Papers by Adam Somlai-Fischer
Cardiovascular Surgery, 1999
The short and the long-term results of our experience with 25 consecutive patients who underwent ... more The short and the long-term results of our experience with 25 consecutive patients who underwent multivalvular surgery for infective endocarditis are analysed. Preoperatively, 20/25 (80%) patients were in New York Heart Association (NYHA) stage III or IV, and 2/25 (8%) patients were in cardiogenic shock. All the diseased valves were replaced with mechanical bileaflet prosthesis except seven mitral valves and one tricuspid valve, which could be repaired. Major postoperative complications occurred in 3/25 (12%) patients: a fatal cerebral haemorrhage, a reversible cerebellar syndrome and an intractable heart failure, which required transplantation. During a mean follow-up of 4.7 years (range 6 months to 16.8 years), 7/25 (28%) patients suffered from valve-related complications: five bleedings (one died), one embolic event and one prosthetic valve thrombosis. The actuarial freedom of valve-related event at 10 years was 61.8 Ϯ 12.4%. There was no prosthetic endocarditis. At follow-up, 20/21 (95%) survivors were in NYHA stage I or II. Long-term outcome in our patient population operated on for multivalvular endocarditis, is satisfactory with no recurrent infection and excellent functional results.
Revue médicale de la Suisse romande, 2002
Constant progress has been made over the years in order to improve the performance of mechanical ... more Constant progress has been made over the years in order to improve the performance of mechanical circulatory support devices. After the introduction of portable blood pump systems into clinical practice, we now study the performance characteristics of totally implantable mechanical circulatory support systems which do not require percutaneous drive lines or percutaneous electrical wiring. As a matter of fact, transcutaneous energy transfer is now achieved by induction, and pump controller performance read-out and pump parameter adjustment is performed by telemetry. The indication for clinical use of such devices has to be evaluated carefully. Mainly patients in need of a heart transplant but having contraindications to move forward (advanced age, former neoplasm, persistent antibodies) have benefits from such devices as destination therapy.
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Revue médicale de la Suisse romande, 2004
In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite dif... more In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abd...
World Journal of Surgery, 1999
With advances in heart transplantation, a growing number of recipients are at risk of developing ... more With advances in heart transplantation, a growing number of recipients are at risk of developing gastrointestinal disease. We reviewed our experience with gastrointestinal disease in 92 patients undergoing 93 heart transplants. All had follow-up, with the median time 4.8 years (range 0.5-9.6 years). During the period of the study we progressively adopted a policy of low immunosuppression aiming toward monotherapy with cyclosporine. Nineteen patients (20.6%) developed 28 diseases related to the gastrointestinal tract. Thirteen patients required 18 surgical interventions, five as emergencies: closure of a duodenal ulcer, five cholecystectomies (one with biliary tract drainage), a sigmoid resection for a diverticulitis with a colovesical fistula, a colostomy followed by a colostomy takedown for an iatrogenic colon perforation, appendectomy, two anorectal procedures, and six abdominal wall herniorrhaphies. At the onset of gastrointestinal disease, 8 patients were on standard triple-drug immunosuppression, all of them within 6 months of transplantation; 13 were on double-drug immunosuppression; and 7 were on cyclosporine alone. All the patients with perforations/fistulas were on steroids. Among the 11 infectious or potentially infectious diseases, 10 were on triple- or double-drug immunosuppression. One death, a patient who was on triple-drug immunosuppression, had a postmortem diagnosis of necrotic and hemorrhagic pancreatitis. Except for an incisional hernia following a laparoscopic cholecystectomy, there was no morbidity and, importantly, no septic complications. We concluded that a low immunosuppression policy is likely to be responsible for the low morbidity and mortality of posttransplant gastrointestinal disease, with a lower incidence of viscous perforation/fistula and infectious gastrointestinal disease.
