Transportation model for acute aortic dissection: implications for reduced treatment centres.

Objectives: The objective of the present study was to model the effects of a reduced number of treatment centres for acute type A aortic dissection on preclinical transportation distance and time. We examined whether treatment in selected centres in Germany would be implementable with respect to time to treatment.

Methods: For our transportation model, the number of aortic dissections and respective mean annual volume were collected from the annual quality reports (2015-2017) of all German cardiac surgery centres (n = 76).

Acute Kidney Injury With a Miniaturized Extracorporeal Circuit for Neonatal Cardiopulmonary Bypass.

Objectives: The objectives of this study were to evaluate the incidence and to identify risk factors for acute kidney injury (AKI) in neonates undergoing cardiopulmonary bypass (CPB) with a miniaturized bloodless primed extracorporeal circuit.

Design: A retrospective cohort study.

Setting: A single-center, tertiary academic hospital.

Orthostatic Resiliency During Successive Hypoxic, Hypoxic Orthostatic Challenge: Successful vs. Unsuccessful Cardiovascular and Oxygenation Strategies.

Rapid environmental changes, such as successive hypoxic-hypoxic orthostatic challenges (SHHOC) occur in the aerospace environment, and the ability to remain orthostatically resilient (OR) relies upon orchestration of physiological counter-responses. Counter-responses adjusting for hypoxia may conflict with orthostatic responses, and a misorchestration can lead to orthostatic intolerance (OI). The goal of this study was to pinpoint specific cardiovascular and oxygenation factors associated with OR during a simulated SHHOC.

Chronic Naltrexone Therapy Is Associated with Improved Cardiac Function in Volume Overloaded Rats.

Purpose: Myocardial opioid receptors were demonstrated in animals and humans and seem to colocalize with membranous and sarcolemmal calcium channels of the excitation-contraction coupling in the left ventricle (LV). Therefore, this study investigated whether blockade of the cardiac opioid system by naltrexone would affect cardiac function and neurohumoral parameters in Wistar rats with volume overload-induced heart failure.

Methods: Volume overload in Wistar rats was induced by an aortocaval fistula (ACF).

Incidence of acute type A aortic dissection in emergency departments.

Due to the symptoms, patients with acute type A aortic dissection are first seen by the ambulance service and diagnosed at the emergency department. How often an aortic dissection occurs in an emergency department per year has been studied. The incidence in the emergency department may be used as a quality marker of differential diagnostics of acute chest pain.

Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care - surgical delay because of initial misdiagnosis.

Background: Acute type A aortic dissection requires immediate surgical treatment, but the correct diagnosis is often delayed. This study aimed to analyse how initial misdiagnosis affected the time intervals before surgical treatment, symptoms associated with correct or incorrect initial diagnosis and the potential of the Aortic Dissection Detection Risk Score to improve the sensitivity of initial diagnosis.

Methods: We conducted a retrospective analysis of 350 patients with acute type A aortic dissection.

Cardiac output measurement during exercise in COPD: A comparison of dye dilution and impedance cardiography.

Introduction: Impedance cardiography (IC) derived from morphological analysis of the thoracic impedance signal is now commonly used for noninvasive assessment of cardiac output (CO) at rest and during exercise. However, in Chronic Obstructive Pulmonary Disease (COPD), conflicting findings put its accuracy into question.

Objectives: We therefore compared concurrent CO measurements captured by IC (PhysioFlow: CO ) and by the indocyanine green dye dilution method (CO ) in patients with COPD.

Limb Skin Temperature as a Tool to Predict Orthostatic Instability.

Orthostatic instability is one of the main consequences of weightlessness or gravity challenge and plays as well a crucial role in public health, being one of the most frequent disease of aging. Therefore, the assessment of effective countermeasures, or even the possibility to predict, and thus prevent orthostatic instability is of great importance. Heat stress affects orthostatic stability and may lead to impaired consciousness and decrease in cerebral perfusion, specifically during the exposure to G-forces.

Left Ventricular Systolic Dysfunction in Patients With Type-A Aortic Dissection Is Associated With 30-Day Mortality.

Objective: The aim of this study was to analyze preoperative and postoperative echocardiographic parameters in patients with type-A acute aortic dissection (ATAAD) and to analyze whether impaired preoperative left ventricular function was associated with short- and long-term survival. To enable multivariable analysis, established risk factors of ATAAD were analyzed as well.

Design: Retrospective single-center study.

Gender-Specific Cardiovascular Reactions to +Gz Interval Training on a Short Arm Human Centrifuge.

Cardiovascular deconditioning occurs in astronauts during microgravity exposure, and may lead to post-flight orthostatic intolerance, which is more prevalent in women than men. Intermittent artificial gravity is a potential countermeasure, which can effectively train the cardiovascular mechanisms responsible for maintaining orthostatic integrity. Since cardiovascular responses may differ between women and men during gravitational challenges, information regarding gender specific responses during intermittent artificial gravity exposure plays a crucial role in countermeasure strategies.

Coronary Microcirculation in Ischemic Heart Disease.

Background: Ischemic heart disease has long been considered to be exlusively caused by stenosis or occlusion. However, the coronary microcirculation too may play an important role in ischemic conditions. Also, the crucial role of microvessels in not only regulating blood flow on a local level but also mediating vascular permeability or inflammatory responses has been recognized.

Near-infrared spectroscopy using indocyanine green dye for minimally invasive measurement of respiratory and leg muscle blood flow in patients with COPD.

