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  • 1
    Online Resource
    Online Resource
    Bend relief fenestration might prevent outflow graft obstruction in patients with left ventricular assist device
    Oxford University Press (OUP) ; 2022
    In:  Interactive CardioVascular and Thoracic Surgery Vol. 35, No. 2 ( 2022-07-09)
    Details
    In: Interactive CardioVascular and Thoracic Surgery, Oxford University Press (OUP), Vol. 35, No. 2 ( 2022-07-09)
    Abstract: OBJECTIVES Patients with left ventricular assist devices may experience external obstruction of the outflow graft through a gelatinous substance within the bend relief (BR; a stiff tube graft guiding the outflow graft). Preventative strategies have been missing. Having faced this problem, we decided to fenestrate the BR to avoid outflow graft obstruction (OGO). METHODS Since December 2010, 167 patients underwent left ventricular assist device implantation using HeartMate II or 3. BR fenestration was introduced on July 2018 (108 patients before, 59 after the introduction of BR fenestration). Follow-up computed tomography scans were obtained from all patients and were screened for OGO by 3 independent investigators. Results were correlated with log file history, echocardiographic and clinical outcomes. RESULTS Demographic data were comparable between groups, with mostly male patients. Patients with BR fenestration were older [63 (standard deviation (SD):10.6) vs 58 (SD: 10.7) years] and had shorter support duration [494 (SD: 383) vs 951 (SD: 875) days] . OGO was observed in 5 patients and occurred only in patients without fenestration. Importantly, it occurred late on postoperative Days 412, 462, 1043, 1184 and 1506. Three patients are still asymptomatic. Surgical revision was required in the other 2 patients for pump thrombosis or continuous low flow. One of them died 36 days after revision due to right heart failure. CONCLUSIONS Our results suggest that fenestration of the BR may be a preventative strategy to avoid external OGO. OGO occurred late, which suggests a careful long-term follow-up.
    Type of Medium: Online Resource
    ISSN: 1569-9293 , 1569-9285
    URL: Article
    DOI: 10.1093/icvts/ivac149
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2096257-5
    detail.hit.zdb_id: 3167862-2
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  • 2
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    Cardiac Surgery 2019 Reviewed
    Georg Thieme Verlag KG ; 2020
    In:  The Thoracic and Cardiovascular Surgeon Vol. 68, No. 05 ( 2020-08), p. 363-376
    Details
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 68, No. 05 ( 2020-08), p. 363-376
    Abstract: For the year 2019, almost 25,000 published references can be found in PubMed when entering the search term “cardiac surgery.” We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for article selection and reviewed the main fields of adult cardiac surgery (i.e., coronary, valve, aortic, and heart failure surgery). The past decade has experienced an enormous development of interventional techniques that compete more and more with classic surgery. This contest was broadly visible in 2019. It peaked over the interpretation of the EXCEL trial data, where percutaneous coronary intervention and coronary artery bypass grafting (CABG) for left main disease were compared. A novel pathomechanism for CABG was proposed, potentially answering open questions in the field. In aortic valve surgery, two low-risk trials comparing transcatheter aortic valve implantation (TAVI) to classic aortic valve replacement (surgical aortic valve replacement) received attention for showing equal or superior short-term outcomes for TAVI. Longer follow-up information from recent trials became available presenting results emphasizing the need for joint decision making. While publications addressing surgery on the aorta and the mitral and tricuspid valves were less abundant, there was substantial activity regarding left ventricular assist device support and heart transplantation. This article attempts to summarize the most pertinent publications. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide a condensed summary of 2019s publications with a stimulus for in-depth reading and a basis supporting patient information.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    URL: Article
    DOI: 10.1055/s-0040-1713648
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 3
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    Predictors of Outcome for Aortic Valve Reimplantation Including the Surgeon—A Single-Center Experience
    Georg Thieme Verlag KG ; 2020
    In:  The Thoracic and Cardiovascular Surgeon Vol. 68, No. 07 ( 2020-10), p. 567-574
    Details
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 68, No. 07 ( 2020-10), p. 567-574
    Abstract: Introduction Aortic valve reimplantation is considered technically demanding. We searched for predictors of long-term outcome including the surgeon as risk factor. Methods We selected all aortic valve reimplantations performed in our department between December 1999 and January 2017 and obtained a complete follow-up. The main indications were combined aortic aneurysm plus aortic valve regurgitation (AR), 69% and aortic dissections (15%). In 14%, valves were bicuspid. Cusp repair was performed in 27% of patients. One-third received additional procedures (coronary artery bypass grafting, mitral, or arch surgery). We performed multivariable analyses for independent risk factors of short- and long-term outcomes, including “surgeon” as variable. Twelve different surgeons operated on 193 patients. We created three groups: surgeons A and B with 84 and 64 procedures, respectively, and surgeon C (10 surgeons for 45 patients). Results Cardiopulmonary bypass and clamp times were 176 ± 45 and 130 ± 24 minutes, respectively. In-hospital mortality was 2%. Postoperatively, 5% had mild and 0.5% had moderate AR. Kaplan–Meier's survival estimates, freedom from reoperation, and freedom from severe AR at 12 years were 97 ± 1, 93 ± 2, and 91 ± 3%, respectively. Age and chronic obstructive pulmonary disease appeared as risk factors for perioperative complications by univariate analysis. Age, coronary artery disease, and duration of cardiopulmonary bypass, but not surgeon, presented as risk factors by multivariable analysis. Conclusion The results suggest that if a David procedure is performed successfully, long-term durability may be excellent. They also suggest that good and durable results are possible even with limited experience of the operating surgeon.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    URL: Article
