Everyday Cardiac Surgery in Jehovah's Witnesses of Typically Advanced Age: Clinical Outcome and Matched Comparison.

Background And Objectives: Jehovah's Witnesses (JW) reject the transfusion of blood components based on their religious beliefs, even if they are in danger of harm or death. In cardiac surgery, this significantly reduces the margin of safety and leads to ethical conflicts. Informed consent should be carefully documented and the patient's family should be involved.

The Impact of Gender and Age in Obese Patients on Sternal Instability and Deep-Sternal-Wound-Healing Disorders after Median Sternotomy.

Objective: The aim of this study was to investigate the relationship between age and sex in regard to the development of deep sternal wound infections and sternal instability following median sternotomy.

Methods: A propensity-score-matching analysis was conducted on 4505 patients who underwent cardiac surgery between 2009 and 2021, all of whom had a BMI of ≥30 kg/m. A total of 1297 matched pairs were determined in the sex group, and 1449 matched pairs we determined in the age group.

Mitral Valve Repair in Advanced Age Groups: Does Cardiac Age Differ from Chronological Age?

Objective: Advanced age is a risk factor in cardiac surgery contributing significantly to a worse outcome. The reasons are frailty and multimorbidity. In this study, we asked: Is there an aging of the heart which differs from chronological age?

Methods: Propensity score matching was performed between 115 seniors ≥ 80 years and 345 juniors < 80 years.

Do Not Withhold Mitral Surgery from Patients with Poor Left Ventricular Function.

Background and Objectives: Increasing reluctance to perform surgical mitral valve repair or replacement particularly in high-risk patients with poor left-ventricular function is trending. These patients are increasingly treated interventionally, e.g.

How Strong Can We Pull? Critical Thresholds for Traction Forces on the Aortic Annulus: Measurements on Fresh Porcine Hearts.

Friable or infected tissue remains a challenge in surgical aortic valve replacement. We recently described the "Caput medusae" method, in which circumferential tourniquets temporarily secure the prosthesis and are then gently knotted. Tourniquets have been shown to develop significantly less force than knots.

Endocarditis: Who Is Particularly at Risk and Why? Ten Years Analysis of Risk Factors for In-hospital Mortality in Infective Endocarditis.

Background: Endocarditis is continuously increasing. Evidence exist that the prognosis is adversely affected by the extent of the disease. We looked at risk factors influencing in-hospital mortality (HM).

Intraoperative Use of Platelet-Rich Fibrin (PRF) Reduces the Postoperative Fistula Rate After Pancreas Surgery.

Background: Patients undergoing pancreatic surgery are predominately very ill and therefore have a high potential for postoperative complications, which often has a life-limiting effect. As leakage of aggressive pancreatic secretions into the abdomen is one of the main reasons for an adverse outcome, measures to reduce it can be beneficial. Platelet-Rich Fibrin (PRF) is often used to seal areas that are already leaking or are susceptible to leakage at the end of the procedure.

Results of Four-Stented Biological Aortic Valves and How They Compare to PARTNER-3.

Objective: According to our nationwide registry, total numbers of surgical aortic valve implantation (sAVR) are constantly declining, while transcathether aortic valve implantation (TAVI) indications are widened toward intermediate- and low-risk patients. So, is there still room for conventionally implanted valves? Can results compete with TAVI or will sAVR be marginalized in the near future?

Methods: Between 2011 and 2019, 1,034 patients (67.1% male, mean = 72.

Platelet-Rich Fibrin in Combination with Local Antibiotics Optimizes Wound Healing After Deep Sternal Wound Problems and Prevents Reinfection.

Objective: Disturbed wound healing is a significant problem in patients after cardiac surgery. Problems with deep sternal wound healing are rare, but can be quite difficult to treat. Furthermore, the therapy is highly expensive and consumes many of the patient's personal resources.

Immunosuppressive Agents and Thoracic Aortic Aneurysm: Real Correlation or Mere Coincidence?

Background: Atherosclerosis, hypertension, age, and fibrillopathies are well-known risk factors for the development of aortic aneurysm. We discovered that a significant proportion of our patients were previously on chemotherapy treatment or long-term treatment with cytostatic agents or immunosuppressive drugs. Thus, we examined this phenomenon.

MitraClip: a word of caution regarding an all too liberal indication and delayed referral to surgery in case of failure.

Objectives: Although indications for the MitraClip are becoming increasingly liberal, the number of patients requiring valve surgery after an insufficient outcome of the procedure is growing. Referral to surgery is, however, frequently delayed. During this time, the patients often deteriorate.

Tourniquet fixing prior to knot tying reduces forces during aortic valve replacement: experimental results from 18 surgeons.

Objectives: To increase the safety of aortic valve replacement, we developed the 'Caput medusae' method, where the prosthesis is prefixed with circumferential tourniquets prior to knot tying. We assumed that an even distribution of forces may help reduce tissue damage. To confirm this theoretically, we compared forces between knots and tourniquets.