Transplantation Proceedings, 1997
Transplantation Proceedings, 1998
T RIPLE-DRUG immunosuppression with cyclosporine A (CyA), azathioprine, and steroids is the curre... more T RIPLE-DRUG immunosuppression with cyclosporine A (CyA), azathioprine, and steroids is the current treatment after heart transplantation. 1-3 This widely accepted therapy leads to a marked improvement in both short-and long-term survival by reducing the incidence of rejection compared to CyA alone or associated with steroids. 4 However, concern remains due to the numerous side effects, such as diabetes and osteoporosis. 5 We and others 6-11 recently showed the safety and even the benefit of early steroid discontinuation during the first year after transplantation without consequences on the overall mortality. Moreover, since 1992, we simplified immunosuppressive treatment and systematically withdrew azathioprine at the end of the second year to maintain long-term CyA monotherapy. In this retrospective, nonrandomized, singlecenter study, we compared the 3-year outcome of patients who were treated with standard triple-drug immunosuppression (transplanted before 1992) on a simplified immunosuppressive regimen (transplanted after 1992), with CyA monotherapy from the end of the second year.
The Thoracic and Cardiovascular Surgeon, 1997
A series of 64 consecutive patients who underwent surgical subxiphoid drainage of pericardial eff... more A series of 64 consecutive patients who underwent surgical subxiphoid drainage of pericardial effusion over an 11-year period, was analysed both for recurrence of pericardial pathology and survival. The mean follow-up time was 4 years (6 months to 10 years). Twelve patients had recurrent effusion (18%), all except one within 6 months: six patients (9%) had another drainage procedure which was the definitive treatment except in one terminal cancer patient with intractable malignant effusion who died of cardiac tamponade. The remaining six recurrent effusions could be treated conservatively. One patient with idiopathic effusion developed late constrictive pericarditis. Patients with underlying malignancy (n = 26) had significantly worse actuarial survival than the others (actuarial survival at 1 and 5 years of 51% and 0% vs 87% and 76%, respectively). However, their probability of remaining free of recurrence did not differ significantly (actuarial freedom at 1 year of 89% vs 76%). In conclusion, subxiphoid drainage provides a simple, safe and expeditious treatment of most symptomatic pericardial effusions with one in ten patients requiring a repeat drainage for recurrence. In particular, it offers a good palliation in most patients with underlying neoplastic disease. Routine echocardiography is recommended at one and six months to catch most of the recurrent effusions.
The Journal of Thoracic and Cardiovascular Surgery, 1998
We analyzed the long-term morbidity and mortality of our experience with combined mitral-aortic s... more We analyzed the long-term morbidity and mortality of our experience with combined mitral-aortic surgery, as well as their determinants. Methods: Among 2109 consecutive patients undergoing valve operations, 200 had mitral-aortic valve procedures with at least implantation of a mechanical prosthesis: 163 of 200 (81.5%) patients had double valve replacement and 37 of 200 (18.5%) had mitral valve repair and aortic valve replacement. All mechanical valves were bileaflet prostheses. Preoperatively, 171 of 200 (85.5%) patients were in New York Heart Association class III-IV. Event-free survivals were determined by means of the Kaplan-Meier method and determinants of survivals with the Cox proportional hazards model (p < 0.05) entering 39 preoperative and perioperative factors. Follow-up was complete for 96% of the patients (192/200). Results: Overall survivals at 5, 10, and 15 years were 88.5% ؎ 0.55%, 73.5% ؎ 4%, and 53.3% ؎ 8.9%, and rates of freedom from valve-related mortality were 92.9% ؎ 1.5%, 85.8% ؎ 3.5%, and 85.8% ؎ 3.5%. The rates of freedom from permanent valve-related impairment were 91.5% ؎ 1.7%, 85.4% ؎ 3.5%, and 79.3% ؎ 6.7%, and those from all valve-related mortality and morbidity were 74.1% ؎ 2.3%, 53.8% ؎ 5%, and 49% ؎ 5.6%. At last follow-up, 90% (139/154) of the survivors were in New York Heart Association class I-II. Left ventricular ejection fraction less than 50%, age older than 70 years, and preoperative ventricular arrhythmias were independent risk factors for valve-related late deaths. Diabetes, ejection fraction less than 50%, and coronary artery disease were independent determinants of all valve-related events. Conclusions: Functional results of survivors of combined mitralaortic surgery are excellent. However long-term valve-related morbidity and mortality are substantial. In the patient population studied, the predictors are determined by patient-related factors, mainly myocardial factors, but not by valve-related factors.