    DOI: 10.1055/s-0038-1675594
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 4
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    Cardiac surgery 2018 reviewed
    Springer Science and Business Media LLC ; 2019
    In:  Clinical Research in Cardiology Vol. 108, No. 9 ( 2019-9), p. 974-989
    Details
    In: Clinical Research in Cardiology, Springer Science and Business Media LLC, Vol. 108, No. 9 ( 2019-9), p. 974-989
    Type of Medium: Online Resource
    ISSN: 1861-0684 , 1861-0692
    URL: Article
    DOI: 10.1007/s00392-019-01470-6
    RVK:
    XA 37040
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2218331-0
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  • 5
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    Minimally-invasive mitral valve repair of symmetric and asymmetric Barlow´s disease
    Springer Science and Business Media LLC ; 2021
    In:  Clinical Research in Cardiology Vol. 110, No. 12 ( 2021-12), p. 1881-1889
    Details
    In: Clinical Research in Cardiology, Springer Science and Business Media LLC, Vol. 110, No. 12 ( 2021-12), p. 1881-1889
    Abstract: Barlow´s disease represents a wide spectrum of mitral valve pathologies associated with regurgitation (MR), excess leaflet tissue, and prolapse. Repair strategies range from complex repairs with annuloplasty plus neochords through resection to annuloplasty-only. The latter requires symmetric prolapse patterns and central regurgitant jets. We aimed to assess repair success and durability, survival, and intraoperative outcomes with symmetric and asymmetric Barlow’s disease. Methods Between 09/10 and 03/20, 103 patients (of 1939 with mitral valve surgery) presented with Barlow´s disease. All received surgery through mini-thoracotomy with annuloplasty plus neochords ( n  = 71) or annuloplasty-only ( n  = 31). One valve was replaced for endocarditis (repair rate: 99%). Results Annuloplasty-only patients were older (64 ± 16 vs. 55 ± 11 years, p  = 0.008) and presented with higher risk (EuroSCORE II: 4.2 ± 4.9 vs. 1.6 ± 1.7, p  = 0.007). Annuloplasty-only patients had shorter cross-clamp times (53 ± 18 min vs. 76 ± 23 min, p   〈  0.001) and received more tricuspid annuloplasty (15.5% vs. 48.4%, p   〈  0.001). Operating times were similar (170 ± 41 min vs. 164 ± 35, p  = 0.455). In three patients, annuloplasty-only caused intraoperative systolic anterior motion (SAM), which was fully resolved by neochords to the posterior leaflet. There were no conversions to sternotomy or deaths at 30-days. Three patients required reoperation for recurrent MR (at 25 days, 2.8 and 7.8 years). At the latest follow-up, there was no MR in 81.4%, mild in 14.7%, and moderate in 2.9%. Three patients died due to non-cardiac reasons. Surviving patients report the absence of relevant symptoms. Conclusions Minimally-invasive Barlow’s repair is safe with good durability. Annuloplasty-only may be a simple solution for complex but symmetric pathologies. However, it may carry an increased risk of intraoperative SAM.
    Type of Medium: Online Resource
    ISSN: 1861-0684 , 1861-0692
    URL: Article
    DOI: 10.1007/s00392-021-01844-9
    RVK:
    XA 37040
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 6
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    Transcatheter Harvest of a Dislocated Sapien Valve With an Inoue Balloon Through the Left Subclavian Artery
    Elsevier BV ; 2012
    In:  Journal of the American College of Cardiology Vol. 59, No. 15 ( 2012-04), p. 1406-
    Details
    In: Journal of the American College of Cardiology, Elsevier BV, Vol. 59, No. 15 ( 2012-04), p. 1406-
    Type of Medium: Online Resource
    ISSN: 0735-1097
    URL: Article
    DOI: 10.1016/j.jacc.2012.01.021
    RVK:
    XA 17760
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2012
    detail.hit.zdb_id: 1468327-1
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  • 7
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    An 86-Year-Old Female with Mitral Regurgitation and Significant Pectus Excavatum
    Georg Thieme Verlag KG ; 2019
    In:  The Thoracic and Cardiovascular Surgeon Reports Vol. 08, No. 01 ( 2019-01), p. e37-e40
    Details
    In: The Thoracic and Cardiovascular Surgeon Reports, Georg Thieme Verlag KG, Vol. 08, No. 01 ( 2019-01), p. e37-e40
    Abstract: Background We report the case of minimally invasive mitral valve repair in an 86-year-old female with symptomatic structural mitral regurgitation and severe pectus excavatum. Case Description The case summarizes four areas of repetitive heart team discussions. First, should an 86-year-old patient still be treated invasively? Second, if so, should treatment be interventional or surgical? Third, if surgical, should we replace or repair at that age and fourth which surgical access is best with respect to her chest deformation? Conclusion We chose to surgically repair the valve using a minimally invasive approach. The patient was extubated 3 hours after surgery and discharged after 7 days.
