Cumulative sum failure analysis for eight surgeons performing minimally invasive direct coronary artery bypass.

Objective: Analysis of average and individual surgical performance for minimally invasive direct coronary artery bypass was used to enhance quality control for that operation.

Methods: A total of 1441 standard minimally invasive direct coronary artery bypass procedures performed from August 1996 to January 2006 were analyzed for mortality and 10 other major perioperative complications. Learning curves and assessment of perioperative outcome were calculated using descriptive statistics and cumulative sum observed minus expected failure analysis for 8 involved surgeons with a personal experience ranging from 27 to 443 procedures.

Influence of Tg, viscosity and chemical structure of monomers on shrinkage stress in light-cured dimethacrylate-based dental resins.

Objectives: The aim of this study was to investigate the influence of the molecular mobility and the chemical structure of dimethacrylates most commonly used in dental composites on shrinkage stress from experimental matrices.

Methods: Three established neat monomers BisGMA (B), UEDMA (U) and TEGDMA (T), two experimental comonomers BisGMA-based (B-T(70/30) and B-T(50/50)) and two comonomers UEDMA-based (U-T(88/11) and U-T(66/33)) in weight%, were elaborated. Camphorquinone (CQ) and N,N-cyanoethylmethylaniline (CEMA), as photoinitiator and reducing agent, were added.

Surgical experience with 77 primary cardiac tumors.

Background: To assess the prognosis and to develop management strategies for primary cardiac tumors all patients were included in an ongoing study.

Method: From Oct. 1994 until December 2003 we prospectively evaluated all patients with cardiac tumors.

Stentless versus conventional xenograft aortic valve replacement: midterm results of a prospectively randomized trial.

Background: The purpose of this study was to analyze the 5- to 8-year clinical results after prospectively randomized stentless versus conventional aortic valve replacement.

Methods: Two hundred twenty-three patients received stentless (Freestyle or Toronto, n = 127) or conventional stented (CE porcine, n = 96) xenograft aortic valve replacement between March 1996 and March 1999 using a prospectively randomized protocol and were discharged from the hospital. Patient age at operation was 71.

Valve-in-a-valve concept for transcatheter minimally invasive repeat xenograft implantation.

Objectives: This study sought to evaluate the feasibility of minimally invasive transapical repeat valve-in-a-valve (VinV) implantation.

Background: Reoperative heart valve replacement for degenerated xenografts is associated with an increased surgical risk.

Methods: Conventional Carpentier Edwards porcine aortic (n = 5) and mitral (n = 2) valve prostheses were implanted in 7 pigs.

Granular flows in a rotating drum: the scaling law between velocity and thickness of the flow.

The flow of dry granular material in a half-filled rotating drum is studied. The thickness of the flowing zone is measured for several rotation speeds, drum sizes and beads sizes (size ratio between drum and beads ranging from 47 to 7400). Varying the rotation speed, a scaling law linking mean velocity vs.

Acute type A dissection at 17 weeks of gestation in a Marfan patient.

A 29-year-old Marfan patient at 17 weeks of gestation was diagnosed with acute type A aortic dissection and severe aortic regurgitation. Aortic valve and aortic arch replacement was successfully performed under circulatory arrest with deep hypothermia. At 34 weeks of gestation, the patient underwent a cesarean section and delivered a healthy baby.

Anastomotic devices for coronary artery bypass grafting: technological options and potential pitfalls.

With the advent of off-pump coronary artery bypass grafting and minimally invasive coronary artery bypass grafting, significant efforts have been made to facilitate construction of the graft to coronary anastomosis. As a result, a number of anastomotic devices have been developed. While the ideal anastomotic device should be easy to use, to produce a geometrically optimal anastomosis with minimal endothelial damage and minimal blood-exposed non-intimal surface, a number of design constraints apply.

Perspectives in endoscopic cardiac surgery.

Surgical telemanipulators are obviously used in cardiac surgery to provide the surgeon in a confined space the same stereoscopic vision, full dexterity, unimpaired hand-eye alignment and tactile feedback as in open surgery. This is the basic concept that enables the controlled fine soft tissue manipulation that is needed in bypass grafting and valve surgery. In 2005, a total of 2984 cardiac procedures were performed worldwide using the da Vinci system.

Seven-year follow-up after minimally invasive direct coronary artery bypass: experience with more than 1300 patients.

Background: Minimally invasive direct coronary artery bypass (MIDCAB) for revascularization of the left anterior descending artery has become a routine operation. Here we present the experience after more than 1300 MIDCAB procedures with up to 7 years of follow-up.

Methods: All patients undergoing standard MIDCAB between 1996 and 2004 were included.

Minimally invasive transapical beating heart aortic valve implantation--proof of concept.

Objective: To evaluate the feasibility of minimally invasive transapical beating heart aortic valve implantation (TAP-AVI) for high-risk patients with aortic stenosis.

Methods: TAP-AVI was performed via a small anterolateral minithoracotomy with or without femoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Cribier-Edwards, Edwards Lifesciences, Irvine, CA, USA) was used.

Reverse remodeling of cardiac collagen protein expression after surgical therapy for experimental aortic stenosis.

