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Kirschbaum A, Surowiec TM, Pehl A, Wiesmann T, Bartsch DK, Mirow N. Local lung coagulation post resection: an ex-vivo porcine model. Lasers Med Sci 2021; 37:443-447. [PMID: 33759033 PMCID: PMC7986647 DOI: 10.1007/s10103-021-03280-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022]
Abstract
Following non-anatomical resection of lung parenchyma with a Nd:YAG laser, a coagulated surface remains. As ventilation starts, air leakage may occur in this area. The aim of the present study was to investigate, whether additional coagulation either before or after ventilation has an additional sealing effect. Freshly slaughtered porcine heart-lung blocks were prepared. The trachea was connected to a ventilator. Using a Nd:YAG laser (wavelength: 1320 nm, power: 60 W), round lesions (1.5 cm in diameter) with a depth of 1.5 cm were applied to the lung using an 800-μm laser fiber (5 s per lesion). Group 1 (n = 12) was control. Additional coagulation was performed in group 2 (n = 12) without and in group 3 (n = 12) with ventilation restarted. Air leakage (ml) from the lesions was measured. The thickness of each coagulation layer was determined on histological slices. Differences between individual groups were analyzed by one-way ANOVA (significance p < 0.05). After resection, 26.2 ± 2.7 ml of air emerged from the lesions per single respiration in group 1. Air loss in group 2 was 24.6 ± 2.5 ml (p = 0.07) and in group 3 23.7 ± 1.8 ml (p = 0.0098). In comparison to groups 1 and 2 thickness of the coagulation layers in group 3 was significantly increased. After non-anatomical porcine lung resection with a Nd:YAG laser, additional coagulation of the ventilated resection area can reduce air leakage.
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Affiliation(s)
- A Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Marburg, Marburg, Germany.
| | - Th M Surowiec
- Department of Mathematics and Computer Science, University of Marburg, Marburg, Germany
| | - A Pehl
- Institute of Pathology, University Hospital Marburg, Marburg, Germany
| | - Th Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany
| | - D K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Marburg, Marburg, Germany
| | - N Mirow
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital Marburg, Marburg, Germany
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Ramzan R, Cybulski P, Ruppert V, Weber P, Irqsusi M, Mirow N, Rastan A, Vogt S. Does MRNA Upregulation of Cytochrome C Oxidase Subunit 4 Isoform 2 Sustain Atrial Fibrillation? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dominik E, Rohrbach S, Li L, Knapp F, Mirow N, Vogt S, Böning A, Niemann B. Ablation for Permanent Atrial Fibrillation: Metabolic Impact of Obesity-Associated Signals. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salzmann-Djufri M, Giessler T, Rohrbach S, Knapp F, Ling L, Vogt S, Mirow N, Böning A, Niemann B. New-Onset Atrial Fibrillation—Metabolic Markers, Cytokines, and Remodeling Anticipating Paroxysmal Atrial Fibrillation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Irqsusi M, Mansouri L, Ramaswamy A, Ramzan R, Vogt S, Mirow N, Rastan A. Differential Expression of Matrix Metalloproteinases 1 and 9 and Tissue Inhibitors 1 and 2 in Mitral Valve Disease—Indicators for Progression of the Disease? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Irqsusi
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - L. Mansouri
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - A. Ramaswamy
- Institute for Pathology, Philipps-University, Marburg, Germany
| | - R. Ramzan
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - S. Vogt
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - N. Mirow
- Department of Heart Surgery, Philipps-University, Marburg, Germany
| | - A. Rastan
- Department of Heart Surgery, Philipps-University, Marburg, Germany
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Van Laethem J, Figiel J, Mahnken H, Ramzan R, Irqsusi M, Mirow N, Vogt S, Rastan A. Predictive Value of Anatomic Papillary Muscle Positioning for the Development of Mitral Valve Insufficiency. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - J. Figiel
- Philipps-University, Klinik für Diagnostische und Interventionelle Radiologie, Marburg, Germany
| | - H. Mahnken
- Philipps-University, Klinik für Diagnostische und Interventionelle Radiologie, Marburg, Germany
| | - R. Ramzan
- Philipps-University, Heart Surgery, Marburg, Germany
| | - M. Irqsusi
- Philipps-University, Heart Surgery, Marburg, Germany
| | - N. Mirow
- Philipps-University, Heart Surgery, Marburg, Germany
| | - S. Vogt
- Philipps-University, Heart Surgery, Marburg, Germany
| | - A. Rastan
- Philipps-University, Heart Surgery, Marburg, Germany
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Volevski L, Andrási B, Irqsusi M, Vondran M, Vogt S, Mirow N, Rastan A. Impact of Aortic Pathology on Stent-Graft-Induced Postimplantation Syndrome. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L. Volevski
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - B. Andrási
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - M. Irqsusi
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - M. Vondran
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - S. Vogt
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - N. Mirow
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
| | - A. Rastan
- Department of Cardiac Surgery, University of Marburg, Marburg, Germany
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Tenderich G, Koerner M, Stuettgen B, Minami K, El-Banayosy A, Arusoglu L, Mirow N, Wlost S, Gromzik H, Kleesiek K, Meyer H, Koerfer R. Mechanical Circulatory Support after Orthotopic Heart Transplantation. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100712] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Frequently the only therapy for primary graft- and right heart failure, as well as low output syndrome from acute of chronic rejection, is implantation of a mechanical circulatory support system, until recompensation or retransplantation. At our institution, mechanical assist devices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chronic rejection with low output syndrome (n=2). Patients (pts) with primary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed®-System for left ventricular support, one pt the Thoratec®-System for biventricular support. Patients with right heart failure (RHF) received the Biomedicus® centrifugal pump for right ventricular support. Nine pts suffered from acute rejection. Six pts received an IABP, one the Biomedicus® as femoro-femoral bypass, one the Abiomed®-System for biventricular support, two the Thoratec®-System for biventricular support and two within this group switched from the Biomedicus® pump to the Thoratec®-System for biventricular support. Patients with chronic graft failure (n=2) received the Novacor®-System (LVAD) for left ventricular support, one received a Tojobo®-System and an oxygenator for biventricular support post coronary artery bypass surgery. Support time ranged from 0.5-h to 73 days. Five pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The use of a mechanical assist device after heart transplantation is encouraging only in the case of early right heart failure, as well as primary and chronic graft failure. In view of the poor results, the use of mechanical assist devices should not be recommended in the case of heart failure caused by acute rejection.
