Platelet morphology in patients with mechanical circulatory support.

Objective: Mechanical circulatory support is a therapy for patients with end stage cardiac insufficiency. The thromboembolic events are feared complications during support, due to the surface thrombogenicity of the implanted device. Activated blood platelets play a major role in this context.

Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair.

Objectives: We sought to analyze risk factors for long-term survival (up to 36 years) after surgical repair of tetralogy of Fallot (TOF).

Background: Survival after repair is excellent, but data >20 years are rare.

Methods: From 1958 to 1977, 658 patients underwent correction of TOF at our institution and were analyzed for survival.

Selective modulation of inducible nitric oxide synthase isozyme in myocardial infarction.

Background: Inducible nitric oxide synthase (iNOS) is activated in cardiac disorders. We investigated the contribution of increased iNOS activity to the development of left ventricular dysfunction after myocardial infarction by selective inhibition of the isozyme.

Methods And Results: Male New Zealand rabbits were subjected to myocardial infarction.

Simvastatin reduces graft vessel disease and mortality after heart transplantation: a four-year randomized trial.

Background: Accelerated graft vessel disease (GVD) represents the most serious long-term complication of heart transplantation. A possible cause underlying this progressive coronary vascular disease is believed to be post-transplantation hypercholesterolemia.

Methods And Results: In a 4-year prospective randomized study with heart transplant recipients, the efficacy of primary antihypercholesterolemic therapy with simvastatin was compared with that of general dietary therapy.

Influence of anodal electrode position on transvenous defibrillation efficacy in humans: a prospective randomized comparison.

Nonthoracotomy lead systems for implantable cardioverter defibrillators (ICDs) have reduced operative mortality and morbidity as compared to epicardial lead systems but are usually associated with higher defibrillation thresholds (DFTs). The purpose of this prospective randomized trial was to investigate if the second defibrillation electrode in the left subclavian vein can increase defibrillation efficacy and decrease DFT as compared to the superior vena cava (SVC) position in nonthoracotomy lead systems for ICDs. Seventeen patients (mean age: 49.

Long-term results of total repair of tetralogy of Fallot in adulthood: 35 years follow-up in 104 patients corrected at the age of 18 or older.

Long-term survival after surgical repair of tetralogy of Fallot (TOF) is reported to be excellent if the patients are corrected in childhood. However, age at operation has been demonstrated as an important risk-factor. The aim of our study was to investigate whether adult patients also benefit from surgery.

Tacrolimus: a superior agent to OKT3 for treating cases of persistent rejection after intrathoracic transplantation.

Acute myocardial rejection refractory to treatment still contributes significantly to patient death after intrathoracic transplantation. A historical series of 25 patients who received OKT3 (5 mg/day for 10 days) was compared with our current experience with 14 patients treated with tacrolimus (0.1 mg/kg/day targeting whole blood concentrations of 13 to 18 ng/ml): all 39 patients having persistent rejection unresponsive to treatment at the time of conversion.

Surgical therapy for coronary artery disease in patients with a left ventricular ejection fraction of 25% or less.

Background: In patients with advanced coronary artery disease (CAD) and markedly decreased left ventricular ejection fraction (EF) symptoms of myocardial ischemia and insufficiency may be complicated by ventricular arrhythmias. Appropriate surgical therapy must be tailored to the individual symptoms. The aim of this study was to compare the different current methods.

Resection of hypernephromas with vena caval or right atrial tumor extension using extracorporeal circulation and deep hypothermic circulatory arrest: a multidisciplinary approach.

Objective: Among retroperitoneal tumors, renal cell carcinoma most often invades the retrohepatic inferior vena cava or the right atrium. Even in these cases, radical nephrectomy may be performed with curative intention. The aim of this retrospective study was to elucidate the impact of cardiopulmonary bypass and hypothermic circulatory arrest on surgical complications, primary mortality, and long-term survival.

Transgenic human decay accelerating factor makes normal pigs function as a concordant species.

Background: Increasing interest has focused on xenotransplantation as a potential solution to the organ shortage. To overcome hyperacute rejection, pigs have been produced that are transgenic for human decay accelerating factor (DAF). For the evaluation of the effects of human DAF, an ex vivo working heart model was used.

Improvement of heart-, lung-, and liver-performance during mechanical circulatory support by the Novacor-system.

Objective: Since its clinical introduction, the Novacor left ventricular assist system (LVAS) has proved to be a reliable and safe method for bridging to cardiac transplantation. To find out whether univentricular assistance is sufficient in patients with severe global heart failure, multi organ monitoring using the COLD system was performed.

