Sp Sommer

In-situ topical cooling of lung grafts: early graft function and surfactant analysis in a porcine single lung transplant model.

OBJECTIVE Improvement of organ preservation is essential to facilitate acceptance of marginal donor lungs for transplantation. Thus, recruiting non-heart-beating donors (NHBD) may be one reasonable strategy to augment the organ-pool especially in the field of pulmonary transplantation. Topical cooling (TC) of donor lungs could provide fast organ-protection and is an available procedure even in smaller centers. In this study transplanted lung function and surfactant activity in same lungs, which were preserved by TC, were assessed following transplantation. METHODS Twelve porcine allogeneic single lung transplants were performed. Six lungs that were flush preserved through the antegrade route served as controls. The other six lungs were preserved by TC for 30 min after induction of cardiac arrest by repeated application of cold saline (8 degrees C) to both pleural cavities. Lungs of both groups were stored in LPD solution for 24 h at 8 degrees C. After transplantation, the recipients right bronchus and right pulmonary artery were clamped. Major endpoints included early graft function over a period of 7 h. Hemodynamic measures and respiratory functions were recorded in 30-min intervals. Surfactant function was determined before transplantation and 2 h after reperfusion by broncho-alveolar lavage fluid analysis. RESULTS Only four animals of the control-group survived the 7 h reperfusion period. Right heart failure occurred in two animals after 150 and 240 min of reperfusion. All six animals in the TC group survived the observation period. Pulmonary vascular resistance (p<0.01), pulmonary artery pressure (p=0.03), and lung tissue water content remained significantly lower in topically cooled allografts (p=0.01) vs. controls. Surfactant function after transplantation was comparable in both groups with a trend towards lower protein contents (p=0.07) in the broncho-alveolar fluid of grafts after TC. CONCLUSIONS In-situ TC seems to be a reliable strategy to preserve lungs for up to 24 h. It even surpasses the results of LPD-perfused grafts in hemodynamic function and survival time.

Pulmonary preservation with Bretscheider's HTK and Celsior solution in minipigs.

BACKGROUND Pulmonary preservation with high potassium/low oncotic pressure Euro-Collins (EC) solution is associated with endothelial dysfunction and reduced surfactant function. We compared two low potassium solutions, histidine-tryptophane-ketoglutarate (HTK) and Celsior, to EC in lung ischemia-reperfusion injury. METHODS In 19 minipigs, the left lung was perfused in situ with cold preservation solution (EC, n=6; HTK, n=6; Celsior, n=7). Reperfusion was started after 90 min of warm ischemia. The right pulmonary artery and main bronchus were clamped. Bronchoalveolar lavage (BAL) was obtained before ischemia and after 2 h of reperfusion. Surfactant activity was determined from the BAL in a pulsating bubble surfactometer. RESULTS Animals in the EC group survived 3.7+/-1.4 h. Six Celsior and five HTK treated animals survived the observation period of 7 h (P<0.001). Compliance of the reperfused lung deteriorated less in both Celsior and HTK groups (P<0.001). In EC and HTK animals, the pO(2)/FiO(2) ratio was lower (P=0.002), and pulmonary vascular resistance was higher (P=0.02) than in Celsior animals. Surfactant function was impaired after reperfusion in all groups. CONCLUSIONS Compared to EC, HTK solution showed moderate and Celsior distinct improvement of post-ischemic pulmonary function. However, surfactant function was not well preserved in any group.

[Early single-center experience with the 3F-enable aortic valve bioprosthesis].