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Affiliation(s)
- G. Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - M.M. Koerner
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - B. Stuettgen
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - K. Minami
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - A. El-Banayosy
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - L. Arusoglu
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - N. Mirow
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - S. Wlost
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - H. Gromzik
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - K. Kleesiek
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - H. Meyer
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - R. Koerfer
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
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Tenderich G, Arusoglu L, El-Banayosy A, Morshuis M, Mirow N, Hornik L, Wlost S, Koerfer R, Koerner MM. Influence of Different Assist Devices on Survival after Orthotopic Heart Transplantation. Int J Artif Organs 2018. [DOI: 10.1177/039139889902201110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- G. Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - L. Arusoglu
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - A. El-Banayosy
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - M. Morshuis
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - N. Mirow
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - L. Hornik
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - S. Wlost
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - R. Koerfer
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - M. M. Koerner
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
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Niemann B, Salzmann M, Giesler T, Rohrbach S, Mirow N, Vogt S, Grieshaber P, Roth P, Böning A. New Onset Postoperative Atrial Fibrillation: Relevance of Peri- and Intraoperative Characteristics for Incidence of Atrial Fibrillation and Patient Outcome? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Niemann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - M. Salzmann
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - T. Giesler
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - S. Rohrbach
- Institute of Physiology, Justus Liebig University Giessen, Giessen, Germany
| | - N. Mirow
- Department for Cardiac Surgery and Thoracic Vascular Surgery, UKGM - Marburg, Marburg, Germany
| | - S. Vogt
- Department for Cardiac Surgery and Thoracic Vascular Surgery, UKGM - Marburg, Marburg, Germany
| | - P. Grieshaber
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz- Kinderherz- und Gefäßchirurgie, Justus Liebig Universität Giessen, Giessen, Germany
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Vogt S, Ramzan R, Irqsusi M, Mirow N, Moosdorf R. Mitochondrial Pharmaco-Bioenergetics in Heart Surgical Patients: Do We Harm When We Treat? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Vogt
- Philipps- Universität Marburg, Biochemisch- Pharmakologisches Zentrum, Kardiovaskuläres Forschungslabor, Marburg, Germany
| | - R. Ramzan
- Philipps- Universität Marburg, Biochemisch- Pharmakologisches Zentrum, Kardiovaskuläres Forschungslabor, Marburg, Germany
| | - M. Irqsusi
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
| | - N. Mirow
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
| | - R. Moosdorf
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
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Irqsusi M, Mirow N, Schenk T, Vogt S, Moosdorf R. Cranial Computed Tomography Imaging for Postoperative Neurological Damage after Coronary Artery Bypass Surgery: What is it Good for? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Irqsusi
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
| | - N. Mirow
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
| | - T. Schenk
- Universitätsklinikum Gießen und Marburg GmbH, Institut für diagnostische und interventionelle Radiologie, Marburg, Germany
| | - S. Vogt
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
| | - R. Moosdorf
- Universitätsklinikum Gießen und Marburg GmbH, Klinik für Herz - und thorakale Gefäßchirurgie, Marburg, Germany
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Kirschbaum A, Mirow N. [Infiltration of Cardiac Vessels by Lung Cancer: Incidence, Classification, Operative Technique with Heart Lung Bypass, and Results]. Zentralbl Chir 2016; 142:96-103. [PMID: 27027279 DOI: 10.1055/s-0041-107768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Carcinomas of the lung that infiltrate the blood vessels close to the heart (left atrium, pulmonary artery and aorta) without spreading to mediastinal lymph nodes or developing distant metastases are rare overall. Such situations are often classified as primarily inoperable by interdisciplinary tumour boards. This is only the case if, for technical reasons, an experienced thoracic surgeon does not feel able to perform a resection with a surrounding margin of healthy tissue. The surgical strategy to be employed must be chosen individually depending on the infiltrated structure. Complete tumour staging should always be carried out. This also helps in deciding whether neoadjuvant chemotherapy should be given before resection. A heart-lung machine must always be used if larger defects occur due to the resection of blood vessels close to the heart. Using a heart-lung machine in the case of tumour resection does not lead to problems of tumour cell dissemination. Nevertheless, the duration of use of the heart-lung machine should be kept to a minimum, also because of the anticoagulation required. The cardiac defects can be closed securely with the bovine patching materials that are now available. Postoperative morbidity and mortality are low after such resections. Curative resection of blood vessels close to the heart infiltrated by carcinomas of the lung can lead to 5-year survival rates of up to 50 %.
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Affiliation(s)
- A Kirschbaum
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinik Marburg, Deutschland
| | - N Mirow
- Klinik für Herzchirurgie, Universitätsklinik Marburg, Deutschland
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Kirschbaum A, Rössler C, Rexin P, Steinfeldt T, Bartsch DK, Mirow N. [Bipolar Sealing of Lung Veins with 5 mm and 10 mm Instruments - Bursting Pressures Measured in an Ex-Vivo Model]. Zentralbl Chir 2016; 141:330-4. [PMID: 27027277 DOI: 10.1055/s-0042-100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In every anatomic lung resection, lung veins need to be sealed and divided. If open surgery is performed, veins are usually treated with ligatures. In minimally-invasive procedures a vascular stapler is used. Blood vessels can be securely closed with modern bipolar sealing technology. Since this method has rarely been used in lung veins, we carried out the present study on an ex-vivo model to test whether satisfactory bursting pressures can be achieved using 5 mm and 10 mm MARSEAL® sealing instruments. MATERIAL AND METHODS The experimental investigations were carried out on heart-lung preparations (including both lungs) from freshly-slaughtered pigs (weight: 199 lbs). After the lung veins were dissected, three groups were formed according to size: group 1: 1-7 mm, group 2: 8-10 mm and group 3: > 10 mm. Bipolar sealing was performed with a 5 mm or 10 mm MARSEAL® sealing device and the special SealSafe® G5 electric current. Vessels closed by simple ligation served as a control group. A pressure sensor was implanted into the unsealed end of the blood vessel. Air was pumped into the blood vessel and the bursting pressure - the pressure (in mbar) at which the vessel began to leak - was determined digitally. The mean bursting pressures were compared using the non-parametric Mann Whitney U test (the level of significance was p < 0.05). RESULTS In group 1 the mean bursting pressures for the 5 mm and 10 mm instruments were found to be 167.1 ± 38.7 mbar and 113.8 ± 23.3 mbar, respectively. Both were significantly inferior to the pressure of 178.8 ± 44.5 mbar achieved by the control group. In group 2 the bursting pressures were 122.7 ± 27.8 mbar with the 5 mm instrument and 93.5 ± 39.6 mbar with the 10 mm instrument. The mean bursting pressure for the control group was 180.7 ± 35.8.mbar. In group 3 the mean bursting pressures were 98.2 ± 28.8 mbar with the 5 mm instrument and 65.5 ± 19.7 mbar with the 10 mm instrument. All attempts to seal the entire left atrium failed. CONCLUSION In our ex-vivo model of lung veins, acceptable bursting pressures were achieved in blood vessels with a maximum diameter of 10 mm. Bipolar impedance-controlled sealing may create an adequate seal on pulmonary veins up to a diameter of 10 mm. The use of a 10 mm instrument has no advantage compared to a 5 mm instrument. Secure sealing of the left atrium is not possible.
