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ObjectivesSurgical management of tricuspid valve regurgitation mainly consists of tricuspid valve annuloplasty, usually performed with implantation of a rigid ring or a flexible band.MethodsWe performed a retrospective analysis on 820 patients who underwent tricuspid valve repair between March 2002 and July 2009 with either a flexible Cosgrove-Edwards band (n = 415; Edwards Lifesciences LLC, Irvine, Calif) or a rigid Carpentier-Edwards Classic annuloplasty ring (n = 405; Edwards Lifesciences). Mean patient age was 69.2 ± 9.5 years, 54.1% were female, and average logistic EuroSCORE was 13.3% ± 12.5%. Concomitant procedures were performed in 94.6% of patients (mitral valve surgery, 80.6%; aortic valve surgery, 28.2%; coronary artery bypass grafting, 24.5%; atrial fibrillation ablation, 44.5%). One fifth of the operations were reoperative procedures. Follow-up was 94% complete, with mean duration of 21.0 ± 19.0 months.ResultsThirty-day mortality was 10.1% (Cosgrove-Edwards, 11.9%; Carpentier-Edwards, 8.4%), and 5-year survival was 62.4% (Carpentier-Edwards, 64.7%; Cosgrove-Edwards, 60.3%). Postoperative echocardiography showed significant improvement in tricuspid valve function, with reduction in tricuspid regurgitation grade from 2.3 ± 0.7 to 0.7 ± 0.7, and no differences between groups. Use of a Carpentier-Edwards ring, however, was associated with significantly higher risk of dehiscence (Carpentier-Edwards, 8.7%; Cosgrove-Edwards, 0.9%; P

Conventional therapeutic drug monitoring based on measuring immunosupressive drug concentrations in blood is important in the clinical management of immunosuppressive therapy in transplantation medicine. Since rejection or infection occurs at irregular drug concentrations immunosuppressive drug therapy is often empiric and prophylactic in nature. In addition, blood immunosuppressant levels are only indirect predictors of the pharmacologic effects on immune cells, because the genetic heterogeneity the immune systems of transplant recipients are not equally sensitive to drug effects. Therefore, therapeutic drug monitoring requires the application of reliable and effective methods to study the pharmacodynamic variability by direct measurements of drug effects on immune cell functions. Flow cytometry offers a multiplicity of quantitative analysis possibilities, from detection of phosphorylated molecules up to complex multicolor analysis of whole blood samples. A large spectrum of flow cytometry-based applications for pharmacodynamic monitoring is available and allows detection and analysis of diverse function of T cells and dendritic cell subsets. By combining several assays, it is possible to generate a broad picture of the immune status of every single transplanted recipient. Furthermore, it is even possible to differentiate between synergistic and antagonistic pharmacodynamic effects of immunosuppressive drug combination therapy in vitro and to predict the pharmacodynamic drug effects in transplanted recipients. Such a pharmacodynamic drug monitoring may offer the opportunity to complete conventional therapeutic drug monitoring and, therefore, to tailor immunosuppressive therapy more individually.

Conventional therapeutic drug monitoring based on measuring immunosupressive drug concentrations in blood is important in the clinical management of immunosuppressive therapy in transplantation medicine. Since rejection or infection occurs at irregular drug concentrations immunosuppressive drug therapy is often empiric and prophylactic in nature. In addition, blood immunosuppressant levels are only indirect predictors of the pharmacologic effects on immune cells, because the genetic heterogeneity the immune systems of transplant recipients are not equally sensitive to drug effects. Therefore, therapeutic drug monitoring requires the application of reliable and effective methods to study the pharmacodynamic variability by direct measurements of drug effects on immune cell functions. Flow cytometry offers a multiplicity of quantitative analysis possibilities, from detection of phosphorylated molecules up to complex multicolor analysis of whole blood samples. A large spectrum of flow cytometry-based applications for pharmacodynamic monitoring is available and allows detection and analysis of diverse function of T cells and dendritic cell subsets. By combining several assays, it is possible to generate a broad picture of the immune status of every single transplanted recipient. Furthermore, it is even possible to differentiate between synergistic and antagonistic pharmacodynamic effects of immunosuppressive drug combination therapy in vitro and to predict the pharmacodynamic drug effects in transplanted recipients. Such a pharmacodynamic drug monitoring may offer the opportunity to complete conventional therapeutic drug monitoring and, therefore, to tailor immunosuppressive therapy more individually.