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Bad Bevensen, Germany

Wimmer-Greinecker G.,Heart and Vessel Center Bad Bevensen | Bouchot O.,University Hospital | Verhoye J.P.,Cardio Pneumologic Center | Perrault L.P.,Montreal Heart Institute | And 4 more authors.
Annals of Thoracic Surgery

Background: During off-pump coronary artery bypass graft (OPCABG) surgery, a bloodless surgical field is mandatory for visualization and construction of optimal coronary anastomoses. Presently used temporary vascular occluders are known to cause endothelial dysfunction and vessel injury. The present prospective multicenter randomized clinical trial evaluates safety and efficacy of a novel thermosensitive polymer (LeGoo) as an atraumatic temporary vascular occluder. Methods: Between July 2008 and February 2010, 110 patients undergoing OPCABG were randomized between LeGoo (LG) and conventional vessel loops (VL) for coronary artery occlusion during construction of the distal anastomosis. A semiquantitative 4-point scale was used to evaluate the degree of bloodless surgical field and surgical comfort. Duration of coronary artery occlusion was also recorded. Safety during the operation and ensuing 30 days was evaluated by a composite endpoint of major adverse cardiac events that consisted of death from all causes, graft occlusion, myocardial infarction, and low cardiac output. Results: Fifty-six patients (117 distal anastomoses) were randomly assigned to LG and 54 patients (122 anastomoses) to VL. There were 2 anastomoses crossed over from LG to the control arm, and 3 from control to LG. Five anastomoses in LG patients were treated with an alternative device (shunts). Satisfactory hemostasis was achieved in 88.0% of LG anastomoses (103 of 117) compared with 60.7% of VL anastomoses (74 of 122; p < 0.001). Mean total anastomotic time was 12.8 minutes in the LG group and 15.1 minutes in the VL group (p < 0.001). This difference was more pronounced for arteries on the posterior and lateral than on the anterior walls of the heart. Composite adverse events were similar in the two groups: 3 of 48 LG patients and 3 of 46 VL patients. There was 1 death in the LG group. One patient in the LG group and 1 in the VL arm had a myocardial infarction. No operation was converted from OPCABG to CABG with cardiopulmonary bypass. Conclusions: LeGoo is a safe and effective temporary coronary occluder during OPCABG. It provided a dry surgical field for visualization of the anastomotic field and surgical comfort more frequently than conventional vessel loops. In addition, anastomotic times were shorter with LG. Major cardiac adverse events were similar in the LG and VL arms. © 2011 The Society of Thoracic Surgeons. Source

Deschka H.,University of Munster | Nolte T.,Heart and Vessel Center Bad Bevensen | MacHner M.,Heart and Vessel Center Bad Bevensen | Wimmer-Greinecker G.,Heart and Vessel Center Bad Bevensen
Journal of Cardiac Surgery

We describe a case of an acute type A dissection, where technical problems during the frozen elephant trunk technique led to a distortion of the hybrid stent graft with severe stenosis of the thoracic aortic endoprosthesis. Interventional aortoplasty was performed to re-establish flow. This new technique bears some risk of technical failure and therefore should be applied only after careful considerations. © 2014 Wiley Periodicals, Inc. Source

Deschka H.,University of Munster | Muller D.,Heart and Vessel Center Bad Bevensen | Dell'Aquila A.,University of Munster | Matthaus M.,Heart and Vessel Center Bad Bevensen | And 2 more authors.
Geriatrics and Gerontology International

Aim: The general assumption that non-elective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life (QOL) might lead to a non-justified exclusion of elderly patients from surgical treatment. The aim of the present study was to assess survival, functional outcome and quality of life of octogenarians undergoing non-elective cardiac surgery. Methods: Between 2009 and 2011, 62 consecutive octogenarians (mean age 83.5±3.5 years) underwent urgent (n=33) or emergency (n=29) cardiac surgery. In 69% of patients, coronary artery bypass grafting was carried out, and 24% of patients underwent coronary artery bypass grafting plus valve surgery. Preoperative risk, as well as the postoperative course, was analyzed. All discharged patients were contacted to gain information about survival, functional capacity and QOL using the Barthel Mobility Index and the Short Form 12 Health Survey questionnaire. Results were compared with age-adjusted population data. Results: In-hospital mortality was 32.3% overall, 9.3% in urgent cases and 56.7% in emergency cases. After a mean follow-up period of 447±359 days, survival of the discharged patients was 93.1% (urgent) and 76.9% (emergency), respectively. QOL measures of the survivors were equivalent to those of the general elderly population. Functional capacity, calculated with Barthel Index, was high in both groups (86±13 and 81±21). A total of 92% of the patients were living at home. Conclusions: Although non-elective cardiac surgery in the elderly is related to high in-hospital mortality, physical and psychological recovery of the survivors is encouraging. QOL equals that of the general elderly population, and good functional status offers a highly independent life. Therefore, age per se should not disqualify patients from urgent or emergency cardiac surgery. © 2016 Japan Geriatrics Society. Source

Deschka H.,Heart and Vessel Center Bad Bevensen | Machner M.,Heart and Vessel Center Bad Bevensen | Wimmer-Greinecker G.,Heart and Vessel Center Bad Bevensen
Thoracic and Cardiovascular Surgeon

Right ventricular rupture after open heart surgery is a rare but severe postoperative complication. In most cases, right ventricular bleeding is associated with mediastinitis and either directly caused by inflammatory processes or iatrogenically through penetration of dehiscent sternal edges or vacuum-assisted closure therapy. We describe a case of right ventricular rupture due to osseous arrosion in a closed chest in the absence of mediastinitis which led to the creation of a massive presternal false aneurysm. © 2013 Georg Thieme Verlag KG Stuttgart - New York. Source

Deschka H.,Heart and Vessel Center Bad Bevensen | Machner M.,Heart and Vessel Center Bad Bevensen | El Dsoki S.,Heart and Vessel Center Bad Bevensen | Alken A.,Heart and Vessel Center Bad Bevensen | Wimmer-Greinecker G.,Heart and Vessel Center Bad Bevensen
International Journal of Artificial Organs

Purpose: Extracorporeal membrane oxygenation (ECMO) support is a widely accepted treatment option for patients with cardiogenic shock, but it is still related to a high incidence of severe complications and death. We present an alternative implantation technique to prevent life-threatening vascular complications. Methods: Between January 2008 and January 2011, a total of 28 patients with acute myocardial failure and consecutive cardiogenic shock required ECMO as supportive treatment. Pre-implantation procedures were isolated CABG, CABG combined with mitral valve reconstruction or ventricular septal defect closure, respectively. The implantation of ECMO was performed by connecting the ascending aorta via an 8 mm Dacron prosthesis with the arterial line and percutaneous puncture of the femoral vein. The chest was closed after installation of ECMO was completed. The arterial line was directed subxyphoidally and removal was possible without thoracotomy. Results: Average support duration was 8.7 ± 3.9 days. An additional intra-aortic balloon pump was used in 23 patients (89.3%). Cerebrovascular events occurred in 21.4% and gastrointestinal complications in 9.1%. Acute renal failure was treated with continuous renal replacement therapy in 64.3%. In eight cases a systemic infection had to be treated. One patient with pre-existing severe peripheral arterial disease suffered from limb malperfusion, requiring leg amputation. Twelve patients were successfully weaned from ECMO and 8 patients (28.6%) were discharged from hospital. Conclusions: This alternative cannulation strategy offers effective cardiopulmonary support while minimizing the risk of limb hypo- or hyperperfusion without requiring reopening of the thorax. © 2013 Wichtig Editore. Source

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