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Affiliation(s)
- A Kirschbaum
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Deutschland
| | - C Rössler
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Deutschland
| | - P Rexin
- Pathologie, Universitätsklinikum Marburg, Deutschland
| | - T Steinfeldt
- Anästhesie, Universitätsklinikum Marburg, Deutschland
| | - D K Bartsch
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Marburg, Deutschland
| | - N Mirow
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Marburg, Deutschland
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Keuchel M, Höffken H, Mirow N, Vogt S, Moosdorf R. Transischemic Dilation as Predictor for Heart Failure in SPECT Data Analysis of Patients with Heart Disease. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Irqsusi M, Becker J, Vogt S, Vannucchi A, Azizov F, Mirow N, Rolfes C, Kasseckert S, Moosdorf R. Early Prediction of Acute Kidney Injury after On-Pump Coronary Artery Bypass Grafting by Quantification of Urinary Timp-2 and Igfbp-7 Protein Levels Compared to Serum Creatinine and Urea Concentration. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vogt S, Ramzan R, Irqsusi M, Mirow N, Dolga A, Culmsee C, Moosdorf R. Myocardial ROS Production in Case of Stress is Decreased by Inhibition of the Mitochondrial Respiratory Complex IV. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mahoozi HR, Zittermann A, Hakim Meibodi K, Burchert W, Gummert JF, Mirow N. Erdheim-Chester disease in a female cardiac surgery patient. Thorac Cardiovasc Surg 2011; 60:428-30. [PMID: 21594819 DOI: 10.1055/s-0030-1271017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We report a case of Erdheim-Chester disease (ECD) with isolated cardiac involvement in a 74-year-old female patient. The patient initially presented with superior vena cava syndrome and PET-CT imaging demonstrating an obstructing hypermetabolic lesion in the right atrium, and a distinct nonobstructing hypermetabolic lesion in the left atrium, expected to be malignant. There was no evidence of extracardiac disease. At surgical exploration, consistent with malignancy, the right atrial tumor was found to have grown into the pericardium and was resected to address symptoms and for histological diagnosis which revealed ECD on immunohistochemistry. We conclude that isolated cardiac ECD should be included in the surgical strategy for cardiac tumors showing infiltrative growth.
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Affiliation(s)
- H R Mahoozi
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Bad Oeynhausen, Germany
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Mahoozi HR, Zittermann A, Hakim-Meibodi K, Gummert J, Mirow N. Case report of Erdheim-Chester disease in a female cardiac surgery patient. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mirow N, Zittermann A, Körperich H, Börgermann J, Koertke H, Knobl H, Gieseke J, Ostertun B, Coskun T, Kleesiek K, Burchert W, Gummert JF. Diffusion-weighted magnetic resonance imaging for the detection of ischemic brain lesions in coronary artery bypass graft surgery: relation to extracorporeal circulation and heparinization. J Cardiovasc Surg (Torino) 2011; 52:117-126. [PMID: 21224820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Cognitive decline is a well recognized complication after on-pump coronary artery bypass graft (CABG) surgery. We investigated whether the design of extracorporeal circulation (ECC) and the extent of perioperative heparinization have an impact on neurological dysfunction. METHODS Sixty-three CABG surgery patients were randomly perfused with an uncoated ECC-set (group A) or with two different heparin-coated ECC-sets (groups B and C). In groups A and B, systemic heparin was given in doses of 400 IU/kg body weight, whereas group C received 150 IU/kg body weight. ECC sets in group C included a diagonal pump and low priming as opposed to roller pumps in groups A and B. Furthermore, in group C blood contact to surfaces other than endothelium and heparin coated material was eliminated. Brain lesions were detected by diffusion-weighted magnetic resonance imaging (DWI). Neurological complications were assessed clinically until discharge (manifest motoric, sensitive or cognitive disturbance). Biochemical coagulation and inflammation parameters were measured pre-, peri-, and postoperatively. RESULTS No major neurological events were observed in either group until discharge. DWIs showed 61 new lesions in 19 of 45 patients who terminated all MRI study procedures. Number and volume of the lesions did not differ between groups (P>0.05). Biochemical and inflammatory parameters showed the expected time courses and variations between groups. CONCLUSION Ischemic brain lesions are frequently observed in CABG surgery patients but are neither associated with clinically relevant neurological complications nor with ECC set-up and intraoperative heparin dosage. DWI may help in the development of new surgical strategies to reduce postoperative brain damage.
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Affiliation(s)
- N Mirow
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad, Oeynhausen, Germany.