Reliability of near-infrared spectroscopy, measuring indocyanine green (ICG) for minimally invasive assessment of relative muscle blood flow during exercise has been examined in fit young individuals but not in chronic obstructive pulmonary disease (COPD). Here we ask whether it could be used to evaluate respiratory and locomotor muscle perfusion in COPD patients. Vastus lateralis muscle blood flow (MBF, the reference method calculated from arterial and muscle ICG concentration curves) and a blood flow index [BFI, calculated using only the (same) muscle ICG concentration curves] were compared in 10 patients (forced expiratory volume in 1 s: 51 ± 6% predicted) at rest and during cycling at 25, 50, 75, and 100% of peak work rate (WR).

Health-related quality of life of patients after surgery for acute Type A aortic dissection.

Objectives: Acute Type A aortic dissection (ATAAD) and the ensuing surgical therapy may be experienced as a traumatic event by patients. This study aimed at analysing the prevalence of post-traumatic stress disorder (PTSD) and the physical and mental well-being of survivors of surgically treated ATAAD.

Methods: A total of 393 survivors were contacted and asked to fill in various health questionnaires.

Prognostic value of 3-dimensional echocardiographical heart volume assessment in patients scheduled for left ventricular assist device implantation.

Objectives: Left ventricular assist device (LVAD) support is an increasingly important and successful therapeutic option for patients with end-stage heart failure. As chronic heart failure progresses, the left and right ventricles adapt by enlarging its volume and patients present for LVAD implantation with varying degrees of dilatation. By quantitatively assessing right ventricular (RV) and left ventricular (LV) volumes using 3D transoesophageal echocardiography and correlating the findings with clinical outcomes, we aim to investigate the prognostic value of LV and RV volumes for early survival after LVAD implantation.

Asanguineous priming of miniaturized paediatric cardiopulmonary bypass circuits for congenital heart surgery: independent predictors associated with transfusion requirements and effects on postoperative morbidity.

Objectives: In paediatric cardiac surgery, body weight-adjusted miniaturized cardiopulmonary bypass (CPB) circuits within a comprehensive blood-sparing approach can reduce transfusion requirements. Haemodilution resulting from mixing the patient's blood with a CPB crystalloid solution may be reduced to the extent that asanguineous priming becomes possible. Therefore, we adopted asanguineous priming in our clinical routine.

Incidence and echocardiographic predictors of early postoperative right ventricular dysfunction following left ventricular assist implantation in paediatric patients.

Objectives: Left ventricular assist device implantation is an established therapy for paediatric patients with end-stage heart failure. Early right ventricular dysfunction (RVD) after implantation still remains a challenge in the postoperative period. This study sought to determine the incidence of RVD and to identify echocardiographic predictors of RVD in paediatric patients, as well describing associated clinical outcome.

Accuracy of predicted haemoglobin concentration on cardiopulmonary bypass in paediatric cardiac surgery: effect of different formulae for estimating patient blood volume.

Introduction: When applying a blood-conserving approach in paediatric cardiac surgery with the aim of reducing the transfusion of homologous blood products, the decision to use blood or blood-free priming of the cardiopulmonary bypass (CPB) circuit is often based on the predicted haemoglobin concentration (Hb) as derived from the pre-CPB Hb, the prime volume and the estimated blood volume. We assessed the accuracy of this approach and whether it may be improved by using more sophisticated methods of estimating the blood volume.

Patients And Methods: Data from 522 paediatric cardiac surgery patients treated with CPB with blood-free priming in a 2-year period from May 2013 to May 2015 were collected.

CardioScape mapping the cardiovascular funding landscape in Europe.

Aims: The burden of cardiovascular disease is increasing worldwide, which has to be reflected by cardiovascular (CV) research in Europe. CardioScape, a FP7 funded project initiated by the European Society of Cardiology (ESC), identified where CV research is performed, how it is funded and by whom. It could be transformed into an on-line and up-to-date resource of great relevance for researchers, funding bodies and policymakers and could be a role model for mapping CV research funding in Europe and beyond.

Heterogeneity of blood flow and metabolism during exercise in patients with chronic obstructive pulmonary disease.

The study investigated whether the capacity to regulate muscle blood flow (Q) relative to metabolic demand (VO) is impaired in COPD. Using six NIRS optodes over the upper, middle and lower vastus lateralis in 6 patients, (FEV:46±12%predicted) we recorded from each: a) Q by indocyanine green dye injection, b) VO/Q ratios based on fractional tissue O saturation and c) VO as their product, during constant-load exercise (at 20%, 50% and 80% of peak capacity) in normoxia and hyperoxia (FO:1.0).

Microvascular responses to (hyper-)gravitational stress by short-arm human centrifuge: arteriolar vasoconstriction and venous pooling.

Purpose: We hypothesized that lower body microvessels are particularly challenged during exposure to gravity and hypergravity leading to failure of resistance vessels to withstand excessive transmural pressure during hypergravitation and gravitation-dependent microvascular blood pooling.

Methods: Using a short-arm human centrifuge (SAHC), 12 subjects were exposed to +1Gz, +2Gz and +1Gz, all at foot level, for 4 min each. Laser Doppler imaging and near-infrared spectroscopy were used to measure skin perfusion and tissue haemoglobin concentrations, respectively.

A method for assessing heterogeneity of blood flow and metabolism in exercising normal human muscle by near-infrared spectroscopy.

Heterogeneity in the distribution of both blood flow (Q̇) and O2 consumption (V̇O2) has not been assessed by near-infrared spectroscopy in exercising normal human muscle. We used near-infrared spectroscopy to measure the regional distribution of Q̇ and V̇O2 in six trained cyclists at rest and during constant-load exercise (unloaded pedaling, 20%, 50%, and 80% of peak Watts) in both normoxia and hypoxia (inspired O2 fraction = 0.12).