    Type of Medium: Online Resource
    ISSN: 2194-7635 , 2194-7643
    URL: Article
    DOI: 10.1055/s-0039-1700881
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
    detail.hit.zdb_id: 2706759-2
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  • 8
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    Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience
    Georg Thieme Verlag KG ; 2019
    In:  The Thoracic and Cardiovascular Surgeon Vol. 67, No. 06 ( 2019-09), p. 437-443
    Details
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 67, No. 06 ( 2019-09), p. 437-443
    Abstract: Background Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA. Methods Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36). Results Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire. Conclusions Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    URL: Article
    DOI: 10.1055/s-0038-1670632
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
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  • 9
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    Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis
    Georg Thieme Verlag KG ; 2018
    In:  The Thoracic and Cardiovascular Surgeon Vol. 66, No. 07 ( 2018-10), p. 564-571
    Details
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 66, No. 07 ( 2018-10), p. 564-571
    Abstract: Background Isolated tricuspid valve (TV) surgery is considered a high risk-procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo-MITS) or through sternotomy. Methods We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-MITS (n = 26) and compared them to redo-Sternotomy (n = 17). A group of primary-MITS (n = 61) served as control. Results The redo-MITS approach consisted of a right anterolateral mini-thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo-MITS patients were oldest and had the most comorbidities (EuroScore II: 9.83 ± 6.05% versus redo-Sternotomy: 8.42 ± 7.33% versus primary-MITS: 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo-Sternotomy had the highest 30-day mortality (24%), the poorest long-term survival, and the highest perioperative complication rate. Redo-MITS did not differ in perioperative outcome from primary-MITS. Multivariable logistic regression analysis identified redo-Sternotomy (odds ratio [OR]  = 9.76; 95% confidence interval [CI] 1.88–63.26), liver cirrhosis (OR = 9.88; 95% CI 2.20–54.20), and body mass index (BMI) (OR = 1.16; 95% CI 1.02–1.35) as independent predictors of 30-day mortality. The Cox model revealed redo-Sternotomy (hazard ratio [HR]  = 2.67; 95% CI 1.18–6.03), liver cirrhosis (HR = 3.31; 95% CI 1.45–7.58), and pulmonary hypertension (HR = 2.26; 95% CI 1.04–4.92) as risk factors for poor long-term survival. TV surgery significantly reduces NYHA class. Conclusion Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    URL: Article
    DOI: 10.1055/s-0038-1627452
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2018
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  • 10
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    Right Mini-Thoracotomy for Aortic Plus Mitral with or without Tricuspid Valve Surgery
    Georg Thieme Verlag KG ; 2022
    In:  The Thoracic and Cardiovascular Surgeon Vol. 70, No. 03 ( 2022-04), p. 174-181
    Details
    In: The Thoracic and Cardiovascular Surgeon, Georg Thieme Verlag KG, Vol. 70, No. 03 ( 2022-04), p. 174-181
    Abstract: Objectives Minimally invasive surgery is increasingly performed for isolated aortic or mitral valve procedures. However, combined minimally invasive aortic and mitral valve surgery is rare. We report our initial experience performing multiple valve procedures through a right-sided mini-thoracotomy (RMT) compared with sternotomy. Methods A total of 264 patients underwent aortic and mitral with or without tricuspid valve surgery through RMT (n = 25) or sternotomy (n = 239). Propensity score matching was used for outcome comparisons. Results Of the 264 patients, 25 (age: 72 ± 10 years; 72% male) underwent double (n = 19) and triple valve surgery (n = 6) through RMT and 239 (age: 71 ± 11 years; 54% male) underwent double (n = 176) and triple valve surgery (n = 63) through sternotomy. Sternotomy patients had more co-morbidities and preoperative risk factors (EuroSCORE II 10.25 ± 10.89 vs. RMT 3.58. ± 4.98; p  〈  0.001). RMT procedures were uneventful without intraoperative complications or conversions to sternotomy. After propensity score matching, surgical procedures were comparable between groups with a higher valve repair rate in RMT. Despite longer cardiopulmonary bypass times in RMT, there was no evidence for differences in 30-day mortality (RMT: n = 2 vs. sternotomy: n = 2) and there were no significant differences in other outcomes. During 5-year follow-up, reoperation was required in sternotomy patients only (n = 2). Follow-up echocardiography showed durable results after valve surgery. RMT patients showed higher survival probability compared with sternotomy, although this difference was not significant (hazard ratio = 0.33; 95% confidence interval: 0.06–1.65; p = 0.18). Conclusion Combined aortic plus mitral with or without tricuspid valve surgery can safely be performed through a RMT with a trend toward better mid-term outcomes.
    Type of Medium: Online Resource
    ISSN: 0171-6425 , 1439-1902
    URL: Article
    DOI: 10.1055/s-0040-1721083
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
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