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Gummert J, Aboud A, Parsa M, Renner A, Börgermann J, Paluszkiewicz L, Mirow N, Schirmer U, Hakim K. Is minimal invasive mitral valve surgery a risk factor? - A comparison in 394 consecutive patients between 121 conventional and 273 minimal invasive procedures. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krannich JH, Leyh RG, Gorski A, Körfer R, Mirow N, El-Arousy M, Körtke H. Self-managed anticoagulation after mechanical heart valve replacement is superior to general practitioner management in health related quality of life. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Körtke H, Feige T, Wagner O, Mirow N, Eitz T, Morshuis M, Körfer R. Telemedical thrombosis service after mechanical heart valve replacement – first results. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mirow N, Zittermann A, Koertke H, Maleszka A, Knobl H, Coskun T, Kleesiek K, Koerfer R. Heparin-coated extracorporeal circulation in combination with low dose systemic heparinization reduces early postoperative blood loss in cardiac surgery. J Cardiovasc Surg (Torino) 2008; 49:277-284. [PMID: 18431350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM According to a recently performed meta-analysis, heparin-bonded circuits do not reduce blood loss in cardiac surgery patients compared to nonheparin-bonded circuits within the first 24 h postoperatively. We investigated the effects of heparin-coated circuits in combination with a reduced systemic heparin dose on early postoperative blood loss (first 12 h), platelet function, and postoperative complications. METHODS Patients who underwent their first coronary artery bypass graft surgery were included in a randomized prospective study. Group A (n=149) was perfused with an uncoated extracorporeal circulation (ECC)-set and groups B (n=152) and C (n=149) with heparin-coated ECC-sets. In groups A and B, conventional dose systemic heparin was given, whereas group C received low dose systemic heparin. Blood loss was assessed within the first 12 h postoperatively. Moreover, biochemical parameters of pro-coagulant activity and immunological function were measured. RESULTS None of the pro-coagulant activity markers and immunological parameters measured differed preoperatively or postoperatively between study groups. However, intraoperative platelet counts and maximal intraoperative concentrations of platelet factor 4, ss-thromboglobulin, and poly-morpho-nuclear (PMN)-elastase were lowest in group C, whereas group C also had the highest concentrations of thrombin-antithrombin complex (P<0.018-0.001). Blood loss within the first 12 h postoperatively was 457 +/- 204 mL in group A, 431 +/- 178 mL in group B, and 382 +/- 188 mL in group C (P<0.01). Complication rates and 30-day mortality did not differ between study groups. CONCLUSION The combined use of heparin-coated circuits and low dose systemic heparinization is able to reduce early postoperative blood loss without enhancing the risk of complications.
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Affiliation(s)
- N Mirow
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
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Saeed D, El-Banayosy A, Zittermann A, Fritzsche D, Mirow N, Morshuis M, Koerfer R. Prädiktoren für das Überleben nach Implantation einer intraaortalen Ballonpumpe. Z Herz- Thorax- Gefäßchir 2007. [DOI: 10.1007/s00398-007-0581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Saeed D, El-Banayosy A, Zittermann A, Fritzsche D, Mirow N, Morshuis M, Koerfer R. A Risk Score to Predict 30-Day Mortality in Patients with Intra-Aortic Balloon Pump Implantation. Thorac Cardiovasc Surg 2007; 55:163-7. [PMID: 17410501 DOI: 10.1055/s-2006-955879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Several risk factors for early mortality after intra-aortic balloon pump (IABP) implantation have been described. METHODS We performed a retrospective analysis in 120 patients receiving peri- or postoperative IABP support. Univariate and multivariate analyses were carried out to assess variables potentially influencing 30-day mortality in order to develop a risk score for the prognosis of survival and for the decision on optimal patient-specific treatment. RESULTS The 4 parameters (mean arterial pressure, adrenaline dose, central venous pressure, and blood lactate concentrations) at 6 hours of IABP use were independently related to 30-day mortality. They were used to develop a risk score (0 - 4 points). With this score, patients who scored 3 or 4 points had no probability of surviving, whereas patients with a score of zero had a probability of 84.4 %. A prospectively screened cohort of 145 patients confirmed the reliability of our risk score. CONCLUSIONS Our data demonstrate that a score can predict 30-day mortality in patients with IABP implantation. Such a score can be useful to find out whether or not ECMO/VAD implantation is necessary.
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Affiliation(s)
- D Saeed
- Department of Cardiothoracic Surgery, Heart Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
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Körtke H, Zittermann A, Tenderich G, Mirow N, Wagner O, Bockhorst K, Körfer R. Self-management of oral anticoagulation therapy improves long-term survival in patients with mechanical heart valve replacement. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schulte-Eistrup S, Schulz U, Tenderich G, Mirow N, Minami K, Körfer R. Early and long - term results of heart transplantation with extended ischemic time using Custodiol. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Körtke H, Minami K, Breymann T, Seifert D, Baraktaris A, Wagner O, Kleikamp G, el-Banayosy A, Mirow N, Körfer R. [INR self-management after mechanical heart valve replacement: ESCAT (Early Self-Controlled Anticoagulation Trial)]. Z Kardiol 2002; 90 Suppl 6:118-24. [PMID: 11826814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Severe thromboembolic and hemorrhagic complications following mechanical heart valve replacement essentially occur due to intense oral anticoagulation and fluctuating individual INR values around the target range. INR self-management can help to minimize these fluctuations. Beginning this therapeutic control immediately after mechanical heart valve replacement further reduces anticoagulant-induced complications. Included in the study were 1200 patients. The quality of oral anticoagulation also improved through INR self-management. Over an observation period of two years, nearly 80% of INR values recorded by the patients themselves were within the target therapeutic range of 2.5-4.5. This corresponds to a high significance of p < = 0.001 in favor of INR self-management. Only 64.9% of INR values monitored by family practitioners were within the desired range. The results differed slightly in quality between patient groups with different levels of training (comprehensive, secondary modern, grammar with or without university). Of patients trained in INR self-management following mechanical heart valve replacement, 91.7% maintained their competence in this technique throughout the entire follow-up period. Only 8.3% of those trained immediately after surgery were unable to continue with INR self-management.
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Affiliation(s)
- H Körtke
- Herz- und Diabeteszentrum Nordrhein-Westfalen Ruhr-Universität Georgstr. 11 32545 Bad Oeynhausen, Germany.
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Mirow N, Brinkmann T, Minami K, Tenderich G, Schulte-Eistrup S, Kleesiek K, Körfer R. Low dose systemic heparinization combined with heparin-coated extracorporeal circulation. Effects related to platelets. J Cardiovasc Surg (Torino) 2001; 42:579-85. [PMID: 11562580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND A heparin coated cardiopulmonary bypass system combined with full and low dose systemic heparinization in coronary bypass surgery was investigated in a prospective, randomised study. Roller pumps, coronary suction and an open cardiotomy reservoir were used. METHODS One hundred and nineteen patients were divided into 3 groups: group A (n=39) had a standard uncoated extracorporeal circulation (ECC)-set and systemic heparin was given in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept at = or >480 sec. Group B (n=42) had the same ECC-set completely coated with low molecular weight heparin, i.v. heparin was administered in the same dose as in group A, ACT was again kept at = or >480 sec. Group C (n=38) had the same coated ECC set as group B, but i.v. heparin was reduced to 150 IE/kg and during ECC ACT was maintained of = or >240 sec. RESULTS Platelet decrease was significantly less in both groups utilizing coated circuitry as compared to control group A. Activation of thrombocytes as marked by b-thromboglobulin (not PF4) was significantly decreased in patients treated with coated circuits combined with low dose systemic heparinization and postoperative bleeding was significantly reduced. CONCLUSIONS We conclude that in heparin coated extracorporeal circulation combined with either full dose or reduced systemic heparinization compared to uncoated circuits platelet count reduction is significantly less. Platelet activation as marked by b-thromboglobulin and postoperative blood loss are decreased with coated equipment and low i.v. heparinization.
