Combined one-stage surgery of the supraaortic branches and the coronary arteries was performed on 17 consecutive patients, 13 men and 4 women, having a mean age of 56.7 +/- 8 years. Angina pectoris was the primary symptom in all patients. Signs of cerebro-vascular insufficiency were present in 4 cases, 2 with syncopies, one with amaurosis fugax, and one with drop-out symptoms. All patients were invasively examined. Coronary angiogram verified triple vessel disease in 13 cases, double vessel disease in 3 and single vessel disease in one. Angiography of the carotid artery proved unilateral disease in 11 patients, in 5 both sides were either stenosed or occluded. One patient had a left-sided proximal 80% lesion of the subclavian artery. In all cases, the supraaortic branches were done first, followed by revascularization of the coronary artery system. All patients survived the early postoperative course; one died suddenly 33 months after operation. After 16.8 +/- 14 months, 11 out of 15 patients felt much better. Signs of cerebro-vascular insufficiency were not present. Our conclusion: one-stage surgery of the supraaortic branches and the coronary arteries would seem justified. A list of indications is presented.
Third renal transplants were performed in 31 patients (25 men and 3 women: mean age 33 +/- 11 years) with terminal renal failure. Surgical complications occurred in four of them. Acute rejection crises were frequent (48%). In three cases acute humoral vascular rejection led to loss of the grafted kidney. One patient died within 3 months. The proportion of functioning transplants was 83% at 3 months, 59% at 1 year and 20% at 5 years. Such factors as the concentration of panel-reactive antibodies, a history of previous acute humoral rejection crises or the timing of the previous transplant loss had no influence on the prognosis of the new graft. After a mean observation period of 35, 4 months patients whose HLA-DR antigens matched those of the donor at one or two loci had a markedly higher proportion of functioning renal transplants (69% and 64%, resp.) than patients without HLA-DR compatibility (0%; P less than 0.01). These results indicate that a third renal transplant does not carry any increased perioperative risk, and that the proportion of functioning transplants is good in the short term, though the long-term results are poor. Prolonged survival of the renal transplant can be expected only if there is an optimal HLA-DR match between donor and recipient.
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