Implementation of the aortic no-touch technique to reduce stroke after off-pump coronary surgery.

Objectives: Despite substantial scientific effort, the relationship between stroke after coronary artery bypass grafting and the use of the aortic no-touch off-pump technique (anOPCAB) remains incompletely understood. The present study aimed to define the effect of anOPCAB on the occurrence and time point of stroke.

Methods: A total cohort of 15,042 consecutive patients underwent surgical myocardial revascularization at a single institution.

Current indications for stentless aortic bioprostheses.

The best aortic prostheses have been debated for decades. The introduction of stentless aortic bioprostheses was aimed at improving hemodynamics and potentially the durability of aortic bioprostheses. Despite the good short- and long-term outcomes after implantation of stentless aortic bioprostheses, their use remains limited owing to the technically demanding implantation techniques.

Stentless Bioprostheses for Aortic Valve Replacement in Octogenarians: The Influence of Coronary Artery Disease.

Background: We sought to determine the long-term results of stentless biological heart valve replacement in octogenarians to find out whether coronary artery disease or the coronary artery bypass grafting (CABG) procedure itself influences survival in these aged patients.

Methods: From 4,012 patients undergoing aortic valve replacement (AVR) with a stentless prosthesis (Freestyle, Medtronic) at a single center, 721 patients were older than 80 years. They had a mean age of 83 ±  2 (2,320 patient years), the male/female ratio was 42:58, NYHA (New York Heart Association) class I and II was prevalent in 22.

Freestyle stentless bioprosthesis for aortic valve therapy: 17-year clinical results.

Background: Aortic valve replacement with stentless bioprostheses has been shown to produce lower aortic gradients than stented bioprostheses, thus facilitating left ventricular mass regression and preventing heart failure. We sought to determine the long-term results of stentless biological aortic valve replacement over a 17-year follow-up.

Methods: Between 1996 and 2012, 2551 patients underwent isolated aortic valve replacement with a stentless prosthesis (Medtronic Freestyle) at a single center.

Are aortic valve reoperations after primary replacement with stentless heart valve prostheses more demanding than after stented biological prostheses?

Objective: Reoperations after aortic valve replacement (AVR) with stentless valve prostheses are believed to be surgically more difficult than after stented prostheses.

Methods: Between January 1996 and December 2006, 1,340 of 3,785 patients with AVR in a single institution received a stentless valve prosthesis in aortic position (Medtronic Freestyle, Medtronic GmbH, Meerbusch, Germany). Reoperations after stentless AVR occurred in 27 patients (2.

The history of the management of sternal osteomyelitis and mediastinitis - from Hippocrates until today.

Even during the time of Hippocrates, Galen and their colleagues recognized mediastinal affections. However, they were not considered with the surgical treatment. First progress in the treatment options of this severe disease, still denoted as 'terra incognita', over to today's gold standard are pictured.

Revascularization surgery as a treatment concept for heart failure.

Patients with heart failure symptoms due to ischemic cardiomyopathy face a poor prognosis without adequate treatment. In these patients with viable ischemic myocardium, revascularization surgery is not a new but an established treatment concept. the CASS study, published in 1983, was already able to document the superiority of coronary artery revascularization in patients with poor left ventricular function.

Stentless aortic valves. Current aspects.

The design of stentless valve prostheses is intended to achieve a more physiological flow pattern and superior hemodynamics in comparison to stented valves. First - generation stentless bioprosthesis were the Prima valve, the Freestyle valve and the Toronto stentless porcine valve. The second generation of stentless valves, as the Super stentless aortic porcine valve, need only one suture line.

Management of sterno-mediastinitis.

With an incidence rate of 1-4%, mediastinitis following cardiac surgery is a rarely occurring complication, but may show a mortality rate of up to 50%. Risk factors for sternal instability are insulin-dependent diabetes mellitus, obesity, immunosuppressed state, chronic obstructive pulmonary disease, osteoporosis, history of radiation, renal failure, body height, smoking and nutritional state. The aim of this paper is to show an overview of this clinical picture, present the risk factors and elucidate the therapy options chronologically.

Coronary artery surgery: now and in the next decade.

In coronary artery surgery the superiority of the internal mammary artery graft in 10-year survival was documented in 1986. In 1999 it was demonstrated that death, reoperation and percutaneous transluminary coronary angioplasty were more frequent in patients undergoing single rather than bilateral internal mammary artery grafting. Today coronary artery bypass grafting surgery is challenged by the success story of modern interventional cardiology.

[Examination of the opportunity costs and turnover situation in patients with deep sternal infections].

Background: Each and every hospital of any kind is forced, due to increased cost pressure, to work as economically and as efficiently as possible. This even applies when the operational orientations of the hospitals institutions are different. In the present article an analysis of the repercussions of the treatment of postoperative complications in terms of entrepreneurial practice is given.