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Affiliation(s)
- N Mirow
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.
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Tenderich G, Dagge A, Schulz U, Holzinger J, Hornik L, Mirow N, Minami K, Körfer R. Successful use of cardiac allograft from serotonin antagonist intoxication. Transplantation 2001; 72:529. [PMID: 11502988 DOI: 10.1097/00007890-200108150-00029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compromised organ donors are generally not accepted for heart transplantation (HT) despite the increasing number of critically ill patients on the waiting lists. By extending the donor criteria to include certain cases of intoxication, the organ shortage may be reduced. METHODS The case of a successful orthotopic HT with an allograft from a donor poisoned by antidepressant overdose is presented. RESULTS Early graft function was satisfactory with anteroseptal dyskinesis and an ejection fraction of 75% on echocardiography. The cardiac allograft recipient suffered some postoperative complications including gastrointestinal problems. The following period was up to now uneventful. Discharge from the intensive care unit was after 4 days. In-hospital stay was prolonged at 26 days. CONCLUSIONS Because of limited myocardial toxicity, donor hearts from certain victims of antidepressant intoxication may be safely used for HT. Existing cardiac organ donor criteria must be reevaluated to maximise the available organ pool.
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Affiliation(s)
- G Tenderich
- Heart and Diabetes Center North Rhine-Westfalia, Department of Thoracic and Cardiovascular Surgery, Ruhr-University of Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany
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Mirow N, Brinkmann T, Minami K, Tenderich G, Kleesiek K, Körfer R. Heparin-coated extracorporeal circulation with full and low dose heparinization: comparison of thrombin related coagulatory effects. Artif Organs 2001; 25:480-5. [PMID: 11453879 DOI: 10.1046/j.1525-1594.2001.025006480.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thrombin related coagulatory effects of a heparin-coated cardiopulmonary bypass system combined with full and low dose systemic heparinization were investigated in a prospective, randomized study in coronary bypass surgery patients. One hundred nineteen patients were divided into 3 groups. Group A (n = 39) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IU/kg body weight. During ECC activated clotting time (ACT) was maintained at > or =480 s. Group B (n = 42) had the same ECC set completely coated with low molecular weight heparin. Intravenous heparin was given in the same dose as in Group A, and ACT was kept at the same level. Group C (n = 38) had the same coated ECC set as Group B, but intravenous heparin was reduced to 150 IU/kg, and during ECC, ACT was set to be > or =240 s. The same ECC components were used in all 3 groups including roller pumps, coronary suction, and an open cardiotomy reservoir. Thrombin generation as indicated by F1/F2 was significantly elevated at an ECC duration >60 min if heparin-coated ECC combined with low dose systemic heparinization was employed. Complexed thrombin (TAT) was significantly elevated after administration of protamine. Release of D-dimers indicating fibrinolysis was not significantly different between groups. Signs of clinical thromboembolism, i.e., postoperative neurological deficit, occurred in 2 patients in Group A and 1 patient in Group C. We conclude that heparin-coated extracorporeal circulation combined with reduced systemic heparinization intraoperatively leads to significantly increased thrombin generation, but not to increased fibrinolysis.
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Affiliation(s)
- N Mirow
- Heart Center North Rhine Westfalia, Clinic for Thoracic and Cardiovascular Surgery, Ruhr University of Bochum, Georgstr.11, 32545 Bad Oeynhausen, Germany.
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Mirow N, Minami K, Kleikamp G, Tenderich G, Puhlmann T, Körfer R. Clinical use of heparin-coated cardiopulmonary bypass in coronary artery bypass grafting. Thorac Cardiovasc Surg 2001; 49:131-6. [PMID: 11432470 DOI: 10.1055/s-2001-14287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Clinical handling, risk and benefit of a heparin-coated cardiopulmonary bypass system combined with reduced systemic heparinization in coronary bypass surgery was investigated in a prospective, randomized clinical study. 243 patients (Pts.) were divided into 3 groups: group A (n = 83) had a standard uncoated extracorporeal circulation (ECC) set, and systemic heparin was administered in an initial dose of 400 IE/kg body weight. During ECC activated clotting time (ACT) was kept > or = 480 sec. Group B (n = 77) had the same ECC set completely coated with low-molecular-weight heparin; i.v. heparin was given in the same dose as in group A, ACT was kept at the same level. Group C (n = 83) had the same coated ECC set as group B, but i.v. heparin was reduced to 150 IE/kg, and was set to be > or = 240 sec during ECC ACT. The same circulatory components were used in all 3 groups including roller pumps, coronary suction and an open cardiotomy reservoir. In the postoperative clinical course, recovery was not significantly different between groups, especially with respect to organ dysfunction; but there was significantly reduced postoperative bleeding where heparin-coated ECC and low-dose systemic heparinization were both used. This circulatory technique was also associated with a distinctly lower need for postoperative blood replacement. We conclude that heparin-coated extracorporeal circulation combined with either full-dose or reduced systemic heparinization can be used effectively with the same standard equipment and procedures as in uncoated technology. Combination with low-dose i.v. heparin leads to significantly decreased blood loss and less need for blood replacement.
