Economic aspects of long-term left ventricular assist device treatment for chronic heart failure.

Aims: Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end-stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long-term costs of LVAD therapy and identify diagnoses resulting in expensive stays.

Calcium channel blockers and clinical outcomes in patients with continuous-flow left ventricular assist devices.

Aims: Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients after LVAD implantation.

[Mitral valve: When conservative, when surgical, when interventional therapy?].

The management of severe symptomatic mitral regurgitation is in contrast to the aortic-valve-intervention more challenging due to the complex mitral-valve anatomy. In primary mitral regurgitation surgical therapy is recommended, whereas there are various therapeutic options in secondary mitral regurgitation. Besides the established mitral-valve Transcatheter Edge-to-Edge-Repair (M-TEER) and the interventional annuloplasty - devices dynamic developments have recently been made in the field of Transcatheter Mitral Valve Replacement-therapy (TMVR).

Outcomes of aortic valve replacement via partial upper sternotomy versus conventional aortic valve replacement in obese patients.

Objectives: Excellent outcomes after minimally invasive aortic valve replacement (mini-AVR) have been reported. Therefore, mini-AVR has become a popular treatment option in many cardiac surgery centres. However, whether obese patients particularly benefit from mini-AVR remains unclear.

Early outcomes in re-do operation after acute type A aortic dissection: results from the multicenter REAAD database.

This study provides early results of re-operations after the prior surgical treatment of acute type A aortic dissection (AAD) and identifies risk factors for mortality. Between May 2003 and January 2014, 117 aortic re-operations after an initial operation for AAD (a mean time from the first procedure was 3.98 years, with a range of 0.

Cardiac reoperations in octogenarians: Do they really benefit?

Aim: According to the demographic development of our society, the numbers of octogenarians referred to cardiac surgery are continuously growing. Although the benefit of first-time cardiac procedures for these patients is well documented, the fate of octogenarians after redo-procedures, with special regard to long-term survival, functional status and quality of life, is poorly investigated.

Methods: We retrospectively identified 84 consecutive patients aged ≥80 years, who underwent a cardiac reoperation at the department for Cardiothoracic Surgery in the Heart & Vessel Center Bad Bevensen between January 2007 and 2013.

Can Perioperative Right Ventricular Support Prevent Postoperative Right Heart Failure in Patients With Biventricular Dysfunction Undergoing Left Ventricular Assist Device Implantation?

Objectives: Depending on the pre-existing condition of the right ventricle (RV), left ventricular assist device (LVAD) implantation may have a detrimental effect on RV function, subsequently leading to right heart failure. This study details the authors' experience with perioperative mechanical RV support in patients with biventricular impairment but primarily scheduled for isolated LVAD implantation.

Design: Retrospective study.

Pulmonary Bleeding During Right Ventricular Support After Left Ventricular Assist Device Implantation.

Objectives: Right heart failure still occurs in up to 20% of patients after implantation of a left ventricular assist device (LVAD). One treatment option for these patients is the implantation of a temporary right ventricular assist device (RVAD). Experimental data suggest that non-pulsatile perfusion of the lungs is associated with an increased rate of pulmonary hemorrhage.

Contributory Role of Fluorine 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnosis and Clinical Management of Infections in Patients Supported With a Continuous-Flow Left Ventricular Assist Device.

Background: The current study sought to demonstrate the advantages offered by fluorine 18-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) in patients supported with continuous-flow left ventricular assist devices (CF-LVADs) in detecting infection and the consequent effect on clinical decisions.

Methods: Between April 2009 and September 2013, 40 PET examinations were performed in 31 patients (78.1% men; mean age, 51.

Non-elective cardiac surgery in octogenarians: Do these patients benefit in terms of clinical outcomes and quality of life?

Aim: The general assumption that non-elective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life (QOL) might lead to a non-justified exclusion of elderly patients from surgical treatment. The aim of the present study was to assess survival, functional outcome and quality of life of octogenarians undergoing non-elective cardiac surgery.

Methods: Between 2009 and 2011, 62 consecutive octogenarians (mean age 83.

Distortion of a hybrid stent graft following a frozen elephant trunk procedure.