ZusammenfassungHintergrund und Ziel:Patienten mit einer operationswürdigen Aortenklappenpathologie und signifikanten Begleiterkrankungen sollten von einer verkürzten intraoperativen Myokardischämiezeit sowie einer reduzierten Zeit an der extrakorporalen Zirkulation (EKZ) profitieren. Mit einer nahtlos zu implantierenden Aortenklappenprothese könnte dieses Ziel erreicht werden. Hier wird über die ersten klinischen Ergebnisse mit der nahtlos zu implantierenden 3F-Enable-Aortenklappenprothese berichtet.Material und Methodik:Die biologische 3F-Enable- Aortenklappenprothese wurde in fünf Patienten implantiert (27 mm: n = 3; 23 mm: n = 1; 21 mm: n = 1). Zur Beurteilung der Funktion der implantierten Aortenklappe wurden intraoperativ, vor Entlassung sowie 3 und 6 Monate postoperativ echokardiographische Untersuchungen durchgeführt.Ergebnisse:Die EKZ-Zeit betrug 87 ± 36 min (Spanne 49–141 min), die Zeit der myokardialen Ischämie 55 ± 27 min (Spanne 32–97 min) und die Klappenimplantationszeit 184 ± 195 s (Spanne 10–420 s). Die letzte postoperative echokardiographische Untersuchung (5,2 ± 1 Monate postoperativ) ergab bei allen Patienten eine kompetente Aortenklappe. Bei zwei Patienten zeigte sich jedoch eine paravaluläre Aortenklappenregurgitation, die zu einer Aortenklappeninsuffizienz II° bzw. II°–III° führte. Die mittleren transvalvulären Klappengradienten lagen bei 5,8 ± 1,3 mmHg (Spanne 4,2–7,1 mmHg), und die Klappenöffnungsfläche wurde planimetrisch mit 3,2 ± 0,4 cm2 (Spanne 2,6–3,6 cm2) bestimmt.Schlussfolgerung:Die ersten klinischen Implantationsergebnisse mit der 3F-Enable-Aortenklappenprothese zeigen, dass die Implantation ohne Nähte möglich ist. Das Auftreten pararavalvulärer Aortenklappenregurgitationen bei zwei Patienten (40%) ist jedoch unbefriedigend. Daher sollten eine Verbesserung des Prothesendesigns bzw. Modifizierungen der Implantationstechnik erfolgen, um die sichere Positionierung bzw. Verankerung der Prothese im nativen Aortenklappenanulus zu gewährleisten.AbstractBackground and Purpose:Patients with aortic valve (AV) pathology and severe comorbidities should benefit from reduced myocardial ischemic and extracorporeal circulation (ECC) time. Sutureless implantation of AV prosthesis may reduce myocardial ischemic and ECC time significantly. The authors report on their preliminary results with the first implants of the 3F-Enable sutureless AV prosthesis.Material and Methods:The 3F-Enable prosthesis was implanted in five patients. Prostheses sizes were 27 mm (n = 3), 23 mm (n = 1), and 21 mm (n = 1), respectively. Intraoperatively, at patient’s discharge as well as 3 and 6 months postoperatively, the AV prosthesis was evaluated by echocardiography.Results:ECC time was 87 ± 36 min (range 49–141 min), myocardial ischemic time 55 ± 27 min (range 32–97 min), and AV implant time 184 ± 195 s (range 10–420 s). The latest postoperative echo (5.2 ± 1 months postoperatively) revealed a fully competent AV in three patients, in two patient paravalvular leakage was detected at the severity of an aortic regurgitation (AR) II°, and AR II°–III°, respectively. The mean pressure gradients were 5.8 ± 1.3 mmHg (range 4.2–7.1 mmHg), valve orifice area was 3.2 ± 0.4 cm2 (range 2.6–3.6 cm2).Conclusion:The first clinical results of the 3F-Enable sutureless AV prosthesis are feasible; however, a paravalvular leakage was detected in two patients (40%). Thus, device and procedural enhancements are required to assure positioning and anchoring of the prosthesis.