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Affiliation(s)
- N Mirow
- Department of Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
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Reiss N, El-Banayosy A, Breymann T, Kleikamp G, Mirow N, Minami K, Körfer R. Implantation of HIA-Medos system in children with and without cardiopulmonary bypass. Crit Care 2001. [PMCID: PMC3300090 DOI: 10.1186/cc1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kleikamp G, Reiβ N, Mirow N, Hansky B, El-Banayosy A, Minami K, Körfer R. Noncardioplegic myocardial protection in high-risk coronary artery bypass grafting. Crit Care 2001. [PMCID: PMC3300088 DOI: 10.1186/cc1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Mirow N, Brinkmann T, Reiβ N, Kleikamp G, Kleesiek K, Körfer R. Low-molecular-weight heparin-coated cardiopulmonary bypass: coagulatory and clinical findings. Crit Care 2001. [PMCID: PMC3300089 DOI: 10.1186/cc1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mirow N, Brinkmann T, Tenderich G, Minami K, Kleesiek K, Körfer R. AKTIVIERUNG DER BLUTGERINNUNG WÄHREND DES KARDIOPULMONALEN BYPASS MIT HEPARINBESCHICHTUNG. BIOMED ENG-BIOMED TE 2001. [DOI: 10.1515/bmte.2001.46.s1.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reiss N, El-Banayosy A, Mirow N, Minami K, Körfer R. Implantation of the Biomedicus centrifugal pump in post-transplant right heart failure. J Cardiovasc Surg (Torino) 2000; 41:691-4. [PMID: 11149634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Right heart failure after heart transplantation represents a life-threatening complication. When conventional therapy including NO-inhalation fails the only choice to reach sufficient haemodynamic conditions may be the implantation of a right ventricular support system. METHODS In all cases the Biomedicus centrifugal pump was implanted by cannulation of the right atrium and pulmonary artery. RESULTS Since March 1989 950 heart transplant procedures were performed at our center. In nine cases (7 male, 2 female, mean age 52 years) implantation of a right ventricular support system was necessary because of deterioration of right ventricular function. The implantation was carried out in 7 cases immediately after transplantation, in 2 cases after 2 days. The support time ranged from 4-348 hours. Six patients could be weaned, 2 patients underwent retransplantation and died and 1 patient died on the support system. Three of the six weaned patients died in the further course because of multiorgan failure. CONCLUSIONS Mechanical right ventricular support is often the only therapeutical tool to reach adequate haemodynamic conditions in post-transplant right heart failure. The Biomedicus centrifugal pump provides good conditions in these cases. Weaning is often possible after short-term support. The mortality rate is determined by multiorgan failure in immuno-suppressed patients. Retransplantation seems not to be successful despite maximal treatment.
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Affiliation(s)
- N Reiss
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
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Tenderich G, Koerner MM, Stuettgen B, Mirow N, Arusoglu L, Morshuis M, Bairaktaris A, Minami K, Koerfer R. Pre-existing elevated pulmonary vascular resistance: long-term hemodynamic follow-up and outcome of recipients after orthotopic heart transplantation. J Cardiovasc Surg (Torino) 2000; 41:215-9. [PMID: 10901524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Elevation of pulmonary vascular resistance (PVR) has been considered to predict a bad outcome after orthotopic heart transplantation (HTx). A transpulmonary gradient (TG) > or =15 mmHg and PVR > or =5 wood (w) are correlated with a three-fold increase in 2-days as well as 30-days and 6-, 12-month mortality. METHODS We performed a retrospective analysis of 400 consecutive transplanted patients (pts) on hemodynamic data over a time period of 3.5 years. In 83 pts (23%) preoperative PVR was > or =5 w and TG >15 mmHg. Vasodilator studies were performed in this group of pts in order to evaluate pulmonary vasoreactivity or hemodynamic improvement. RESULTS Hemodynamic follow-up post-transplantation showed a significant (p<0.001) decrease in mean TG to 8.8 mmHg within the first, 7.7 after the fifth year as well as decrease in PVR from 5.5 to 1.6, within the first and fifth year post-transplantation. Compared to the control group (n=286) (re-transplants n=6 and pediatric pts n=25 excluded) pts with TG <15 mmHg and/or PVR <5 w, transplanted within the same period, 30-day mortality and cumulative survival after 1 and 5 years do not show any significant difference with a mortality of 3%, 22% and 33% (p<0.05). Subgroup analysis for pts with endstage of ischemic versus dilatative cardiomyopathy has not shown any significant difference in mortality. CONCLUSIONS In a retrospective analysis of 400 pts elevated PVR does not predict a bad outcome after orthotopic heart transplantation in early and late mortality.
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Affiliation(s)
- G Tenderich
- Department of Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany
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Minami K, Boethig D, Mirow N, Kleikamp G, Koertke H, Godehardt E, Koerfer R. Mitroflow pericardial valve prosthesis in the aortic position: an analysis of long-term outcome and prognostic factors. J Heart Valve Dis 2000; 9:112-22. [PMID: 10678383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Pericardial valves combine optimal hemodynamic properties with limited durability. To describe the long-term performance of Mitroflow pericardial valves in the aortic position, outcome and risk factors up to 12 years after implantation were analyzed. METHODS A retrospective study, based on follow up of 1,029 patients who received 1,044 Mitroflow pericardial valves in the aortic position between February 1985 and December 1996, was performed. Follow up was 98.2% complete. Average follow up was 3.79 years. Mean patient age was 75.2+/-6.5 years (range: 27.9-90.9 years). At surgery, 86.3% of patients were aged over 70 years. Among patients, 482 (46.8%) had concomitant operations. RESULTS Results (+/- SE) are given for evident and possible (in parentheses) valve-related events; the latter included all reported postoperative strokes and sudden deaths. Actuarial event-free rates after 5 and 10 years respectively were: structural valve deterioration: 99.2+/-0.5% and 77.6+/-4.4%; non-structural valve deterioration: 99.7+/-0.2% and 99.7+/-1.2%; valve-related complications: 95.7+/-0.9% and 73.5+/-4.0% (5 years 90.1+/-1.2%, 10 years 57.0+/-4.3%); endocarditis: 96.6+/-0.8% and 92.6+/-1.6%; explantation: 98.6+/-0.5% and 80.1+/-3.9%; cerebrovascular accident 95.2+/-0.9% and 82.5+/-3.5%; embolism 99.9+/-0.1% and 99.9+/-0.5%; bleeding 99.8+/-0.2% and 99.8+/-1.3%; overall mortality 69.9+/-1.8% and 35.3+/-3.0%; valve-related death 97.5 +/-1.1% and 95.1+/-4.2% (5 years 91.9+/-1.4%, 10 years 76.1+/-3.2%). The 30-day mortality rate was 4.1%. Patients aged 70 years or more with valve diameters of < or =23 mm showed 10-year freedom rates of 85.8+/-4.6% for structural valve degeneration and 95.1+/-1.2% for evident valve-related death. The detailed risk factor analysis showed results that were in accordance with clinical experience. CONCLUSION Long-term results with Mitroflow pericardial valves in the aortic position compare well with those for other widely used bioprostheses, especially in patients aged > or =70 years and with small aortic root diameters (< or =23 mm).