Methods: In seven patients (mean age 38.

Surgery of the thoracic aorta using deep hypothermic total circulatory arrest. Are there neurological consequences other than frank cerebral defects?

Objective: Deep hypothermic total circulatory arrest has reduced primary morbidity and mortality in thoracic aortic surgery. Although frank neurological deficits have been proven to be a rare complication of this technique, the rate of subtle but irreversible neuropsychological disorders remains unknown.

Methods: A total of 23 patients (15 male, 8 female) who had undergone surgery for dissection or aneurysm of the thoracic aorta using deep hypothermic total circulatory arrest (mean 25.

[A comparison of ultrafast computed tomography, magnetic resonance angiography and selective angiography for the detection of coronary bypass patency].

Purpose: Validation of ultrafast-CT and MR-angiography (MRA) in comparison with angiography for detection of early postsurgical arterial and venous coronary artery bypass graft (CABG) patency.

Methods: 21 patients with a total of 55 CABG (34 venous and 21 arterial) were studied with angiography, ultrafast-CT (EBT), and MRA.

Results: With EBT, patency of 43/45 angiographically patent CABG could be correctly assessed (sensitivity: 96%).

Endothelialized biological heart valve prostheses in the non-human primate model.

Objective: The main disadvantage of implanted cardiac valve bioprostheses remains primarily tissue failure due to calcification. Coating of bioprostheses with viable autologous endothelial cells may delay or even eliminate tissue calcification and subsequent cardiac dysfunction.

Methods: Glutaraldehyde-preserved Hancock bioprostheses (n = 5), pretreated with glutamic acid (8%) and cryopreserved allografts (n = 5) were lined, using endothelial cells harvested from the external jugular vein.

Thirty-year results of Starr-Edwards prostheses in the aortic and mitral position.

Background: Between 1963 and 1977 a total of 415 patients admitted to the University Hospital Munich underwent an isolated valve replacement with a Starr-Edwards prosthesis in the aortic or mitral position.

Methods: A retrospective follow-up of 87.1% of the patients representing 4,254 patient-years was completed.

Thirty years survival after double valve replacement with Starr-Edwards prostheses in aortic and mitral position.

We report about a patient who underwent double valve replacement with two Starr-Edwards prostheses in aortic and mitral position 30 years ago. Under anticoagulation medication he survived 28 years without any valve-related events. In the 29th year he sustained a cerebral infarction from which he recovered, having only a residual left arm paresis.

[Quality assurance in heart surgery. General and personal concepts].

In the era of managed health care quality assurance has become more and more important. In cardiac surgery immense costs have to be justified. Some of the patients might be treated alternatively with drugs or by cardiological interventions.

S-methylisothiourea inhibits inducible nitric oxide synthase and improves left ventricular performance after acute myocardial infarction.

The contribution of increased inducible nitric oxide synthase (iNOS) activity to the development of left ventricular dysfunction after acute myocardial infarction (MI) was investigated New Zealand rabbits (n = 24) were randomly treated with either saline, S-methylisothiourea sulfate (SMT; selective iNOS inhibitor) or N-omega-nitro-L-arginine (NOLA; non-isoform selective NOS inhibitor). Left ventricular hemodynamics and myocardial blood flow were measured before coronary occlusion and on postoperative day 3 (POD 3). MI resulted in left ventricular dysfunction and increased myocardial iNOS activity.

25 years follow-up of patients after replacement of the aortic valve with a Smeloff-Cutter prosthesis.

Thirty years ago the Smeloff-Cutter double-caged ball prosthesis was developed for aortic valve replacement. Between 1967 and 1977 a total of 46 patients admitted to the University Hospital Munich underwent an isolated aortic valve replacement with the Smeloff-Cutter prosthesis. Postoperatively all patients received anticoagulation treatment with phenprocoumon (Marcumar).

Prevention of hyperacute rejection by human decay accelerating factor in xenogeneic perfused working hearts.

As a potential source of organs for xenotransplantation, pigs that are transgenic for human decay accelerating factor (DAF) have been bred in order to overcome hyperacute rejection. We investigated the protective effect of human DAF in a porcine working heart model perfused by human blood. Hearts of normal landrace pits served as controls.

[The value of ultrafast computerized tomography in detection of the patency of coronary bypasses].

Bypass graft patency with ultrafast computed tomography (= Electron Beam Tomography, EBT) was examined in 72 bypass grafts (47 saphenous veins, 25 internal mammary arteries) in 30 patients and compared with coronary angiography. Angiography was performed a mean of 4.4 +/- 3.