Erste klinische Erfahrungen mit der 3FEnable-Aortenklappen-Bioprothese

ZusammenfassungHintergrund und Ziel:Patienten mit einer operationswürdigen Aortenklappenpathologie und signifikanten Begleiterkrankungen sollten von einer verkürzten intraoperativen Myokardischämiezeit sowie einer reduzierten Zeit an der extrakorporalen Zirkulation (EKZ) profitieren. Mit einer nahtlos zu implantierenden Aortenklappenprothese könnte dieses Ziel erreicht werden. Hier wird über die ersten klinischen Ergebnisse mit der nahtlos zu implantierenden 3F-Enable-Aortenklappenprothese berichtet.Material und Methodik:Die biologische 3F-Enable- Aortenklappenprothese wurde in fünf Patienten implantiert (27 mm: n = 3; 23 mm: n = 1; 21 mm: n = 1). Zur Beurteilung der Funktion der implantierten Aortenklappe wurden intraoperativ, vor Entlassung sowie 3 und 6 Monate postoperativ echokardiographische Untersuchungen durchgeführt.Ergebnisse:Die EKZ-Zeit betrug 87 ± 36 min (Spanne 49–141 min), die Zeit der myokardialen Ischämie 55 ± 27 min (Spanne 32–97 min) und die Klappenimplantationszeit 184 ± 195 s (Spanne 10–420 s). Die letzte postoperative echokardiographische Untersuchung (5,2 ± 1 Monate postoperativ) ergab bei allen Patienten eine kompetente Aortenklappe. Bei zwei Patienten zeigte sich jedoch eine paravaluläre Aortenklappenregurgitation, die zu einer Aortenklappeninsuffizienz II° bzw. II°–III° führte. Die mittleren transvalvulären Klappengradienten lagen bei 5,8 ± 1,3 mmHg (Spanne 4,2–7,1 mmHg), und die Klappenöffnungsfläche wurde planimetrisch mit 3,2 ± 0,4 cm2 (Spanne 2,6–3,6 cm2) bestimmt.Schlussfolgerung:Die ersten klinischen Implantationsergebnisse mit der 3F-Enable-Aortenklappenprothese zeigen, dass die Implantation ohne Nähte möglich ist. Das Auftreten pararavalvulärer Aortenklappenregurgitationen bei zwei Patienten (40%) ist jedoch unbefriedigend. Daher sollten eine Verbesserung des Prothesendesigns bzw. Modifizierungen der Implantationstechnik erfolgen, um die sichere Positionierung bzw. Verankerung der Prothese im nativen Aortenklappenanulus zu gewährleisten.AbstractBackground and Purpose:Patients with aortic valve (AV) pathology and severe comorbidities should benefit from reduced myocardial ischemic and extracorporeal circulation (ECC) time. Sutureless implantation of AV prosthesis may reduce myocardial ischemic and ECC time significantly. The authors report on their preliminary results with the first implants of the 3F-Enable sutureless AV prosthesis.Material and Methods:The 3F-Enable prosthesis was implanted in five patients. Prostheses sizes were 27 mm (n = 3), 23 mm (n = 1), and 21 mm (n = 1), respectively. Intraoperatively, at patient’s discharge as well as 3 and 6 months postoperatively, the AV prosthesis was evaluated by echocardiography.Results:ECC time was 87 ± 36 min (range 49–141 min), myocardial ischemic time 55 ± 27 min (range 32–97 min), and AV implant time 184 ± 195 s (range 10–420 s). The latest postoperative echo (5.2 ± 1 months postoperatively) revealed a fully competent AV in three patients, in two patient paravalvular leakage was detected at the severity of an aortic regurgitation (AR) II°, and AR II°–III°, respectively. The mean pressure gradients were 5.8 ± 1.3 mmHg (range 4.2–7.1 mmHg), valve orifice area was 3.2 ± 0.4 cm2 (range 2.6–3.6 cm2).Conclusion:The first clinical results of the 3F-Enable sutureless AV prosthesis are feasible; however, a paravalvular leakage was detected in two patients (40%). Thus, device and procedural enhancements are required to assure positioning and anchoring of the prosthesis.