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Affiliation(s)
- K Minami
- Department of Thoracic and Cardiovascular Surgery, Heart Center North-Rhine Westfalia, Bad Oeynhausen, Germany
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Reiß N, Minami K, Kleikamp G, Scheid P, Mirow N, Hellige G, Breymann T, Körfer R. BRIDGING ZUR HERZTRANSPLANTATION BEI KINDERN UND JUGENDLICHEN - KLINISCHE UND EXPERIMENTELLE STUDIEN MIT PNEUMATISCH UND HYDRAULISCH BETRIEBENEN SYSTEMEN. BIOMED ENG-BIOMED TE 2000. [DOI: 10.1515/bmte.2000.45.s1.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tenderich G, Arusoglu L, El-Banayosy A, Morshuis M, Mirow N, Hornik L, Wlost S, Koerfer R, Koerner MM. Influence of different assist devices on survival after orthotopic heart transplantation. Int J Artif Organs 1999; 22:764-8. [PMID: 10612304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND In 1995, a risk factor of 1.88 was indicated for one-year mortality in connection with bridging to heart transplantation. Both one-year and three-year survival rates in patients bridged to transplantation were less than 80%. METHODS From 3/89 to 12/98, 903 orthotopic heart transplantations were performed at our center in 888 recipients. Bridging was necessary in 142 patients. RESULTS The one-year survival rate was 76% in pts without VAD, 86% in pts bridged with VAD and 66% in pts with VAD due to postcardiotomy syndrome. The three-year survival rates were 73%, 80% and 55% respectively. CONCLUSIONS Early and late results in patients bridged to transplantation remarkably improved over 1995. One-year and long-term survival rates are significantly lower when assist devices are used in patients with postcardiotomy syndrome. Despite a high incidence of assist-related complications, electively bridged patients showed significantly better early and long-term results than the control group.
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Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Abstract
BACKGROUND The long-term outcome of orthotopic heart transplantation is limited by the development of cardiac allograft vasculopathy, rejection, infection, and malignancy. METHODS After heart transplantation, we treated patients with thoracic and cardiovascular diseases: preexisting coronary artery sclerosis in 2 patients, cardiac allograft vasculopathy in 19, valvular disease in 3, mycotic ascending aortic aneurysm in 2, superior vena cava stenosis in 2, and lung neoplasm in 10 patients. RESULTS We successfully performed coronary artery bypass grafting for preexisting coronary artery sclerosis, valve replacement for valvular disease, and patch enlargement for superior vena cava stenosis. Percutaneous transluminal coronary angioplasty for cardiac allograft vasculopathy achieved excellent initial results, but the incidence of restenosis was high (67%). One patient who underwent coronary artery bypass grafting for cardiac allograft vasculopathy died immediately after operation. Graft replacement was performed for mycotic aortic aneurysm, but 1 patient required reoperation because of recurrent aneurysm. The long-term survival rate in patients undergoing surgical resection for lung neoplasm was poor (50%). CONCLUSIONS The need for thoracic and cardiovascular interventions in patients after heart transplantation was low (4.7%). Use of the appropriate procedures can improve the long-term survival after heart transplantation.
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Affiliation(s)
- T Koyanagi
- Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany
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Tenderich G, Koerner MM, Posival H, Arusoglu L, Hornik L, Mirow N, Stuettgen B, Wlost S, Minami K, Koerfer R. Hemodynamic follow-up of cardiac allografts from poisoned donors. Transplantation 1998; 66:1163-7. [PMID: 9825812 DOI: 10.1097/00007890-199811150-00009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The current shortage of donor organs, combined with an increasing demand for cardiac allografts, means that extended donor criteria are becoming more and more accepted. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion; few data are currently available in the medical literature. We describe our experience with 19 orthotopic heart transplant recipients of organs from donors after acute intoxication with different agents. METHODS Between March 1989 and December 1997, 883 orthotopic heart transplantations were performed at our transplant unit. Within this group, we accepted donor hearts after ethanol intoxication (n=1), benzodiazepine (n=1), alkylphosphate (E 605) in combination with beta-blocker intoxication (n=1), carbon monoxide poisoning (n=5), digitalis (n=1), digitalis/glibenclamide (n=1), chlormethiazole (n=1), propoxyphene (n=1), alkylphosphate (E 605) (n=1), insulin (n=2), neprobamate/ thiocyacide/flurazepam (n=1), paracetamol (n=1), carbamazepine (n=1), and cyanide (n=1) intoxication. At the time of organ explantation, hemodynamic data were available from all patients. RESULTS Early mortality in this group was 11%; cumulative survival after 5 years was 74%. CONCLUSIONS Based on our limited experience, cardiac allografts from donors exposed to different kinds of poisons can be transplanted in selected cases. If the donor organ is not hemodynamically compromised, showing regular filling pressures on low or mild inotropic support just before explantation, and if there are no electrocardiographic changes in combination with elevation of the transaminases, cardiac allograft transplantation seems to be a safe and life-saving procedure.
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Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Tenderich G, Koerner MM, Stuettgen B, Arusoglu L, Bairaktaris A, Hornik L, Wlost S, Mirow N, Minami K, Koerfer R. Extended donor criteria: hemodynamic follow-up of heart transplant recipients receiving a cardiac allograft from donors > or = 60 years of age. Transplantation 1998; 66:1109-13. [PMID: 9808501 DOI: 10.1097/00007890-199810270-00025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart transplantation (HT) has become a therapeutic option for patients suffering from endstage heart failure. The increasing demand for cardiac allografts has led to a shift toward extended donor criteria. In a retrospective analysis of 859 HT recipients, we report on the hemodynamic outcome of 19 HT patients who received cardiac allografts from donors > or =60 years of age. METHODS From March 1989 to December 1997, we performed 883 orthotopic HT in 74 children and 809 adults at our transplant center. Within this period, 19 patients (17 women and 2 men) received cardiac allografts from donors > or =60 years of age. Recipient age ranged from 57 to 78 years (mean, 65+/-5 years). RESULTS HT could be performed successfully in 19 cases. The early mortality rate was 16% (n=3). The late mortality rate was 37% (n=7). All long-term survivors are stable at New York Heart Association classification II (New York Heart Association Class II = resting hemodynamics: cardiac output normal; left ventricular end diastolic filling pressure elevated; clinically not compromised during mild to moderate workout). Although only 19 patients were retrospectively evaluated, there was a statistically significant (P<0.05) difference in survival among patients who received organs from male (11 vs. 8*) compared with female (8 vs. 2*) (*=death) donors. CONCLUSION In our experience, it is possible to increase the cardiac donor pool by accepting allografts from donors, preferably female, > or =60 years of age in selected cases without a coronary angiogram, if hemodynamic parameters are in a normal range on mild-to-moderate inotropic support. We do not recommend cardiac allografts from donors > or =60 if there are signs of coronary insufficiency in the electrocardiogram, if left ventricle filling pressures are above normal on mild-to-moderate inotropic support and optimum hemodynamic management, or if there are signs of segmental dysfunction or mitral insufficiency >I in the echocardiogram.
