Aortic valve replacement in octogenarians: outcome and predictors of complications.

Introduction: We aimed to evaluate the outcome in octogenarians after aortic valve replacement (AVR) and to determine the perioperative parameters that were predictive of a complicated postoperative course.

Methods: The study population included 304 patients (65% male) aged 82.7 ± 3.

Predictors of postoperative complications in octogenarians undergoing cardiac surgery.

Objective: Aim of the study was to clarify the impact of different pre- and perioperative conditions on outcome in octogenarians undergoing cardiac surgery.

Methods: We retrospectively analyzed preoperative risk factors and intraoperative adverse events and studied in-hospital morbidity and mortality in 646 patients > or = 80 years of age (82.5 +/- 3.

The use of autologous platelet gel (APG) for high-risk patients in cardiac surgery -- is it beneficial?

Background: Wound healing in cardiac surgery has become a major problem due to the impaired risk profile of many patients. The aim of this study was to prove the influence of autologous platelet gel (APG) on wound healing in a special group of high-risk patients undergoing coronary surgery.

Patients And Methods: We performed a prospective, double-blind study in 44 patients with a special risk constellation relating to wound complications (obesity, diabetes, smoker, New York Heart Association (NYHA) III-IV and peripheral vascular disease).

Cardiac valve replacement in patients with end-stage renal failure: impact of prosthesis type on the early postoperative course.

Background: It is still unclear whether biological or mechanical valves should be preferred in patients on chronic dialysis therapy.

Patients And Methods: We retrospectively analyzed data from 104 patients (66.5 +/- 8.

The impact of pre- and postoperative renal dysfunction on outcome of patients undergoing coronary artery bypass grafting (CABG).

Objective: Acute changes in renal function after elective coronary bypass surgery represent a challenging clinical problem. In this study, we evaluated perioperative risk factors for the development of postoperative renal dysfunction (PRD), and the impact of such an event on the perioperative course. Additionally, we investigated the influence of preoperatively mildly increased serum creatinine on perioperative mortality and morbidity.

Predictors and outcome of ICU readmission after cardiac surgery.

Objective: Readmission to the intensive care unit (ICU) after cardiac surgery is associated with higher costs and may be correlated with an increased mortality. We wanted to evaluate predictors of ICU readmission and to analyze the outcome of those patients.

Methods: 3523 patients who underwent CABG and/or valve surgery between 2004 and 2007 were reviewed retrospectively.

Intraaortic balloon pumping in patients with right ventricular insufficiency after cardiac surgery: parameters to predict failure of IABP Support.

Background: The indications for intra-aortic balloon pump (IABP) in the case of a failing right ventricle after operations with extracorporeal circulation (ECC) are still discussed controversially. We investigated the benefit of IABP in patients with a predominantly right ventricular dysfunction after ECC. Additionally, we wanted to identify early and easily available prognostic markers for outcome in all patients receiving IABP support.

Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis.

Objectives: Do prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis.

Methods: Eight cardiac surgical centers provided outcome data of 37,140 consecutive patients who underwent isolated first-time coronary bypass grafting between January 2000 and December 2005. Twenty-two patient characteristics and outcome variables were retrieved.

Intermediate coronary revascularization using the Deltastream blood pump: results from an experimental study.

Background: Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization.

Methods: In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A).

Blood pressure and heart rate immediately after termination of short-term ventricular fibrillation.

Background: Implantable cardioverter/defibrillators (ICDs) can detect ventricular fibrillation (VF) and terminate it. For determining the optimal defibrillation threshold, ventricular fibrillation is repetitively induced and terminated with DC shocks. Depending on the protocol, several fibrillation/defibrillation sequences are mandatory before the final implantation of an ICD.

Inotropic, vasodilating and preconditioning actions of levosimendan in the heart.

Background: Levosimendan improves ventricular function, induces vasodilation and induces myocardial preconditioning. We determined the external efficiency and assessed the effects on arrhythmias.

Methods: In isolated, blood-perfused rabbit hearts, levosimendan (0.

Oxygenation failure after cardiac surgery: early re-intubation versus treatment by nasal continuous positive airway pressure (NCPAP) or non-invasive positive pressure ventilation (NPPV).

Background: Due to an increasing incidence of respiratory failure after cardiac surgery we wanted to study whether nasal continuous positive airway pressure (NCPAP) may improve pulmonary oxygen transfer and may avoid reintubation after coronary operations. Additionally, we compared this protocol to non-invasive positive pressure ventilation (NPPV).

Methods: For a period of 2 years we analyzed all patients that were extubated within 12 hours after coronary surgery, and in whom oxygen transfer (PaO2/FIO2) deteriorated without hypercapnia so that all these patients met predefined criteria for reintubation: group A=immediate reintubation (n=88), group B=NCPAP-treatment (n=173), group C=NPPV (n=18).

Ca2+ sensitizer superior to catecholamine during myocardial stunning?

Background: After open-chest cardiac surgery, ventricular function remains depressed (myocardial stunning). Catecholamines (epinephrine) improve ventricular function by increasing the intracellular Ca(2+) concentration. In parallel, the oxygen consumption is increased, so that the hitherto intact myocardium can be jeopardized.

Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent.

