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The introduction of GRF glue has greatly facilitated the reconstruction of dissected aortic wall layers adjacent to the vascular graft. However, the use of the adhesive for aortic root reconstruction in acute aortic dissection type A may bear a significant risk of late postoperative proximal aortic redissection. Complications associated with the GRF glue are likely to be due to the toxic effects of the formalin component. Therefore, care should be taken that the amount of formalin administered to the glue components remains as low as possible.

Surfactant replacement may become a clinical method for treatment of reperfusion injury after lung transplantation.

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Reperfusion injury is one of the major causes of early morbidity and mortality after lung transplantation. Features of thi s syndrome are pulmonary edema, reduction of compliance, and impaired gas exchange, and these occur in about 20% of all lung transplant recipients. Usual treatment includes prolonged mechanical ventilation with elevated positive end-expiratory airway pressure (PEEP), enhanced mean airway pressure with high oxygen content (Fio2), and, in severe cases, inverse ratio ventilation and extracorporeal membrane oxygenation. We report on the successful treatment with nebulized synthetic surfactant (Exosurf; Wellcome, Burgwedel, Germany) of a patient in whom reperfusion injury developed 5 hours after right lung transplantation.Right lung transplantation was done in a 26-year-old woman who had sarcoidosis with terminal interstitial lung disease and recurrent failure of the right side of the heart. The patient had been dependent on continuous oxygen insufllation for 30 months before transplantation. Pulmonary hypertension was present with a mean pulmonary artery pressure of 50 mm Hg.

Objective-To investigate the long term outcome and prognostic factors after heart transplantation. Setting-University hospital. Subjects-120 heart transplant patients (98 male, 22 female; underlying disease: dilated cardiomyopathy in 69, coronary artery disease in 42, miscellaneous in nine) who had undergone heart transplantation between October 1984 and October 1987. Immunosuppressive treatment was comparable in all patients and rejection episodes were treated in a uniform manner. Methods-Functional status, quality of life, and potential predictors for long term survival were investigated. Results-Actuarial survival rates were 65% at five years and 48% at 10 years; 58 patients survived > 10 years. The major causes of death were cardiac allograft vasculopathy (39%), acute rejection (18%), infection (11%), and malignancy (11%). Long term survivors had good exercise tolerance assessed by the New York Heart Association classification: 47 (81%) in grade I/II; 11 (19%) in grade III/IV. Echocardiography showed good left ventricular function in 48 patients. On angiography, severe allograft vasculopathy was present in only 16 patients (28%). Renal function was only slightly impaired, with mean (SD) serum creatinine of 148.5 (84.9) µmol/l. Multiple potential predictors of long term survival were analysed but none was found useful. Conclusions-Heart transplantation represents a valuable form of treatment. Survival for more than 10 years with a good exercise tolerance and acceptable side eVects from immunosuppression can be achieved in about 50% of patients. (Heart 1999;82:47-51)

Our results confirm that replacement of the descending aorta can be performed today with acceptable low mortality and morbidity and with consistent exclusion of the aneurysm or dissection. Long-term results of endovascular stent-grafts in the descending aorta are unclear. In our opinion endovascular stent-grafts should be reserved for high risk patients, acute dissection or acute aortic rupture.

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