- Email: [email protected]
Preservation of saphenous vein endothelium
Ann Thorac Surg 2004;77:1505– 6
1. Yamada M, Takeuchi S, Shiojiri Y, et al. Surgical leadpreserving procedures for pacemaker pocket infection. Ann Thorac Surg 2002;74:1494 –9. 2. Dieter RA Jr, Asselmeier GH, McCray RM, Grissom JH, Zimmerman RC. An alternative to removal of an infected pacemaker. Geriatrics 1973;28:78 –80.
Reply To the Editor: We greatly appreciate the comments of Dr Dieter. We read with interest the report by him and his colleagues [1] published in 1973 in which they reported successful treatment of 3 patients in whom infected pacemaker systems were salvaged. We acknowledge their pioneering work on the concept of preservation of the infected pacemaker system. Removal of the entire pacing system is still generally considered necessary to ensure eradication of infection associated with the implanted pacemaker. We agree and have followed this practice. However, it is not only costly but also sometimes disadvantageous to remove a well-functioning lead. Currently, removal of pacemaker leads is often difficult because of the more secure lead-anchoring systems. Although newer methods of transvenous lead extraction have proved to be effective, the complication rate associated with these methods should not be ignored. In our study [2], 17 patients whose infection was limited to the pacemaker pocket were treated successfully by one of two types of lead-preserving procedure. To date, no recurrent infection has been observed in these patients as well as 1 additional patient who underwent our procedure in 2003. We will prudently continue performing our lead-preserving procedures on a case-by-case basis. We thank Dr Dieter for his thoughts and encouragement. Makoto Yamada, MD Toshihiro Takaba, MD First Department of Surgery Showa University 1-5-8 Hatanodai Shinagawa-ku Tokyo 142-8666, Japan e-mail: [email protected]
References 1. Dieter RA Jr, Asselmeier GH, McCray RM, Grissom JH, Zimmerman RC. An alternative to removal of an infected pacemaker. Geriatrics 1973;28:78 –80. 2. Yamada M, Takeuchi S, Shiojiri Y, et al. Surgical lead-
1505
preserving procedures for pacemaker pocket infection. Ann Thorac Surg 2002;74:1494 –9.
Preservation of Saphenous Vein Endothelium To the Editor: I read with a great deal of interest the article by Thatte and colleagues [1]; their work is well presented and, in my view, very valuable. I congratulate them for two important contributions to the study of the fate of veins used as arterial grafts: (1) the use of multiphoton microscopy and specific fluorescent stains for calcium and nitric oxide metabolism and (2) the introduction of the newly formulated storage solution GALA (glutathione, ascorbic acid, l-arginine). In 1998, my colleagues and I [2] published an article on perivascular delivery of NO using a polymer and an NO donor (spermine/NO) applied around a vein graft implanted in the arterial circulation of hypercholesterolemic rabbits. These experiments demonstrated a significant reduction in neointimal hyperplasia in the treated vein grafts as compared with those bathed in saline solution or polymer alone. We noted in our study that the major limitation of this method of NO delivery in humans would be due to technical difficulties in controlling the application of the polymer ⫹ spermine/NO mixture and the inflammatory reaction that it produces in the surrounding tissues. We called for research in other methods of delivery of NO. I hope that further testing of the GALA solution using animal models such as the one we described will demonstrate the beneficial effects of this very simple and readily available modality of delivery and that surgeons soon will be able to use it for the benefit of their patients. Aurelio Chaux, MD Cardiothoracic Surgery Saint Johns Hospital and Health Center 1328 Twenty-Second St Santa Monica, CA 90404 e-mail: [email protected]
References 1. Thatte HS, Biswas KS, Najjar SF, et al. Multi-photon microscopic evaluation of saphenous vein endothelium and its preservation with a new solution, GALA. Ann Thorac Surg 2003;75:1145–52. 2. Chaux A, Ruan XM, Fishbein MC, et al. Perivascular delivery of a nitric oxide donor inhibits neointimal hyperplasia in vein grafts implanted in the arterial circulation. J Thorac Cardiovasc Surg 1998;115:604 –14.
REVIEW OF RECENT BOOKS Advanced Therapy of Cardiac Surgery, 2nd Edition Edited by Kenneth Franco, MD, and Edward Verrier, MD 2003, Hamilton, Ontario, Canada, BC Decker 642 pp, illustrated, $129.00 ISBN: 1-55009-061-5 Reviewed by Verdi J. DiSesa, MD This is the second edition of Franco and Verrier’s Advanced Therapy of Cardiac Surgery. Like the first volume, this book has its focus on new operations, new biological knowledge, new techniques, and new technologies presently available to the heart © 2004 by The Society of Thoracic Surgeons Published by Elsevier Inc
surgeon or perhaps to become so in the near future. The topics range from blood conservation, to off-pump surgery, to the inflammatory consequences of cardiopulmonary bypass, to prosthetic valve endocarditis, to aortic surgery, to mechanical devices, to xenotransplantation. The editors have been nothing if not encyclopedic about the scope of their reach. They have succeeded admirably in touching on conceivably every area of active investigation in the biology and technology of early 21st century heart surgery and have tapped a well of national and international expert authors to help them do so. Because the volume has literally dozens of co-authors, there is Ann Thorac Surg 2004;77:1505– 6 • 0003-4975/04/$30.00 doi:10.1016/j.athoracsur.2003.07.039
MISCELLANEOUS
References
CORRESPONDENCE
1. Yamada M, Takeuchi S, Shiojiri Y, et al. Surgical leadpreserving procedures for pacemaker pocket infection. Ann Thorac Surg 2002;74:1494 –9. 2. Dieter RA Jr, Asselmeier GH, McCray RM, Grissom JH, Zimmerman RC. An alternative to removal of an infected pacemaker. Geriatrics 1973;28:78 –80.