We describe a case of an acute type A dissection, where technical problems during the frozen elephant trunk technique led to a distortion of the hybrid stent graft with severe stenosis of the thoracic aortic endoprosthesis. Interventional aortoplasty was performed to re-establish flow. This new technique bears some risk of technical failure and therefore should be applied only after careful considerations.

Central closed chest implantation of extracorporeal membrane oxygenation to prevent limb ischemia.

Purpose: Extracorporeal membrane oxygenation (ECMO) support is a widely accepted treatment option for patients with cardiogenic shock, but it is still related to a high incidence of severe complications and death. We present an alternative implantation technique to prevent life-threatening vascular complications.


Methods: Between January 2008 and January 2011, a total of 28 patients with acute myocardial failure and consecutive cardiogenic shock required ECMO as supportive treatment.

Prolonged intensive care treatment of octogenarians after cardiac surgery: a reasonable economic burden?

Objectives: In accordance with the rising prevalence of octogenarians undergoing cardiac surgery, these patients utilize an increasing portion of intensive care unit (ICU) capacities, provoking economic and ethical concerns. In this study, we evaluated the outcomes and costs generated by the prolonged postoperative ICU treatment of octogenarians.

Methods: Between July 2009 and August 2010, 109 of 1063 patients required ICU treatment of at least 5 days after cardiac surgery.

Survival, functional capacity, and quality of life after cardiac surgery followed by long-term intensive care stay.

Background: The rising prevalence of multimorbid patients undergoing cardiac surgery often leads to prolonged postoperative intensive care unit (ICU) treatment. The fate of these patients after discharge is poorly investigated. This study is aimed to assess survival, functional outcome, and quality of life (QOL) in patients after an ICU stay of at least 5 days.

Suction-irrigation drainage: an underestimated therapeutic option for surgical treatment of deep sternal wound infections.

Objectives: Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period.

Methods: Between January 2009 and December 2011, a total of 3274 cardiac procedures with complete median sternotomy were performed in our department.

Presternal false aneurysm due to osseous arrosion of the right ventricle.

Right ventricular rupture after open heart surgery is a rare but severe postoperative complication. In most cases, right ventricular bleeding is associated with mediastinitis and either directly caused by inflammatory processes or iatrogenically through penetration of dehiscent sternal edges or vacuum-assisted closure therapy. We describe a case of right ventricular rupture due to osseous arrosion in a closed chest in the absence of mediastinitis which led to the creation of a massive presternal false aneurysm.

Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases.

Objectives: Partial upper sternotomy is a routine approach to aortic valve surgery. For surgery of the ascending aorta or the aortic arch, this method is not well established yet.

Methods: From October 2007 to October 2010, 50 consecutive patients underwent procedures of the ascending aorta and the aortic arch using partial upper sternotomy.

Alveolar recruitment strategy during cardiopulmonary bypass does not improve postoperative gas exchange and lung function.

Pulmonary dysfunction with impairment of lung function and oxygenation is one of the most serious problems in the early postoperative period after cardiac surgery. In this study we investigated the effect of alveolar recruitment strategy during cardiopulmonary bypass on postoperative gas exchange and lung function. This prospective randomized study included 32 patients undergoing elective myocardial revascularization with cardiopulmonary bypass.

Carbon dioxide field flooding reduces neurologic impairment after open heart surgery.

Background: Air emboli released from incompletely deaired cardiac chambers may cause neurocognitive decline after open heart surgery. Carbon dioxide (CO2) field flooding is reported to reduce residual intracavital air during cardiac surgery. A protective effect of carbon dioxide insufflation on postoperative brain function remains unproven in clinical trials.

Emergency endovascular interventions for acute thoracic aortic rupture: four-year follow-up.

Objective: High mortality and paraplegia rates associated with the surgical management of acute thoracic aortic ruptures limit its success. It was our objective to evaluate whether emergency endovascular interventions would improve the outcomes of these patients.

Methods: Sixty patients aged 28 to 83 years were admitted to our institution with an acute rupture of the thoracic aorta (27 ruptured aneurysms, 15 perforated type B dissections, 18 traumatic ruptures).

Current status of robotically assisted coronary revascularization.

This article reviews the current status of totally endoscopic coronary revascularization using telemanipulation systems for robotic assistance. Current challenges in implementing a robotic surgical program are discussed, and application of the technology in both arrested and beating heart procedures is considered.