The Journal of Thoracic and Cardiovascular Surgery, 1997
replacements). Follow-up was 96% complete (2967 patient-years; mean 9.5 years per patient). Actua... more replacements). Follow-up was 96% complete (2967 patient-years; mean 9.5 years per patient). Actuarial event-free rates at 10 years and linearized rates (in parentheses) of late complications were as follows: embolism, 85.0%-2.3% (2.3% per patient-year); anticoagulant-related hemorrhage, 74.8%-2.7% (3.3% per patient-year); cerebrovascular accident, 81.8%-+ 2.5% (2.6% per patient-year); prosthesis thrombosis, 98.5%-0.7% (0.1% per patient-year); endocarditis, 97.2%-1.1% (0.4% per patient-year); prosthesis dysfunction, 97.1%-+ 1.0% (0.4% per patient-year); hemolytic anemia, 98.5%-+ 0.7% (0.1% per patient-year); reoperation, 97.4% + 1.0% (0.4% per patient-year); overall mortality, 63.3%-2.7% (4.2% per patientyear); and valve-related death (including sudden death), 84.7%-+ 2.2% (1.4% per patient-year). Independent preoperative risk factors were as follows: (1) for embolism, cardiac failure as indication for operation and history of prior systemic embolism; (2) for cerebrovascular accidents, the same two factors and age; (3) for endocarditis, diabetes, chronic alcoholism, and aortic valve replacement; (4) for overall mortality, age, ejection fraction (or cardiac index or cardiothoracic index), chronic alcoholism, and history of systemic embolism; and (5) for valve-related death, chronic alcoholism, degenerative cause of valve disease, and prosthetic diameter 23 mm or smaller. Ninety percent of survivors were in New York Heart Association functional class I or II at the end of follow-up. In conclusion, this study confirms the excellent durability of the St. Jude Medical valve and the remarkable functional benefit for the majority of the patients. However, prosthesis-related complications are still common, particularly for small-diameter prostheses. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.
European Journal of Cardio-Thoracic Surgery, 1998
Objective: This retrospective study was designed to assess the risks of acute ascending aorta dis... more Objective: This retrospective study was designed to assess the risks of acute ascending aorta dissection (AAD) as a rare but potentially fatal complication of open heart surgery. Method: Among 8624 cardiac surgical procedures under cardiopulmonary bypass (CPB) and cardioplegic myocardial protection from 1978 to 1997, 10 patients (0.12%) presented with a secondary or so called 'iatrogenic' AAD. There were seven men and three women, mean age 64 ± 9 years, ranging from 47 to 79. The original procedures involved five coronary artery bypass grafts (CABG), one repeat CABG, one aortic valve replacement (AVR), one AVR and CABG, one mitral valvuloplasty (MVP) and CABG and one ascending aorta replacement. We retrospectively analyzed their hospital records. Results: Group I consisted of seven patients with AAD intraoperatively and group II consisted of three patients who developed acute AAD 8-32 days after cardiac surgery. In group I, treatment consisted of the original procedure, plus grafting of the ascending aorta in six patients and closed plication and aortic wrapping in one. In group II, two patients received a dacron graft and one patient developed lethal tamponnade due to aortic rupture before surgery. Postoperatively, six patients responded well and three died (33%), two patients from group I on the 2nd postoperative day with severe post-anoxic encephalopathy, and one from group II with severe peroperative cardiogenic shock. Conclusion: Preventing AAD with the appropriate means remains standard practice in cardiac surgery. If AAD occurs, it requires prompt diagnosis and interposition graft to allow a better prognosis. Intraoperative AAD happens at the beginning of CPB jeopardizing perfusion of the supraaortic arteries.
