Partial versus Complete Sternotomy for Aortic Valve Replacement-Multicenter Study.

Background:  The benefits of minimally invasive techniques in cardiac surgery remain poorly defined. We evaluated the short- and mid-term outcomes after surgical aortic valve replacement through partial upper versus complete median sternotomy (MS) in a large, German multicenter cohort.

Methods:  A total of 2,929 patients underwent isolated surgical aortic valve replacement via partial upper sternotomy (PUS,  = 1,764) or MS ( = 1,165) at nine participating heart centers between 2016 and 2020.

Living Longer or Better-Patient's Choice in Cardiac Surgery Is Gender-Dependent-A Multicenter Study.

In view of the increasing age of cardiac surgery patients, questions arise about the expected postoperative quality of life and the hoped-for prolonged life expectancy. Little is known so far about how these, respectively, are weighted by the patients concerned. This study aims to obtain information on the patients' preferences.

Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry.

Objectives: Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration.

Methods: Data provided by 10 German heart centers underwent propensity score-matched retrospective analysis.

Impact of pre-existing comorbidities on outcomes of patients undergoing surgical aortic valve replacement - rationale and design of the international IMPACT registry.

Background: Degenerative aortic valve disease accounts for 10-20% of all cardiac surgical procedures. The impact of pre-existing comorbidities on the outcome of patients undergoing surgical aortic valve replacement (SAVR) needs further research.

Methods: The IMPACT registry is a non-interventional, prospective, open-label, multicenter, international registry with a follow-up of 5 years to assess the impact of pre-existing comorbidities of patients undergoing SAVR with the INSPIRIS RESILIA aortic valve on outcomes.

CT-derived left ventricular global strain in aortic valve stenosis patients: A comparative analysis pre and post transcatheter aortic valve implantation.

Introduction: We assessed the potential of CT strain to detect changes in myocardial function in patients referred for TAVI pre and post intervention.

Patients And Methods: 25 consecutive patients with symptomatic aortic valve stenosis in whom TAVI had been performed were included in this analysis. Functional CT data sets acquired before and 3 to 6 months after TAVI were available.

Leaflet thrombosis following transcatheter aortic valve implantation.

Background: Transcatheter aortic valve implantation (TAVI) is increasingly being offered to high-risk patients with symptomatic aortic valve stenosis. Recent reports have suggested a high incidence of subclinical leaflet thrombosis following bioprosthestic aortic valve replacement. We report the frequency and clinical presentation of leaflet thrombosis identified by cardiac CT in patients referred for follow-up contrast enhanced CT angiography following TAVI.

A European Multicenter Study of 616 Patients Receiving the Freedom Solo Stentless Bioprosthesis.

Background: The purpose of this study was to evaluate the safety and performance of the Freedom Solo valve in aortic valve replacement by clinical and hemodynamic outcomes.

Methods: Six hundred sixteen patients underwent aortic valve replacement in 18 European centers; mean age was 74.5 ± 5.

Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses.

Introduction: The geometry of the aortic annulus and implanted transcatheter aortic valve prosthesis might influence valve function. We investigated the influence of valve type and aortic valve calcification on post-implant geometry of catheter-based aortic valve prostheses.

Methods: Eighty consecutive patients with severe aortic valve stenosis (mean age 82 ± 6 years) underwent computed tomography before and after TAVI.

Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Background: Epicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation.

Impact of medical treatment on long-term results after surgical ablation of atrial fibrillation in cardiac surgical patients.

Background: The aim of this study was to evaluate the long-term outcome (4 years) of high-intensity-focused-ultrasound (HIFU) cardiac ablation, the significance of postablation antiarrhythmic drugs (AADs) and predictors of successful sinus rhythm (SR) restoration.

Methods: 103 patients were prospectively enrolled in a single-center study. The preoperative atrial fibrillation (AF) type was paroxysmal in 36%, permanent in 53%, persistent in 5% and flutter in 6% patients.

A method to determine suitable fluoroscopic projections for transcatheter aortic valve implantation by computed tomography.