Further Evolution of a New Nonbiological Transcatheter Valvular Prosthesis.

Background: Polymeric heart valves are constructed from flexible synthetic materials, therefore aiming to combine the advantageous hemodynamic of biological and the longevity of mechanical valve prostheses. One such valve prototype in development is the PIZZA valve constructed of flexible triangular silicone leaflets on a foldable metal base for perspective transcatheter implantation. Here we present further improvements in its performance through structural modifications.

Endocarditis: An Ever Increasing Problem in Cardiac Surgery.

Background:  Endocarditis remains one of the most threatening diagnoses in cardiac surgery and is still increasing. Particularly, device-related as well as prosthetic endocarditis appears to be on the rise. Early mortality and periprocedural complications are high jeopardizing the success of surgical efforts.

Clinical Short-Term Outcome and Hemodynamic Comparison of Six Contemporary Bovine Aortic Valve Prostheses.

Background: Conventional stented valves (CV) remain gold standard for aortic valve disease. Bovine prostheses have been improved and rapid deployment valves (RDV) have arrived in the recent decade. We compare clinical and hemodynamic short-term outcome of six bovine valves.

Q-PULS, a new quasi-physiological pulsatile extracorporeal model to simulate heart function.

Objectives: The invention of new surgical procedures requires testing at different stages including animal models. To facilitate this process, we have developed a computer-controlled extracorporeal circulation system for testing of an explanted porcine heart simulating a variety of physiological parameters. Mitral valve function can be assessed before and after induced valve insufficiency and after valve repair.

How Do Transcatheter Heart Valves Fit in Mitral Annuloplasty Rings and Which Combination Can be Recommended?

Background:  Transcatheter heart valve (THV) as valve-in-ring is increasingly used in the mitral position. Semi-rigid rings may serve as a more appropriate scaffold for proper anchoring of a THV as they may change from their oval to a round shape thereby fitting to the implanted THV.

Methods:  One rigid and five semi-rigid rings of four manufacturers, Edwards Physio I and II, Sorin 3D Memo, Medtronic Simulus, and St.

MitraClip for High-Risk Patients with Significant Mitral Insufficiency: Shall We Unreservedly Recommend It?

Background: MitraClip (Abbott Inc.) is propagated as a palliative option for high-risk patients with mitral insufficiency considered not qualifying for surgical repair. A proportion of patients requires consecutive surgery because of technical failure or inappropriate clinical improvement.

The obesity paradox is still there: a risk analysis of over 15 000 cardiosurgical patients based on body mass index.

Objectives: Obesity is an ever-growing problem in contemporary cardiac surgery. Although it accounts for many perioperative comorbidities, it has not been shown to increase mortality. Body mass index (BMI) is therefore not considered in the European System for Cardiac Operative Risk Evaluation (EuroSCORE).

Hemodynamic Performance of Endovascular Valves as Valve-in-Valve in Small Stented Bioprosthesis.

 Endovascular valve in stented biological valve implantation (valve-in-valve transcatheter aortic valve implantation [TAVI ViV]) is increasingly becoming a valid option for bioprosthesis degeneration. TAVI implantation in small stented biological valves below 23 mm is controversially discussed. Reduced opening area and high gradients are typical objections against this procedure in cases of small bioprosthesis.

Double-Wire versus Single-Wire Sternal Closure in Obese Patients: a Randomized Prospective Study.

 Sternal instability after coronary artery bypass grafting (CABG) is a serious complication. Obese patients are at high risk for sternal instability after CABG. This study was conducted to assess the positive impact of double-wire sternal closure on sternal instability.

Radiation Exposure and Contrast Volume Differ between Transapical and Transfemoral Aortic Valve Implantation with the Edwards SAPIEN Aortic Valve.

Background: To date, little is known about the radiation exposure and the amount of contrast medium given during the transcatheter aortic valve implantation (TAVI) procedure. This study compares our data between the transfemoral (TF) approach and the transapical (TA) approach.

Patients And Methods: A total of 216 TA and 180 TF implantations of the Edwards SAPIEN (Edwards Lifesciences, Irvine, California, United States) valve were consecutively performed by our heart team, consisting of cardiac surgeons and cardiologists.

Suboptimal geometrical implantation of biological aortic valves provokes functional deficits.

Endovascular valves have become a valid option for patients not qualifying for conventional surgery. Biological valves mounted in a stent are currently used. After implantation, however, geometrical distortion of the valve can occur.

Fracture of Colvin-Galloway Future band causing a tear in the anterior mitral leaflet.

The first case of a fracture of a semi-rigid annuloplasty device is reported. A 56-year-old man presented with recurrence of severe mitral and tricuspid regurgitation 10 months after proper implantation of a Colvin-Galloway Future band (Medtronic Inc, Minneapolis, MN). During redo surgery we made the unexpected finding that its metal skeleton was fractured near the posterior segment.