aprotinin group received packed red blood cells, whereas eight (35%) in the control group (P=0.07). Perioperatively FPA levels reflecting thrombin generation were elevated in both groups. The increase in D-dimer levels after surgery was significantly inhibited in the aprotinin group (P<0.001). Early clinical outcome was similar in both groups.

CONCLUSIONS

Aprotinin significantly reduces blood loss in patients undergoing OPCAB surgery. Inhibition of enhanced fibrinolysis can be observed. FPA generation during and after OPCAB surgery seems not to be influenced by aprotinin.