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Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Miche E, Kloppe A, Minami K, Montanus H, Ohlmeier H, Koerfer R, Notohamiprodjo G, Raute-Kreinsen U, Mirow N, Bogunovic N, Gleichmann U. Vascular hamartoma of the left ventricle. J Cardiovasc Surg (Torino) 1998; 39:479-82. [PMID: 9788796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Primary tumors of the heart are very rare. We report a case of a 28-year old female patient in whom a tumor of the left ventricle was first diagnosed by transthoracic echocardiography. Angiography, nuclear magnetic resonance imaging and fasting positron emission tomography with 18-fluorodesoxyglucose suggested the diagnosis of a well vascularized tumor. The tumor was subtotally excised during heart surgery under total cardiopulmonary bypass and histological examination identified a predominantly vascular hamartoma.
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Affiliation(s)
- E Miche
- Herzzentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Kardiologische Klinik, Germany
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Tenderich G, Koerner MM, Stuettgen B, Minami K, El-Banayosy A, Arusoglu L, Mirow N, Wlost S, Gromzik H, Kleesiek K, Meyer H, Koerfer R. Mechanical circulatory support after orthotopic heart transplantation. Int J Artif Organs 1998; 21:414-6. [PMID: 9745997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Frequently the only therapy for primary graft- and right heart failure, as well as low output syndrome from acute of chronic rejection, is implantation of a mechanical circulatory support system, until recompensation or retransplantation. At our institution, mechanical assist devices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chronic rejection with low output syndrome (n=2). Patients (pts) with primary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed-System for left ventricular support, one pt the Thoratec-System for biventricular support. Patients with right heart failure (RHF) received the Biomedicus centrifugal pump for right ventricular support. Nine pts suffered from acute rejection. Six pts received an IABP, one the Biomedicus as femoro-femoral bypass, one the Abiomed-System for biventricular support, two the Thoratec-System for biventricular support and two within this group switched from the Biomedicus pump to the Thoratec-System for biventricular support. Patients with chronic graft failure (n=2) received the Novacor-System (LVAD) for left ventricular support, one received a Tojobo-System and an oxygenator for biventricular support post coronary artery bypass surgery. Support time ranged from 0.5-h to 73 days. Five pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The use of a mechanical assist device after heart transplantation is encouraging only in the case of early right heart failure, as well as primary and chronic graft failure. In view of the poor results, the use of mechanical assist devices should not be recommended in the case of heart failure caused by acute rejection.
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Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
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Tenderich G, Koerner MM, Stuettgen B, Hornik L, Mirow N, Morshuis M, Mannebach H, Minami K, Koerfer R. Does preexisting elevated pulmonary vascular resistance (transpulmonary gradient > 15 mm Hg or > 5 wood) predict early and long-term results after orthotopic heart transplantation? Transplant Proc 1998; 30:1130-1. [PMID: 9636458 DOI: 10.1016/s0041-1345(98)00180-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- G Tenderich
- Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany
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Körner MM, Tenderich G, Baller D, Mannebach H, Minami K, Arusoglu L, Mirow N, Bairaktaris A, Breymann T, Körfer R. Accepting prolonged ischemia times for the donor heart. Transplant Proc 1997; 29:3662-3. [PMID: 9414880 DOI: 10.1016/s0041-1345(97)01064-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M M Körner
- Heart Center North Rhine-Westphalia, Bad Oeynhausen, Germany
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Koerner MM, Tenderich G, Minami K, Morshuis M, Mirow N, Arusoglu L, Gromzik H, Wlost S, Koerfer R. Extended donor criteria: use of cardiac allografts after carbon monoxide poisoning. Transplantation 1997; 63:1358-60. [PMID: 9158034 DOI: 10.1097/00007890-199705150-00027] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND An increasing demand for cardiac allografts for the treatment of end-stage cardiac failure has led to a shift in the traditional views about donor criteria. The use of allografts exposed to high concentrations of carbon monoxide is still under discussion. The current literature on this topic is contradictory. We describe our experience with orthotopic cardiac transplantation, using cardiac allografts after carbon monoxide poisoning. METHODS Between March 13, 1989 and August 1, 1996, 770 orthotopic heart transplantations were performed in our center. Within this period, we accepted five cardiac allografts from brain-dead, carbon monoxide-poisoned donors. Donor history showed carbon monoxide intoxication in all cases. At the time of organ explantation, donor hemodynamic parameters were feeble in all patients. RESULTS The postoperative course was uneventful in three of the five recipients. The overall 3-year survival rate in this small group is 40%. Induction therapy or rescue therapy with mono/polyclonal antibodies was not necessary. Myocardial right-ventricular biopsies did not show any specific signs of carbon monoxide poisoning. CONCLUSIONS In our opinion, cardiac allografts from donors exposed to carbon monoxide can be transplanted successfully in infants and adults, if there are no signs of severe hemodynamic dysfunction in the presence of a normal central venous pressure and low-dose support with catecholamines and there are no electrocardiographic changes in combination with elevated transaminase. With extended donor criteria, the hearts of carbon monoxide-poisoned victims could increase the number of suitable organs and lower the death rate of patients on the United Network for Organ Sharing and Eurotransplant International Foundation waiting lists.
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Affiliation(s)
- M M Koerner
- Heart Center Northrhine-Westphalia, University Hospital of the Ruhr University of Bochum, Bad Oeynhausen, Germany
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