Stephen Westaby

..Comprehensive healthcare systems must consider contemporary evidence and provide the most symptomatic of heart failure patients with effective care. Cardiac resynchronization therapy is no longer the ceiling for this...

..When mean arterial pressure is <55 mmHg with serum lactate >11 mmol/l, death is likely and mechanical circulatory support becomes the only chance for survival...

..Published series demonstrate that 50-75% of patients with profound shock can be salvaged either through native heart recovery, urgent transplantation, or switch to a long-term pump...

..The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies...

..We have now used this method in patients implanted with the Jarvik 2000 heart (Jarvik Heart, Inc, New York, NY) as destination therapy for end-stage (New York Heart Association class IV) heart failure...

..A vascular graft offloads to the descending thoracic aorta so that only the left pleural cavity is opened. Power supply is through an abdominal drive line or postauricular titanium pedestal according to the treatment strategy...

..In this high-risk setting, we believe that a conservative approach to the aortic root and the complete resection of the primary tear are important. We reviewed the results of this policy from our aortic surgery database...

..After extensive laboratory testing, we began clinical trials with an axial flow pump for long-term treatment of New York Heart Association class IV, transplant-ineligible patients...

..After extensive laboratory experience we sought to evaluate the intraventricular Jarvik 2000 Heart in patients with endstage heart failure...

..To verify or refute the value of hospital episode statistics (HES) in determining 30 day mortality after open congenital cardiac surgery in infants nationally in comparison with central cardiac audit database (CCAD) information...

..User-friendly blood pumps with proven durability already exist. Rotary blood pumps must be made available in centers other than those involved in transplantation. The mystique must be removed from this relatively simple intervention...

..In the absence of the transplant option, more innovative circulatory support strategies are required to improve survival in the postcardiotomy setting...

..Further clinical trials of destination therapy are indicated and must use more reliable blood pumps implanted before terminal decline into multiorgan failure...

..The outcome following revascularization in the heart failure patient, the results of revascularization, and the time course of functional recovery after coronary artery bypass graft are also covered...

..In order to gain the full length of this vessel it was mobilised from a left thoracotomy. The aberrant vessel provides autogenous patch material with which to enlarge the ascending aorta and left common carotid artery...

..We analyzed a 10 year experience of all root replacement operations by one surgeon to determine the incidence of coronary complications and risk factors for early mortality...

..Widespread application of this method depends on the availability of an inexpensive user friendly blood pump, appropriate weaning protocols and emerging strategies to promote sustainable myocardial recovery...

..Stentless BPs offer established hemodynamic benefits. We sought to determine whether these advantages translate into improved survival...

..The availability of donor hearts is severely limited, therefore an alternative approach is necessary. We have explored the use of a new type of left-ventricular assist device intended as a long-term solution to end-stage heart failure...

..The aim of the present study was to evaluate the relationship between the SIR and postoperative cognitive performance at 5 days and 3 months...

..Instead of aneurysm ligation and coronary bypass we mobilized the inflow and outflow and performed end-to-end anastomosis. This preserved the native vessel. Restudy in both patients confirmed the effectiveness of this technique...

..We performed partial left ventriculectomy (Batista procedure) that halved left atrial pressure and enabled discontinuation of bypass. Postoperative recovery was then uneventful...

..We tested the hypothesis that a miniaturised axial flow pump with infection-resistant power delivery could improve longevity and quality of life (QOL) in advanced heart failure patients deemed unsuitable for transplantation...

..We studied the outcome after selective sinus replacement in 29 consecutive AAA patients between 1995 and 2001...

..44, P = 0.0002). ET-1 rise is more pronounced in on-pump CABG and ET-1 production could be driven by periprocedural inflammatory reaction...

..Mitochondrial (Bax, p53, caspase 9) and death-receptor mediated (TNFR1, caspase 8) pathways are upregulated but without completion of DNA fragmentation...

..We describe a safe, alternative hybrid transapical approach from the right ventricle that avoids the extensive dissection and potential complications of revision surgery...

..In this study, activity of the Bcl-2 family of mitochondrial apoptotic proteins and their regulator (p53) were assessed during the transition to heart failure...

..This study characterized early changes in biomarkers after revascularization injury during on-pump CABG...

..Apart from a family history of coronary artery disease there was no other medical history of note...

..A pressure overload model was developed to simulate aortic stenosis and assess caspase activity during the transition to heart failure...

..CONCLUSIONS: Stentless bioprostheses are no longer confined to AVR alone. Experience supports the use of stentless bioprostheses where aortic homografts were previously applied. With availability in a wide range of sizes...

..We report a case of rupture of the ventricular septum occurring after treatment with the glycoprotein IIb-IIIa receptor blocker abciximab, in the absence of thrombolysis...

..The objective of this study was to test whether absolute quantification of perfusion with cardiovascular magnetic resonance systematically underestimates MBF in segments subtended by bypass grafts...