Cardiac Surgery is Safe in Female Patients with a History of Breast Cancer - Focus on Coronary Artery Bypass Grafting and Periprocedural Blood Loss

Objectives: In cardiac surgery candidates, a concomitant history of breast cancer suggests adverse outcomes. Particularly, the possibility of internal mammary artery utilization after (hemi-)thoracic irradiation is frequently discussed. Secondary, blood loss, wound healing and incidence of mediastinitis are important issues. However, publications focusing on these issues are limited. Methods: In a case-control study, we analyzed 46 patients with previously treated breast cancer undergoing cardiac surgery matched to 135 control subjects. Patients were analyzed regarding internal mammary artery (IMA) utilization, blood loss and substitution and frequent perioperative complications as well as long-term mortality. Results: No significant differences between groups were observed regarding duration of surgery, IMA utilization, postoperative infections and mortality. Also, IMA preparation side and number of harvested vessels was independent of the priorly irradiated thoracic field in the breast cancer group. A pronounced decline of hemoglobin/hematocrit was evident within the first 6 postoperative hours (3.3 ± 1.8 versus 2.6 ± 1.8 mg/dl; p = 0.02) in breast cancer patients not related to a signifcantly increased drainage loss but associated with an increase of INR (0.31 ± 0.19 versus 0.21 ± 0.21; p < 0.01). Conclusions: In breast cancer patients, cardiac surgical procedures can safely be performed with comparable short- and long-term results. Extracorporeal circulation strategies should be adapted to compensate for surgery-related blood loss.

Degree of Carotid Artery Stenosis in Neurologically Asymptomatic Cardiac Surgical Patients Suffering from Perioperative Stroke: Results of an Observational Study

Background Postoperative stroke in cardiac surgical patients remains a serious adverse outcome. Methods A total of 2,784 consecutively operated cardiac surgical patients without preoperative neurologic impairment were analyzed retrospectively with regard to impact of preoperative carotid stenosis on the incidence of postprocedural new onset of stroke. Therefore, all analyzed patients were assigned to four groups depending on preoperative degree of carotid artery stenosis detected by carotid duplex sonography (group I: < 50%, group II: 50-75%, group III: 76-89%, and group IV: > 90%). Results All pre-, intra-, and postoperative risk factors for neurological disorders were comparable throughout the cohort. Of the 2,784 patients, 65 (2.3%) met the inclusion criteria (preoperatively neurologically asymptomatic status, preoperatively carotid duplex ultrasonography study not older than 6 months, heart surgery with extracorporeal circulation, stroke until 48 hours after operation). Of the 65 patients who met the inclusion criteria, 43 (66.2%) were in group I, 11 (16.9%) in group II, 5 (7.7%) in group III, and 6 (9.2%) in group IV (p = 0.175). The overall incidence of an ipsilateral stroke relating to the carotid stenosis was 38 (1.4%) patients. Of these, 27 (71.1%) patients were in group I, 6 (15.8%) patients in group II, 2 (5.3%) patients in group III, and 3 (7.9%) patients in group IV (p = 0.568). Conclusion This observational study demonstrates that the degree of carotid stenosis in neurologically asymptomatic cardiac surgical patients is not able to predict the probability of perioperative stroke. Until further results from prospective randomized trials with neurologically asymptomatic cardiac surgical patients are presented, a cautious attitude for concomitant carotid endarterectomy is still justified.

Results of tricuspid valve reconstruction using a semirigid ring or a flexible band

Current concepts for tricuspid valve surgery recommend concomitant tricuspid valve reconstruction (TVR) utilizing annuloplasty devices over simple suture annuloplasty.

