Insertion of the intraaortic balloon pump via the ascending aorta or the aortic arch using the HEARTSTRING Proximal Seal System.

Purpose: The HEARTSTRING Proximal Seal System is used to avoid aortic clamping to insert the intraaortic balloon pump (IABP) in the ascending aorta or the aortic arch. This technique is used when calcification or atheroma prevents side clamping of the ascending aorta or the aortic arch.

Description: A vein graft or a small-caliber vascular prosthesis for the later insertion of the IABP is sewn to the ascending aorta or the aortic arch using the HEARTSTRING Proximal Seal System.

Sternal closure after median sternotomy: a new technique using titanium hooks and wires applied parasternally.

Objectives: Osteosynthetic closure of the chest after median sternotomy is usually performed with steel wires. We describe, for the first time, a case series in which titanium hooks were implanted from the sternal surface in patients who required secondary or additional stabilization. In comparison to the classic wires, the diameters of the hooks are approximately three times bigger and therefore reduce the risk of cutting through the bones.

Homografts in aortic position: does blood group incompatibility have an impact on patient outcomes?

Objectives: Aortic homografts are an alternative to mechanical or biological valve prostheses. Homografts are generally not transplanted ABO-compatible while this policy is still under debate. The purpose of this study was to investigate whether ABO compatibility impacts on long-term outcomes or not.

Outcome after homograft redo operation in aortic position.

Objective: Since 1992, homografts have been implanted in our institution. After initial sub-coronary implantation of the homograft, our preferred technique for aortic-valve replacement with homografts became root replacement, which poses a surgical challenge whenever redo procedures are necessary. The aim of the present study was to evaluate the outcome after homograft redo surgery, based on prospective data from the biggest patient cohort in Germany for this procedure.

Pulmonary homografts for aortic valve replacement: long-term comparison with aortic grafts.

Objective: The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.

Methods: Since 1992, 366 adult patients have undergone AVR with homografts at our center.

Early and mid term mortality after coronary artery bypass grafting in women depends on the surgical protocol: retrospective analysis of 3441 on- and off-pump coronary artery bypass grafting procedures.

Background: Since 2002 MI and stroke, not cancer, are leading causes of death in women. We studied 30-days and 1 year mortality of 3441 patients undergoing coronary artery bypass grafting (CABG) operations in our institution performed either conventionally or off pump (OPCAB). Our objective was to investigate the gender-related mortality in both groups.

Mid-term outcomes of patients with PCI prior to CABG in comparison to patients with primary CABG.

The number of percutaneous coronary interventions (PCI) prior to coronary artery bypass grafting (CABG) increased drastically during the last decade. Patients are referred for CABG with more severe coronary pathology, which may influence postoperative outcome. Outcomes of 200 CABG patients, collected consecutively in an observational study, were compared (mean follow-up: 5 years).

Homograft implantation for aortic valve replacement since 15 years: results and follow-up.

Background: The use of homografts in aortic valve replacement is an alternative to other prostheses and has been established in our department for 15 years.

Methods: Since 1992, 360 homografts (HG) have been implanted in adult patients (mean age 51.6 years, 72.

Intraoperative angiography after coronary bypass grafting in a patient presenting with a single coronary artery: a case report.

Among coronary artery anomalies, single coronary artery is one of the rarest anomalies. Pulmonary origins of the coronary arteries, coronary artery fistulae, and anomalous aortic origins of the coronary arteries are the most common anomalies requiring surgical intervention. In this case, we describe the performance of bypass grafting after unsuccessful attempts at percutaneous coronary intervention in a 72-year old male patient with single coronary artery arising from the right sinus of Valsalva and with associated diffuse coronary atherosclerosis.

Myocardial transfection of hypoxia inducible factor-1alpha via an adenoviral vector during coronary artery bypass grafting. - A multicenter phase I and safety study -.

Background: Increasing numbers of patients with advanced coronary artery disease have limited options for percutaneous and/or surgical revascularization. A prospective, randomized, phase I clinical multicenter trial was performed to assess the feasibility and safety of delivering a pro-angiogenic transcription factor termed "hypoxia inducible factor-1alpha", delivered to ischemic cardiac muscle via a type 2 adenoviral (Ad2HIF) vector.

Methods And Results: The 13 patients were included under the following criteria: 1 hypoperfused area of viable ventricular muscle without options for revascularization and left ventricular ejection fraction > or =30%.

Adeno-associated virus-mediated gene transfer in a rabbit vein graft model.

Background: Stenoses of venous grafts represent a major limitation in coronary artery bypass surgery. The use of viral vectors to facilitate over-expression of factors within the graft to promote long-term patency is a promising new therapeutic concept. One of the viral vector systems is the adeno-associated virus (AAV); a non-pathogenic single stranded DNA virus, which elicits only low immunological responses.

Assessment and characterization of time-related differences in plaque composition by intravascular ultrasound-derived radiofrequency analysis in heart transplant recipients.

Background: The survival of heart transplant patients is limited by cardiac allograft vasculopathy (CAV). Intravascular ultrasound (IVUS) and IVUS-derived radiofrequency plaque composition analysis (IVUS-RF) provide further information about the process of coronary atherosclerosis.

Methods: In this study we aimed to assess the time-dependent differences in disease progression in patients with CAV.

Assessment of early atherosclerosis in de novo heart transplant recipients: analysis with intravascular ultrasound-derived radiofrequency analysis.

Background: Cardiac allograft vasculopathy (CAV) is the major limitation in survival of patients after heart transplantation. Cardiac allograft vasculopathy is angiographically silent in the early phase after operation. Intravascular ultrasound (IVUS) is a more sensitive method to detect the early stages of CAV and provides information about its development.

Outcome after aortic valve replacement: comparison of homografts with mechanical prostheses.

Background And Aim Of The Study: Aortic valve replacement (AVR) in younger patients is conventionally performed using a mechanical prosthesis (MP), although homograft (HG) implantation is an accepted alternative. This study compares, retrospectively, the follow up of these two dissimilar prostheses.

Methods: Since 1990, a total of 147 Sorin Bicarbon MPs and 285 HGs have been implanted at the authors' institution, and compared statistically for survival, reoperation rate and valve-dependent complications.

Ten years' experience in aortic valve replacement with homografts in 389 cases.

Background And Aim Of The Study: Aortic valve replacement using homografts is an accepted alternative to the use of other replacement devices, and has been established at the authors' institution for more than 10 years.

Methods: Since 1992, a total of 389 homografts was implanted, and 332 patients (mean age 54 years, 72% males) were followed up. The initial patients (n = 75) had subcoronary implantation, all subsequent patients had root replacement.

Is there an advantage in using homografts in patients with acute infective endocarditis of the aortic valve?

Background And Aim Of The Study: Acute infective endocarditis is a surgical challenge, particularly when paravalvular abscesses and annular destruction are present. The choice of a homograft or mechanical valve prosthesis is an important issue in these patients. The study aim was to compare the outcome with homografts and mechanical valves in patients with acute infective endocarditis.