Background And Aim Of The Study: Reversal of myocardial collagen gene expression was examined in parallel to left ventricular reverse remodeling after surgical correction of experimental aortic stenosis.

Methods: A standard growing sheep model (age at baseline 6-8 months) was used. Measurements were performed at baseline (point A) when inducing left ventricular hypertrophy (LVH) through supracoronary banding, at 8.

[Off-pump coronary artery bypass grafting. State of the art 2006 and results in comparison with conventional coronary artery bypass strategies].

Adverse clinical consequences associated with conventional coronary artery bypass surgery (CCAB) have largely been attributed to cardiopulmonary bypass circuit (CPB), hypothermic cardiac arrest, aortic cannulation, and cross-clamping. Consequently, there has been a growing interest in safer alternatives to CCAB including off-pump beating-heart bypass surgery (OPCAB). Initial concerns regarding completeness of revascularization at the lateral wall were addressed by using modern stabilizers and heart positioning devices.

Emergency coronary artery bypass graft surgery for acute coronary syndrome: beating heart versus conventional cardioplegic cardiac arrest strategies.

Background: Aim of this study was to compare the outcome of beating heart versus conventional coronary artery bypass graft (CABG) strategies in acute coronary syndromes for emergency indications.

Methods And Results: 638 consecutive patients with acute coronary syndrome (ACS) receiving emergency CABG surgery via midline sternotomy from January 2000 to September 2005 were evaluated. Propensity score analysis was used to predict the probability of undergoing beating heart (BH) (n=240) versus cardioplegic cardiac arrest (CA) (n=398) strategies.

Modeling of temperature mapping for quantitative dynamic infrared coronary angiography for intraoperative graft patency control.

Objectives: Intraoperative application of thermal coronary angiography based on dynamic infrared imaging leads to useful qualitative information concerning coronary artery bypass graft flow and anatomy. Additional quantitative flow estimation is desirable to detect graft failures. The aim of this study was to develop a heat-transfer model for quantitative flow estimation in an experimental setup.

Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement.

Objective: The aim of this study was to evaluate the impact of patient prosthesis mismatch (PPM) and additional risk factors on outcome after aortic valve replacement (AVR).

Methods: Four thousand one hundred and thirty-one patients who were operated between May 1996 and April 2004 were evaluated. One thousand eight hundred and fifty-six patients received bileaflet mechanical AVR and 2275 stented xenograft AVR.

Minimally invasive surgery for valve disease.

Heart valve surgery evolved since the early 1960s toward routine clinical application with good patient outcome. Different surgical techniques and valve prostheses have been developed. Thus standard procedures were continuously established.

Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery.

Background: The role of Swan-Ganz catheterization for cardiac surgery and perioperative management has recently been scrutinized.

Methods: Prospective observational study for serious complications related to Swan-Ganz catheterization. 7150 patients undergoing cardiac operations at a major European heart center and academic setting.

Stentless mitral valve replacement by conventional and minimally invasive techniques.

Stentless mitral valve (SMV) replacement is an intriguing concept to preserve the functionality of the physiological mitral valve (MV). Beginning in August 1997 to date, 51 patients, 35 females and 16 males (age: 68.3+/-8.

Augmented reality for intraoperative guidance in endoscopic coronary artery bypass grafting.

Endoscopic bypass grafting can be complicated by limited intraoperative orientation. A method to overlay the preoperative model of the coronary tree on the live endoscopic images of the heart was therefore developed. The method is three-fold: (1) the three-dimensional (3D) model of the coronary tree is reconstructed from traditional angiograms; (2) preoperative images are registered with the intraoperative position of the patient in the operating room (OR); and (3) an iterative and interactive identification of clinically relevant landmarks within the operative field on the heart surface before their registration with the preoperative model of the coronaries.

Stentless mitral valve implantation in comparison to conventional mitral valve repair or replacement at five years.

Objective: A chordally supported stentless mitral valve (SMV) may be a suitable prosthesis for patients with severe degenerative mitral valve disease. We analyzed the five-year results and compared them with results after conventional mitral valve repair or replacement.

Methods: 155 patients, operated on since August 1997, were evaluated.

Surgical PACS for the digital operating room. Systems engineering and specification of user requirements.

For better integration of surgical assist systems into the operating room, a common communication and processing plattform that is based on the users needs is needed. The development of such a system, a Surgical Picture Aquisition and Communication System (S-PACS), according the systems engineering cycle is oulined in this paper. The first two steps (concept and specification) for the engineering of the S-PACS are discussed.

Closed-chest, robotically assisted CABG.

Total endoscopic coronary artery bypass grafting is a robotic assisted procedure to graft the left internal thoracic artery to the left anterior descending coronary artery without opening the chest. Through four 1-cm port incisions the procedure can be performed on the beating heart using a telemanipulation system and an endoscopic vacuum stabilizer to locally immobilize the heart.

Six-month angiographic follow-up of the PAS-Port II clinical trial.

Background: The PAS-Port device (Cardica, Redwood City, CA) allows the rapid deployment of a clampless proximal anastomosis between a vein graft and the aorta.

Methods: Fifty-four patients awaiting elective coronary artery bypass graft surgery were enrolled. Outcome variables were intraoperative device performance, early and 6- month angiographic graft patency, and 12-month clinical follow-up.