..As patients with LVAD are increasing in number, clinicians should be aware of this possible effect...

..This study investigated long-term outcome in valve prosthesis patients with or without AF...

..During the learning curve selective use of SBPs increased hospital mortality for AVR +/- CABG. Consecutive use dispelled the difference and the literature now suggests that SBPs may reduce hospital mortality for high-risk patients...

..The recent remarkable developments in blood pump bioengineering provide an alternative approach and a platform on which to base genetic or stem cell therapies...

..To investigate this, we developed an ovine model of pressure overload-induced heart failure, in which serial left ventricular biopsies were obtained...

..We sought to compare the early hemodynamic performance of pericardial stentless aortic valves with that of well-established porcine stentless aortic prostheses...

..These are less intimidating for the patient but have unsolved risks with uncertain long-term outcome. In the future, an evidence-based balance between conventional surgical procedures versus interventional strategies is required...

..Anecdotal evidence from 7.5 years of event-free survival in the first patient to receive a 'destination' axial flow pump permits justifiable optimism about the future of this approach. It is now time for real progress...

..Ultimately, the variations in aortic root anatomy, surgical experience and their interactions are likely to become major determinants of in vivo performance of stentless aortic valves...

..It minimizes the risk of embolization into the brachiocephalic arteries of debris and malperfusion of the dissected aorta...

..To describe endovascular stent placement in infants as a technically feasible option in circumstances where surgery is considered less favorable...

..This case report demonstrates the difficulty dealing with the minority of patients presenting with presumed ST elevation myocardial infarction, but for whom the life-saving treatment is surgery...

..We aimed to assess the differential implications of creatine kinase-myocardial band (CK-MB) and troponin measurement with the universal definition of periprocedural injury after percutaneous coronary intervention...

..Needle holes self-seal rapidly. Medium-term follow-up by clinical, angiographic, computed tomographic, and magnetic resonance imaging techniques showed no late graft complications--specifically, no dilatation or thrombus formation...

..Coarctation occurring within the aortic arch is rare and may present difficulties during surgical repair. We describe the operative technique and outcome in 6 patients with this unusual anomaly...

..Pericardial stentless valves may be of advantage in elderly patients with significant geometric root mismatch...

..Both autogenous aortic and pulmonary arterial flaps create an extended left main stem without the disadvantages of standard rerouting techniques and full potential for growth remains...

..As an alternative we used a stentless porcine xenograft root (Medtronic Freestyle valve) to manage this problem...

..Consequently, there is a need to evaluate new surgical options for the deteriorating HF patient...

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..The use of composite arterial grafts performed on the beating heart may be the most effective way of minimizing the risk of cerebral injury associated with CABG...

..We describe a case of poststernotomy mediastinitis which produced electrocardiographic changes mimicking an acute inferior myocardial infarction...

..The modern cardiac surgeon needs to have a safe strategy for dealing with these complex cases. We report two cases that illustrate simple and safe cannulation techniques for temporary left and right ventricular failure...

..A case of aortoesophageal fistula caused by a swallowed fish bone leading to respiratory arrest is reported. The clinical presentation was unusual. The successful treatment required the use of hypothermic circulatory arrest...

..Mechanical reliability and biocompatibility were demonstrated. Organ function remained within normal limits during continuous non-pulsatile flow...

..We describe successful replacement of the iliac vein using a descending aortic homograft. The ilio femoral system was avulsed after recannulation of the femoral vein during a third cardiac reoperation...

..We report here the use of a dental bar as an external splint for tracheopexy in a neonate. Follow-up to 18 months shows good tracheal growth and no erosion...

..Our preliminary results indicate that this LVAS may safely provide circulatory assistance for heart transplant candidates...

..We tested the hypothesis that a new continuous flow circulatory assist device could be employed safely to relieve symptoms of heart failure and evaluated the potential to prolong life...

..Their reliability and user-friendly status may soon allow implantation at an earlier stage of cardiac deterioration. Doubts about the feasibility of long-term pulseless circulation are disappearing...

..The understanding of the problems generated by this biotechnological interface is essential for obtaining optimal clinical outcomes...

..If the outflow graft to the ascending aorta indeed reduces aortic stasis and thromboembolic events, the anterior approach with retroauricular power delivery might evolve into a standard procedure...

..To evaluate the Jarvik 2000 axial flow left ventricular assist system (LVAS) as a bridge to transplant and as destination therapy...

..We established consistently nonpulsatile blood flow in a sheep model using the Terumo magnetically suspended centrifugal pump. We then compared end-organ function between pulseless and control animals...

..Device failure is a limitation of permanent mechanical circulatory support. We studied the mechanical reliability of the Jarvik 2000 Heart, an axial flow pump with ceramic bearings designed to provide more than 10 years' durability...