Erste klinische Erfahrungen mit der 3FEnable-Aortenklappen-Bioprothese@@@Early Single-Center Experience with the 3F-Enable Aortic Valve Bioprosthesis

ZusammenfassungHintergrund und Ziel:Patienten mit einer operationswürdigen Aortenklappenpathologie und signifikanten Begleiterkrankungen sollten von einer verkürzten intraoperativen Myokardischämiezeit sowie einer reduzierten Zeit an der extrakorporalen Zirkulation (EKZ) profitieren. Mit einer nahtlos zu implantierenden Aortenklappenprothese könnte dieses Ziel erreicht werden. Hier wird über die ersten klinischen Ergebnisse mit der nahtlos zu implantierenden 3F-Enable-Aortenklappenprothese berichtet.Material und Methodik:Die biologische 3F-Enable- Aortenklappenprothese wurde in fünf Patienten implantiert (27 mm: n = 3; 23 mm: n = 1; 21 mm: n = 1). Zur Beurteilung der Funktion der implantierten Aortenklappe wurden intraoperativ, vor Entlassung sowie 3 und 6 Monate postoperativ echokardiographische Untersuchungen durchgeführt.Ergebnisse:Die EKZ-Zeit betrug 87 ± 36 min (Spanne 49–141 min), die Zeit der myokardialen Ischämie 55 ± 27 min (Spanne 32–97 min) und die Klappenimplantationszeit 184 ± 195 s (Spanne 10–420 s). Die letzte postoperative echokardiographische Untersuchung (5,2 ± 1 Monate postoperativ) ergab bei allen Patienten eine kompetente Aortenklappe. Bei zwei Patienten zeigte sich jedoch eine paravaluläre Aortenklappenregurgitation, die zu einer Aortenklappeninsuffizienz II° bzw. II°–III° führte. Die mittleren transvalvulären Klappengradienten lagen bei 5,8 ± 1,3 mmHg (Spanne 4,2–7,1 mmHg), und die Klappenöffnungsfläche wurde planimetrisch mit 3,2 ± 0,4 cm2 (Spanne 2,6–3,6 cm2) bestimmt.Schlussfolgerung:Die ersten klinischen Implantationsergebnisse mit der 3F-Enable-Aortenklappenprothese zeigen, dass die Implantation ohne Nähte möglich ist. Das Auftreten pararavalvulärer Aortenklappenregurgitationen bei zwei Patienten (40%) ist jedoch unbefriedigend. Daher sollten eine Verbesserung des Prothesendesigns bzw. Modifizierungen der Implantationstechnik erfolgen, um die sichere Positionierung bzw. Verankerung der Prothese im nativen Aortenklappenanulus zu gewährleisten.AbstractBackground and Purpose:Patients with aortic valve (AV) pathology and severe comorbidities should benefit from reduced myocardial ischemic and extracorporeal circulation (ECC) time. Sutureless implantation of AV prosthesis may reduce myocardial ischemic and ECC time significantly. The authors report on their preliminary results with the first implants of the 3F-Enable sutureless AV prosthesis.Material and Methods:The 3F-Enable prosthesis was implanted in five patients. Prostheses sizes were 27 mm (n = 3), 23 mm (n = 1), and 21 mm (n = 1), respectively. Intraoperatively, at patient’s discharge as well as 3 and 6 months postoperatively, the AV prosthesis was evaluated by echocardiography.Results:ECC time was 87 ± 36 min (range 49–141 min), myocardial ischemic time 55 ± 27 min (range 32–97 min), and AV implant time 184 ± 195 s (range 10–420 s). The latest postoperative echo (5.2 ± 1 months postoperatively) revealed a fully competent AV in three patients, in two patient paravalvular leakage was detected at the severity of an aortic regurgitation (AR) II°, and AR II°–III°, respectively. The mean pressure gradients were 5.8 ± 1.3 mmHg (range 4.2–7.1 mmHg), valve orifice area was 3.2 ± 0.4 cm2 (range 2.6–3.6 cm2).Conclusion:The first clinical results of the 3F-Enable sutureless AV prosthesis are feasible; however, a paravalvular leakage was detected in two patients (40%). Thus, device and procedural enhancements are required to assure positioning and anchoring of the prosthesis.