Reply To the Editor: We greatly appreciate the comments of Dr Dieter. We read with interest the report by him and his colleagues [1] published in 1973 in which they reported successful treatment of 3 patients in whom infected pacemaker systems were salvaged. We acknowledge their pioneering work on the concept of preservation of the infected pacemaker system. Removal of the entire pacing system is still generally considered necessary to ensure eradication of infection associated with the implanted pacemaker. We agree and have followed this practice. However, it is not only costly but also sometimes disadvantageous to remove a well-functioning lead. Currently, removal of pacemaker leads is often difficult because of the more secure lead-anchoring systems. Although newer methods of transvenous lead extraction have proved to be effective, the complication rate associated with these methods should not be ignored. In our study [2], 17 patients whose infection was limited to the pacemaker pocket were treated successfully by one of two types of lead-preserving procedure. To date, no recurrent infection has been observed in these patients as well as 1 additional patient who underwent our procedure in 2003. We will prudently continue performing our lead-preserving procedures on a case-by-case basis. We thank Dr Dieter for his thoughts and encouragement. Makoto Yamada, MD Toshihiro Takaba, MD First Department of Surgery Showa University 1-5-8 Hatanodai Shinagawa-ku Tokyo 142-8666, Japan e-mail: [email protected]
References 1. Dieter RA Jr, Asselmeier GH, McCray RM, Grissom JH, Zimmerman RC. An alternative to removal of an infected pacemaker. Geriatrics 1973;28:78 –80. 2. Yamada M, Takeuchi S, Shiojiri Y, et al. Surgical lead-
1505
preserving procedures for pacemaker pocket infection. Ann Thorac Surg 2002;74:1494 –9.
Preservation of Saphenous Vein Endothelium To the Editor: I read with a great deal of interest the article by Thatte and colleagues [1]; their work is well presented and, in my view, very valuable. I congratulate them for two important contributions to the study of the fate of veins used as arterial grafts: (1) the use of multiphoton microscopy and specific fluorescent stains for calcium and nitric oxide metabolism and (2) the introduction of the newly formulated storage solution GALA (glutathione, ascorbic acid, l-arginine). In 1998, my colleagues and I [2] published an article on perivascular delivery of NO using a polymer and an NO donor (spermine/NO) applied around a vein graft implanted in the arterial circulation of hypercholesterolemic rabbits. These experiments demonstrated a significant reduction in neointimal hyperplasia in the treated vein grafts as compared with those bathed in saline solution or polymer alone. We noted in our study that the major limitation of this method of NO delivery in humans would be due to technical difficulties in controlling the application of the polymer ⫹ spermine/NO mixture and the inflammatory reaction that it produces in the surrounding tissues. We called for research in other methods of delivery of NO. I hope that further testing of the GALA solution using animal models such as the one we described will demonstrate the beneficial effects of this very simple and readily available modality of delivery and that surgeons soon will be able to use it for the benefit of their patients. Aurelio Chaux, MD Cardiothoracic Surgery Saint Johns Hospital and Health Center 1328 Twenty-Second St Santa Monica, CA 90404 e-mail: [email protected]
References 1. Thatte HS, Biswas KS, Najjar SF, et al. Multi-photon microscopic evaluation of saphenous vein endothelium and its preservation with a new solution, GALA. Ann Thorac Surg 2003;75:1145–52. 2. Chaux A, Ruan XM, Fishbein MC, et al. Perivascular delivery of a nitric oxide donor inhibits neointimal hyperplasia in vein grafts implanted in the arterial circulation. J Thorac Cardiovasc Surg 1998;115:604 –14.
REVIEW OF RECENT BOOKS Advanced Therapy of Cardiac Surgery, 2nd Edition Edited by Kenneth Franco, MD, and Edward Verrier, MD 2003, Hamilton, Ontario, Canada, BC Decker 642 pp, illustrated, $129.00 ISBN: 1-55009-061-5 Reviewed by Verdi J. DiSesa, MD This is the second edition of Franco and Verrier’s Advanced Therapy of Cardiac Surgery. Like the first volume, this book has its focus on new operations, new biological knowledge, new techniques, and new technologies presently available to the heart © 2004 by The Society of Thoracic Surgeons Published by Elsevier Inc
surgeon or perhaps to become so in the near future. The topics range from blood conservation, to off-pump surgery, to the inflammatory consequences of cardiopulmonary bypass, to prosthetic valve endocarditis, to aortic surgery, to mechanical devices, to xenotransplantation. The editors have been nothing if not encyclopedic about the scope of their reach. They have succeeded admirably in touching on conceivably every area of active investigation in the biology and technology of early 21st century heart surgery and have tapped a well of national and international expert authors to help them do so. Because the volume has literally dozens of co-authors, there is Ann Thorac Surg 2004;77:1505– 6 • 0003-4975/04/$30.00 doi:10.1016/j.athoracsur.2003.07.039
MISCELLANEOUS
References
CORRESPONDENCE