Thomas Rauch

Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation☆

BACKGROUND Cardiopulmonary bypass seems to be a major cause for both intraoperative microemboli and cerebral hypoperfusion. This study investigates high intensive transient signals (HITS) in transcranial Doppler ultrasound (TCD) and serum levels of the neurobiochemical marker protein S-100 in patients who underwent coronary artery bypass operation without cardiopulmonary bypass (off-pump CABG) in comparison with the conventional procedure using cardiopulmonary bypass (CPB). The results are related to the neuropsychologic outcome in both surgical groups. METHODS Forty patients were randomized in 2 groups (20 conventional and 20 off-pump CABG). Neurocognitive status was assessed preoperatively and postoperatively. Venous serum levels of S-100 protein were measured before and after coronary operation, HITS were measured in the middle cerebral artery during the operation. RESULTS The median value of HITS was 394.5 (0 to 2217) in the conventional versus 11 (0 to 50) in the off-pump group, p less than 0.0001. Postoperative S-100 serum levels were: 3.76 (0.13 to 11.2) microg/L (conventional) versus 0.13 (0.04 to 1.01) microg/L (off-pump), p less than 0.0001. Postoperative cognitive testing showed significantly different results with a postoperative impairment of 90% of the patients in the conventional group versus no impairment in the off-pump group. CONCLUSIONS Cognitive impairment seems to be strongly associated to CPB and the occurrence of micro-emboli. The off-pump technique appears to be promising in order to eliminate the source of these neuropyschologic impairments following CABG operation.

Comparison of different anticalcification treatments for stentless bioprostheses

BACKGROUND New anticalcificant treatments have been developed because tissue calcification is a major contributing factor for bioprosthetic valve failure. METHODS Aortic valve leaflet and aortic root tissue samples from stentless bioprostheses treated with No-React (Biocor, Belo Horizonte, Brazil), AOA (Medtronic freestyle, Minneapolis, MN), and BiLinx (St. Jude Medical, St. Paul, MN) were compared to a control group by subcutaneous implantation in 60 male weanling Sprague-Dawley rats. RESULTS Calcium levels were in the range of 0.3 to 2.2 mg/g dry tissue at 3 and 12 weeks in all three treated aortic valve leaflet implants. The BiLinx treatment proved anticalcificant effectiveness on aortic root samples as well. There were statistically significant differences for valve leaflet tissue samples: No-React = AOA < BiLinx < < Control and for aortic root tissue samples: BiLinx < < AOA < Control = No-React. CONCLUSION Calcification of aortic valve leaflets was significantly reduced by all new anticalcificant treatments. Inhibition of cellular calcification (BiLinx) resulted in additional reduction of aortic root calcification. Maximum anticalcificant properties upon both leaflet and aortic root is important as these are considered a functional unit in stentless bioprostheses.

Extracellular matrix gene expression correlates to left ventricular mass index after surgical induction of left ventricular hypertrophy

Abstract The cardiac extracellular matrix (ECM) is a dynamic entity maintaining the structural and functional properties of the myocardium. Little is known about alterations in ECM regulation during controlled induction of compensated left ventricular hypertrophy (LVH) using experimental aortic stenosis.Fifteen growing sheep received supra-coronary banding at an age of 7 ± 1 months whereas 10 age-matched sheep served as the control group (C). Explantation of the hearts was performed 8.3 ± 1 months after banding. Gene sequences for sheep matrix metalloproteinase (MMP)-1,-2,-3,-9 and tissue inhibitors (TIMP)-1,-2,-3 were isolated and cloned. Then mRNA and protein gene expression analyses were performed.Concentric LVH with no evidence of heart failure was diagnosed at explantation. Left ventricular mass index (LVMI) was 150 ± 33 g/m2 (LVH) versus 88 ± 23 (C) and 82 ± 21 (baseline) (p < 0.01 versus LVH). Parallel to LVH there was a significant increase in mRNA and protein expression for MMP-1,-2,-3,-9 and for TIMP-1,-2 whereas there was a significant decrease in TIMP-3 gene expression. A close correlation between changes in LVMI and ECM gene expression was found.Compensated LVH goes along with a significant modification of MMP and TIMP gene expression. Alterations in ECM gene expression may be part of the adaptive process during left ventricular remodeling.

[Patient-adapted valve selection: biological vs. mechanical heart valve replacement in aortic valve diseases].

Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced.In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented.Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12–15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited. Die operative Versorgung von Aortenklappenvitien durch Ersatz der nativen Klappe mit einer Herzklappenprothese hat sich seit der ersten Operation im Jahre 1960 durch Harken zu einer der am häufigsten durchgeführten Eingriffe in der Herzchirurgie entwickelt. Für den Klappenersatz stehen biologische (Xenografts und Homografts) und mechanische Herzklappenprothesen zur Verfügung. Bei der Auswahl der geeigneten Prothese muss zwischen der eingeschränkten Haltbarkeit einer Bioprothese und dem Risiko der lebenslangen Antikoagulation bei einer mechanischen Prothese abgewogen werden. In dem vorliegenden Artikel wird zunächst die Operationsindikation bei Aortenklappenstenose und Aortenklappeninsuffizienz diskutiert. Anhand von Ergebnissen aus der Literatur der letzten 2 Jahre werden die Vor- und Nachteile der mechanischen und biologischen Herzklappenprothesen (Xenograft, Homograft und ROSS-Operation) erörtert. Zusätzlich werden seltener eingesetzte Verfahren wie die Aortenklappenrekonstruktion beleuchtet. Bei der Haltbarkeit biologischer Herzklappenprothesen von etwa 12–15 Jahren und einem steigenden Risiko für Blutungskomplikationen unter Antikoagulation mit zunehplötzlimendem Lebensalter ist die Wahl einer Bioprothese etwa ab dem 65. Lebensjahr empfehlenswert. Ob diese Grenze durch den Einsatz gerüstfreier Bioprothesen herabgesetzt werden kann, bleibt abzuwarten, bis Ergebnisse von Langzeitstudien dieser Klappen vorliegen.Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.

Patientenadaptierte Klappenselektion: biologischer vs. mechanischer Herzklappenersatz bei Aortenklappenvitien

Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced.In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented.Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12–15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited. Die operative Versorgung von Aortenklappenvitien durch Ersatz der nativen Klappe mit einer Herzklappenprothese hat sich seit der ersten Operation im Jahre 1960 durch Harken zu einer der am häufigsten durchgeführten Eingriffe in der Herzchirurgie entwickelt. Für den Klappenersatz stehen biologische (Xenografts und Homografts) und mechanische Herzklappenprothesen zur Verfügung. Bei der Auswahl der geeigneten Prothese muss zwischen der eingeschränkten Haltbarkeit einer Bioprothese und dem Risiko der lebenslangen Antikoagulation bei einer mechanischen Prothese abgewogen werden. In dem vorliegenden Artikel wird zunächst die Operationsindikation bei Aortenklappenstenose und Aortenklappeninsuffizienz diskutiert. Anhand von Ergebnissen aus der Literatur der letzten 2 Jahre werden die Vor- und Nachteile der mechanischen und biologischen Herzklappenprothesen (Xenograft, Homograft und ROSS-Operation) erörtert. Zusätzlich werden seltener eingesetzte Verfahren wie die Aortenklappenrekonstruktion beleuchtet. Bei der Haltbarkeit biologischer Herzklappenprothesen von etwa 12–15 Jahren und einem steigenden Risiko für Blutungskomplikationen unter Antikoagulation mit zunehplötzlimendem Lebensalter ist die Wahl einer Bioprothese etwa ab dem 65. Lebensjahr empfehlenswert. Ob diese Grenze durch den Einsatz gerüstfreier Bioprothesen herabgesetzt werden kann, bleibt abzuwarten, bis Ergebnisse von Langzeitstudien dieser Klappen vorliegen.Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.

Patientenadaptierte Klappenselektion: biologischer vs. mechanischer Herzklappenersatz bei Aortenklappenvitien@@@Patient adapted valve selection: biological vs. mechanical heart valve replacement in aortic valve diseases

Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced.In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented.Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12–15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited. Die operative Versorgung von Aortenklappenvitien durch Ersatz der nativen Klappe mit einer Herzklappenprothese hat sich seit der ersten Operation im Jahre 1960 durch Harken zu einer der am häufigsten durchgeführten Eingriffe in der Herzchirurgie entwickelt. Für den Klappenersatz stehen biologische (Xenografts und Homografts) und mechanische Herzklappenprothesen zur Verfügung. Bei der Auswahl der geeigneten Prothese muss zwischen der eingeschränkten Haltbarkeit einer Bioprothese und dem Risiko der lebenslangen Antikoagulation bei einer mechanischen Prothese abgewogen werden. In dem vorliegenden Artikel wird zunächst die Operationsindikation bei Aortenklappenstenose und Aortenklappeninsuffizienz diskutiert. Anhand von Ergebnissen aus der Literatur der letzten 2 Jahre werden die Vor- und Nachteile der mechanischen und biologischen Herzklappenprothesen (Xenograft, Homograft und ROSS-Operation) erörtert. Zusätzlich werden seltener eingesetzte Verfahren wie die Aortenklappenrekonstruktion beleuchtet. Bei der Haltbarkeit biologischer Herzklappenprothesen von etwa 12–15 Jahren und einem steigenden Risiko für Blutungskomplikationen unter Antikoagulation mit zunehplötzlimendem Lebensalter ist die Wahl einer Bioprothese etwa ab dem 65. Lebensjahr empfehlenswert. Ob diese Grenze durch den Einsatz gerüstfreier Bioprothesen herabgesetzt werden kann, bleibt abzuwarten, bis Ergebnisse von Langzeitstudien dieser Klappen vorliegen.Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced. In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented. Due to the fact that a biological prosthesis has a durability of 12-15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.