Midterm outcome after aortic root replacement with stentless porcine bioprostheses.

Objective: Midterm clinical outcome was evaluated after aortic root replacement with Freestyle® stentless aortic root bioprostheses.

Methods: Between April 1996 and December 2007, 301 patients underwent aortic valve replacement with stentless Medtronic Freestyle® bioprostheses in full-root technique at a single center. Concomitant coronary artery bypass grafting (CABG) was required in 96 patients (32%).

In search of a standardized treatment for poststernotomy mediastinitis.

Poststernotomy mediastinitis following median sternotomy procedures such as open heart surgery is a rare complication which nevertheless has a mortality rate of up to 50 %. Several treatment options are currently available; however, none of them are standardized. Based on the experience gained from open heart surgery performed at the MediClin Heart Institute Lahr/Baden, a therapeutic algorithm was developed.

Female gender does not increase perioperative risk in coronary bypass surgery.

Introduction: Female gender has been identified as an independent risk factor for perioperative mortality in several risk scores for cardiac surgery. Since no explanation has been given for this, this study aimed to evaluate potential differences in the distribution of other risk factors between the genders.

Patients And Methods: 10 714 consecutive coronary bypass patients were analyzed retrospectively.

Short term outcomes of total arterial coronary revascularization in patients above 65 years: a propensity score analysis.

Background: Despite the advantages of bilateral mammary coronary revascularization, many surgeons are still restricting this technique to the young patients. The objective of this study is to demonstrate the safety and potential advantages of bilateral mammary coronary revascularization in patients older than 65 years.

Methods: Group I included 415 patients older than 65 years with exclusively bilateral mammary revascularization.

Aortic valve replacement in octogenarians: identification of high-risk patients.

Objective: This study identifies high-risk octogenarians for surgical aortic valve replacement (AVR) because with the current advances in transcatheter valve therapy, a definition of patient selection criteria is essential.

Methods: Between 1996 and 2006, 493 consecutive octogenarians with symptomatic aortic stenosis underwent AVR with and without (51%) concomitant coronary artery bypass grafting (CABG). To identify high-risk patient groups, risk factors of 6-month mortality were determined using multivariable logistic regression.

[Transparency of medical quality data. Ethical obligation to deliver or instrument to create unfair competitive advantage?].

Annually about 100,000 acute cardiac deaths occur in Germany. For this reason, there is the obvious need, from a public health perspective, to inform the population about possible measures of their prevention and treatment. Ultimately every patient or admission referring doctor can be thought of as a recipient of "marketing".

Impact of gender on outcome after coronary artery bypass surgery.

Following recent studies concerning the increased risk of coronary artery bypass surgery for women, the impact of sex is still a controversial issue. Between 1996 and 2006, 9,527 men and 3,079 women underwent isolated coronary artery bypass in our institute. To adjust for dissimilarities in preoperative risk profiles, propensity score-based matching was applied.

Preoperative platelet inhibition with ASA does not influence postoperative blood loss following coronary artery bypass grafting.

Introduction: Platelet inhibition is thought to increase perioperative blood loss in patients with planned coronary artery bypass grafting (CABG). This retrospective study reviews the results of over 10 000 patients with CABG, comparing continued platelet inhibition with preoperative disruption of this therapy.

Patients And Methods: From 1995 to 2007, 12 023 patients underwent isolated CABG and were included in this study.

The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis--a single center experience with 54 patients.

Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT) followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy.

The Freestyle stentless bioprosthesis in more than 1000 patients: a single-center experience over 10 years.

Background And Aim: Early and mid-term clinical outcomes after aortic valve replacement (AVR) with stentless bioprostheses in a large cohort of patients are presented.

Methods: Between April 1996 and November 2005, 1014 patients underwent AVR with the stentless Medtronic Freestyle bioprosthesis, with 168 using the full-root technique. The mean age was 73+/-3 (range: 20 to 90) years.

Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis.

In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal wound infections.

Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacement.

Background: The impact of valve prosthesis-patient mismatch on long-term outcome after aortic valve replacement estimated by various variables such as projected indexed effective orifice area and internal geometric orifice area obtained from in vivo or in vitro published data is still controversial.

Methods: The effective orifice area was measured by echocardiography in 533 patients. The mean age of the patients was 71 +/- 9 years; mean follow-up time was 4.

Ten-year experience with stentless aortic valves: full-root versus subcoronary implantation.

Background: We compared the midterm outcome after aortic valve replacement with the Freestyle stentless bioprosthesis for the full-root or subcoronary implantation technique, while adjusting for patient and disease characteristics by a propensity score.

Methods: Between 1996 and 2005, 1,014 patients underwent aortic valve replacement with the stentless Medtronic Freestyle bioprosthesis, 168 using full-root technique. Based on a saturated propensity score, 148 matched pairs were created.