European Journal of Cardio-Thoracic Surgery, 2001
Objective: Evaluate impact of active cooling with partial cardiopulmonary bypass (CPB) and low sy... more Objective: Evaluate impact of active cooling with partial cardiopulmonary bypass (CPB) and low systemic heparinization during open repair of thoracoabdoninal aortic aneurysms. Methods: Prospective analysis of 100 consecutive patients undergoing surgical repair of thoracoabdominal aortic aneurysms. Partial CPB and normothermic (368C) or hypothermic (298C) perfusion was selected in accordance to the surgeons preference. In the hypothermic group, aortic cross clamp was applied when the target temperature of the venous blood was achieved and rewarming was started after declamping. Results: 52/100 patients (62:2^10:9 years) received normothermic and 48/100 patients hypothermic perfusion (63:8^10:6 years: NS). Emergent procedures accounted for 18/52 (35%) with normothermia vs. 21/48 (44%: NS) with hypothermia. The number of aortic segments (eight maximum including arch and bifurcation) replaced was 3:9^1:5 with normothermia vs. 4:1^1:5 with hypothermia (NS); Crawford type II aneurysms accounted for 21/52 patients (40%) for normothermia vs. 20/48 (42%:NS) for hypothermia. Total clamp time was 38^21 min with normothermia vs. 47^28 min with hypothermia (P 0:05). Pump time was 55^28 min with normothermia vs. 84^34 min with hypothermia (P 0:001). Mortality at 30 days was 8/52 patients (15%) with normothermia vs. 2/48 (4%) with hypothermia (P 0:06; odds ratio 4.1). Parapareses/plegias occurred in 4/52 patients (8%) with normothermia vs. 4/48 (8%) with hypothermia (NS). Revisions for bleeding were required in 4/52 patients (8%) with normothermia vs. 2/48 patients (4%) with hypothermia (P 0:38). Revisions for distal vascular problems were necessary in 5/52 patients (10%) with normothermia vs. 2/48 (4%) with hypothermia (P 0:25). Freedom from death, paraplegia, and surgical revision was 89.9% with normothermia vs. 94.8% with hypothermia (P 0:04; odds ratio 2.0). Conclusions: Active cooling during repair of thoracoabdominal aortic aneurysms allows for longer cross-clamp times, more complex repairs and improves outcome.
European Journal of Cardio-Thoracic Surgery, 1995
Between January 1981 and December 1991, 4137 adult patients underwent various cardiac procedures ... more Between January 1981 and December 1991, 4137 adult patients underwent various cardiac procedures via a median sternotomy under cardiopulmonary bypass. The overall infection rate was 1.33%, including superficial wound infections (SWI) (1.18%) and deep sternal infection (DSI) (0.145%). Pericardial and retrosternal suction drains with a vent allowed a better drainage of blood and serosities and probably contributed to our low DSI rate. Eleven factors predisposing to infection were evaluated by Fisher&#39;s exact test. Only the operative urgency (P = 0.006), reexploration for bleeding (P = 0.00001) and preoperative renal failure (P = 0.0005) were statistically significant. Twenty of our infected patients had no risk factors for infection. When the risk factors described in the literature were applied to our infected patients, only one had no risk factor.
European Journal of Cardio-Thoracic Surgery, 1995
RESUMO Bisinotto FMB, Braz JRC-Efeitos do Halotano, Isoflurano e Sevoflurano nas Respostas Cardio... more RESUMO Bisinotto FMB, Braz JRC-Efeitos do Halotano, Isoflurano e Sevoflurano nas Respostas Cardiovasculares ao Pinçamento Aórtico Infra-Renal. Estudo Experimental em Cães JUSTIFICATIVA E OBJETIVOS: O pinçamento infra-renal da aorta abdominal pode produzir alterações hemodinâmicas. O objetivo do estudo foi avaliar os efeitos do halotano, isoflurano e sevoflurano sobre a função cardiovascular, em cães submetidos à pinçamento aórtico infra-renal. MÉTODO: O estudo aleatório foi realizado em 30 cães, distribuídos em três grupos, de acordo com o anestésico halogenado utilizado durante a anestesia, em concentrações equipotentes de 0,75 CAM: GH (n=10)-halotano a 0,67%; GI (n=10)-isoflurano a 0,96%; e GS (n=10)-sevoflurano a 1,8%. Em todos os animais foi realizada ligadura infra-renal da aorta, por período de 30 min. Os atributos hemodinâmicos foram estudados nos momentos: C (Controle), Ao15 e Ao30, respectivamente após 15 e 30 minutos do pinçamento aórtico, e DAo e DAo15, respectivamente, imediatamente e após 15 min do despinçamento aórtico. RESULTADOS: Durante o pinçamento aórtico houve, em todos os grupos, aumento das pressões arterial média e do átrio direito, e dos índices cardíaco, sistólico e de trabalho sistólico dos ventrículos direito e esquerdo. A pressão da artéria pulmonar aumentou em GI e GS e a pressão pulmonar ocluída em GH e GI. Após o despinçamento aórtico, houve normalização dos atributos que haviam se elevado, com exceção dos índices cardíaco e sistólico, que continuaram elevados, acompanhados de diminuição do índice de resistência vascular sistêmica. Não houve diferença significante entre os grupos em relação aos atributos estudados, com exceção da freqüência cardíaca que foi sempre menor em GH, em relação aos demais grupos, durante o pinçamento e despinçamento aórtico. CONCLUSÕES: No cão, nas condições experimentais empregadas, a inalação do halotano, isoflurano e sevoflurano em concentrações equipotentes (0,75 CAM) não atenua as respostas cardiovasculares ao pinçamento aórtico infra-renal.