Background: In transcatheter aortic valve implantation (TAVI), optimal selection of fluoroscopic projections that permit orthogonal visualization of the aortic valve plane is important but may be difficult to achieve.

Objective: We developed and validated a simple method to predict suitable fluoroscopic projections on the basis of cardiac CT datasets.

Methods: In 75 consecutive patients that underwent TAVI, angulations in which a 35-mm thick maximum intensity projection would render all aortic valve calcium into 1 plane were determined by manual interaction with contrast-enhanced dual-source CT datasets.

Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging.

Objectives: This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients.

Background: Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization of calcified particles may lead to cerebral ischemia.

Suture-induced right coronary artery stenosis.

An 82-year-old patient developed right heart failure in the days after surgical aortic valve replacement. Coronary CT angiography showed a high-grade stenosis of the mid-right coronary artery. Adjacent suture material seen on noncontrast CT suggested that the lesion was related to surgical closure of the right atrial cannulation site.

[Anticoagulation during pregnancy following an artificial heart valve replacement].

History And Clinical Findings: A 23-year-old woman had received a mechanical bileaflet mitral valve prosthesis because of severe mitral valve insufficiency caused by an acute bacterial endocarditis with vegetations. One year after the operation the patient suffered on two miscarriages under oral anticoagulation by phenprocoumon. Present, she was referred to our center with the question of conversion to low molecular weight heparine because of continued yearning for a baby.

Prevention of sternal dehiscence and infection in high-risk patients: a prospective randomized multicenter trial.

Background: One factor for the development of sternal wound infection (SWI) is bony instability after sternotomy. This study compares two surgical techniques with respect to the occurrence of SWI in patients with an increased risk.

Methods: In this multicenter study, 815 consecutive patients with an increased risk for SWI were prospectively randomly assigned to a conventional osteosynthesis (transsternal or peristernal wiring; n = 440) or to an osteosynthesis with additional lateral reinforcement (Robicsek; n = 375).

[Computer-assisted process simulation: a suitable instrument for process optimization in hospitals].

The increasing financial pressure on hospitals resulting from changes in the health system demands detailed knowledge about the cost and earnings situation in the hospital. An essential part of strategic controlling now entails establishing structured cost-unit accounting. This can then be used for example through process optimization to ascertain savings potential and rationalization measures.

Minimally invasive vein harvesting with the SaphLITE retractor system: is it really better?

Background: The value of newly developed techniques for saphenous vein harvesting remains controversial. Which technique offers the most benefits is still unknown. The aim of this study was to compare the conventional vein harvesting through a continuous skin incision method with 2 less invasive methods and evaluate surgical advantages and postoperative results.

Resource management in cardiovascular engineering: is outsourcing the solution?

In recent years, modern medicine has changed considerably. At maximum care centers, in particular, the use of state-of-the-art medical equipment has become an essential part of patient care. HoWever, using such high-tech products also means a considerable burden on the financial resources available, because additional financing is rare.

Cost unit accounting based on a clinical pathway: a practical tool for DRG implementation.

Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG.

Non-invasive imaging of sutureless vein graft anastomosis with 16-slice multi-detector row spiral computed tomography.

Contrast-enhanced 16-slice multi-detector row spiral computed tomography (MDCT) has been shown to be useful for non-invasive visualization of aortocoronary bypass grafts (CABG). This new-generation scanner could be a good alternative to the common invasive coronary angiography. In this article, we report a patient operated on with the St.

Early increase of procalcitonin after cardiovascular surgery in patients with postoperative complications.

Objective: Type and frequency of postoperative abnormalities were registered after cardiovascular surgery to evaluate the aetiology and diagnostic value of increased concentrations of procalcitonin (PCT) and C-reactive protein (CRP) during the early postoperative period.

Design: Prospective, observational study.

Patients: Two hundred and eight patients undergoing coronary artery bypass grafting or valve replacement requiring cardiopulmonary bypass were monitored for 7 days postoperatively for various types of infectious or non-infectious complications.