The success of coronary artery bypass graft surgery (CABG) depends mainly on the patency of the graft vessels. Aortocoronary vein graft disease is comprised of three distinct but interrelated pathological processes: thrombosis, intimal hyperplasia and atherosclerosis. Early thrombosis is a major cause of vein graft attrition during the first month after CABG, while during the remainder of the first year, intimal hyperplasia forms a template for subsequent atherogenesis, which thereafter predominates.

Coronary artery disease progression in patients who need repeat surgical revascularisation: the surgeon's point of view.

Objective: The purpose of this study was to evaluate changes in native coronary arteries in patients undergoing repeat myocardial revascularisation late (>3 years) after primary coronary artery bypass grafting (CABG).

Methods: The angiographic images of 30 patients obtained at first and redo CABG were assessed for significant (>75%), short (<1 cm) and long (>1 cm) stenosis or total occlusion in native coronary arteries. Bypass grafts were also evaluated for significant stenosis (>50%) or occlusion.

Aspirin-induced platelet inhibition in patients undergoing cardiac surgery.

Platelet function and response to pharmacological inhibition are altered by cardiac surgery. For example, aggregation is increased early after aortic valve replacement (AVR) and platelet response to aspirin is often insufficient after coronary artery bypass grafting (CABG). We hypothesized that the effect of aspirin administration after cardiac surgery might be impaired due to platelet activation.

Management of the persistent ductus arteriosus in infants of very low birth weight: early and long-term results.

The hemodynamically relevant persistent ductus arteriosus (PDA) impairs pulmonary and cardiac function. Frequently, PDA can be closed only via surgery. In this retrospective study, early and long-term results in very low birth weight newborns are evaluated.

Ventricular containment in the prophylaxis of experimental dilated cardiomyopathy.

End-stage heart failure is an increasing clinical problem with only a few satisfactory therapeutic options. Dilated cardiomyopathy (DCM) is associated with a progressive decline in cardiac function. Our hypothesis was to arrest this worsening of cardiac function by mechanical containment of the dilating heart.

Beta-blocker prophylaxis for atrial fibrillation after coronary artery bypass grafting in patients with sympathovagal imbalance.

Background: Atrial fibrillation (AF) is the most common arrhythmia after coronary bypass grafting (CABG) resulting in a prolonged hospital stay and higher costs. The withdrawal of beta-blocker and a sympathovagal imbalance were identified as risk factors for AF.

Methods: In our study we performed a measuring of standard deviation of all normal RR intervals (SDNN) among 142 consecutive patients with beta-blocker therapy before CABG in order to identify a collective who had an increased risk due to a withdrawal of beta-blocker medication.

Independency of myocardial stunning of endothelial stunning?

Background And Objective: Vascular endothelial cells play an important role in the control of vascular tone. The reasons for coronary endothelial dysfunction are complex and may involve ischemia/reperfusion injury. We investigated whether endothelial, smooth muscle, and myocardial dysfunction are independent phenomena.

Reduction in beta-myosin heavy chains in stunned myocardium as assessed by nondenaturing gel electrophoresis.

Myosin plays a key role in the structure and function of cardiac muscle. Three myosin isoenzymes (V(1), V(2), and V(3)) with different ATPase activities have been identified in mammalian ventricles based on their heavy chain constituents. The relative amount of myosin isoenzymes changes under physiological and pathological conditions.

CABG-procedures in patients with pretreatment with the GPIIb/IIIa-receptor antagonist tirofiban (Aggrastat): modification of perioperative management?

In order to investigate the effects of tirofiban administration in cardiac surgery all patients undergoing coronary artery bypass grafting (CABG) which received this drug preoperatively between 1/2002 and 6/2005 (n=232) were studied. Three groups regarding the perioperative administration of antifibrinolytic drugs were compared: group A=controls (n=70), group B=aprotinin (n=110), group C=tranexamic acid (n=52) Furthermore we could differ the patients depending on the time when tirofiban was stopped (<2 h, 2-4 h, >4 h preoperatively). The postoperative blood loss was significantly higher in all tirofiban-patients (A-C) compared to a group of CABG-patients without tirofiban.

Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery?

Objective: Enlargement of the ascending aorta is often combined with valvular, coronary, or other cardiac diseases. Reduction aortoplasty can be an optional therapy; however, indications regarding the diameter of aorta, the history of dilatation (poststenosis, bicuspid aortic valve), or the intraoperative management (wall excision, reduction suture, external reinforcement) are not established.

Methods: In a retrospective study between 1997 and 2005, we investigated 531 patients operated for aneurysm or ectasia of the ascending aorta (diameter: 45-76mm).

Surgery for severe aortic stenosis with low transvalvular gradient and poor left ventricular function -- a single centre experience and review of the literature.

Background: A retrospective comparative study was designed to determine whether the transvalvular gradient has a predictive value in the assessment of operative outcome in patients with severe aortic stenosis and poor left ventricular function.

Methods: From a surgical database, a series of 30 consecutive patients, who underwent isolated aortic valve replacement for severe aortic stenosis with depressed left ventricular (LV) function (EF < 40%), were enrolled in the study and divided into two groups according to the mean transvalvular gradient (TVG): LG(low gradient)-Group < 40 mmHg (n = 13), and HG(high gradient)-Group > 40 mmHg (n = 17). Both groups were then comparatively assessed with respect to perioperative organ functions and mortality.