Clinical Transplantation, 1999
Background. The replacement of Sandimmun ® by Neoral ® in 1995 was thought to cause subsequent re... more Background. The replacement of Sandimmun ® by Neoral ® in 1995 was thought to cause subsequent renal function deterioration due to the better bioavailability of the new drug. We prospectively analyzed the effect of a dose-to-dose drug replacement on renal function over 12 months. Methods and results. The renal function of 47 consecutive heart transplanted patients was prospectively evaluated before (T0), at 1 (T1), 3 (T3), and 12 (T12) months after drug replacement. Mean serum creatinine was not significantly different at T0 and T12 (142 9 55 and 154 9 60 mmol/L, p= 0.1). We were able to reduce cyclosporine total and weight-indexed doses by, respectively, 11% and 14% between T0 and T12 (274 9 86 to 244 9 72 mg/d, p= 0.0003; and 3.7 9 1.4 to 3.2 9 1.2 mg/kg/d, respectively, p= 0.0005). Conclusions. This study demonstrates that the dose-to-dose replacement of Sandimmun by Neoral is feasible, with no direct influence on renal function over a 1-yr follow-up.
Clinical Cardiology, 1998
Buckground: The improvement of surgical techniques and the use of immunosuppressive drugs within ... more Buckground: The improvement of surgical techniques and the use of immunosuppressive drugs within the past 15 years has made heart transplantation an increasingly performed procedure and an accepted treatment for end-stage cardiac failure. Hypothesis: The aim of this study was to describe the changes of the 12-lead electrocardiogram (ECG) after heart transplantation and to determine their prognostic value on complications such as rejection or graft coronary artery disease during follow-up. Methods: The ECGs of 62 consecutive patients were analyzed for 5 years at follow-up periods of l, 2,3,6 months and yearly after transplantation. Results: The most prevalent abnormality was the presence of complete or incomplete right bundle-branch block (RBBB). New RBBB appeared in 69% (43162) of the patients, mainly during the first month (2 1/43). There was no left bundle-branch block. We detected nine episodes of supraventricular arrhythmias: one atrial fibrillation, six atrial flutter, one junctional tachycardia, one orthodromic tachycardia on a Wolff-Parkinson-White syndrome; all appearing during the first 3 months. Three of the six episodes of atrial flutter occurred during an episode of acute rejection. There was
The Annals of Thoracic Surgery, 1997
In this paper i will present our current research in progress where we try to integrate some new ... more In this paper i will present our current research in progress where we try to integrate some new prototypical functions for the networked society into spatial, natural, architectural context. The research connects models and technologies from a set of fields including human computer interaction, computer games, physical computing, spatial design and architecture. Part of the work is based on architecture prototyping, built and functioning installations where the user experiences can be tested on a 1 to 1 scale. Ping Genius Loci (addressing the spirit of the place, 2005-2006, Aether Architecture) is the latest of these architecture prototypes, built up from 400 radio networked, solar powered, self sustainable intelligent analogue pixels, that are placed on a 20 by 20 meters grid. These pixels function in the bright sunshine, where the experience of digital media usually doesn't exist. There are a number of interaction possibilities under development but most interesting based on ...
Journal of Visualization, 2007
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Papers by Adam Somlai-Fischer