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Gersak B.,University of Ljubljana | Kiser A.C.,Firsthealth Arrhythmia Center | Bartus K.,Jagiellonian University | Sadowski J.,Jagiellonian University | And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2012

Objective: Atrial fibrillation (AF) is the most frequently diagnosed cardiac arrhythmia. Anti-arrhythmic drugs may be used to suppress ectopic foci and interrupt reentry circuits, but are often insufficient to treat recurrent AF and have a number of adverse effects. Alternative therapies, such as catheter and surgical ablation, have been explored. This investigation examines the importance of assessing exit block when performing surgical ablation during beating-heart treatment of AF. Methods: This was an evaluation of pooled data from multicenter prospective results obtained in AF patients who received ablation with a new, irrigated, vacuum-integrated device that creates linear lesions during beating-heart/open-chest or minimally invasive, portaccess procedures. Electrocardiogram or Holter data were collected intra-operatively and at 1, 3, 6, and 12 months. Outcomes were also evaluated for patients who were or 'were not' tested for exit block following the ablation procedure. Results: A total of 93 patients were treated (61 open-chest surgeries, 32 port-access procedures). There were no device-related complications and no operative mortality. At 341 days' average follow-up, 71/86 (83%) patients were free from AF, 66/86 (77%) were in sinus rhythm, and 60/86 (70%) were free from AF and off Class I and III anti-arrhythmic drugs (AADs). At 12 months, 23/23 (100%) patients with exit block confirmed were AF free compared with 13/21 (62%) patients with exit block not tested (p ≤ 0.01, Fisher's exact test); 20/23 (87%) were in sinus rhythm compared with 12/21 (57%) patients with exit block not tested (p ≤ 0.05, Fisher's exact test); and 20/23 (87%) were AF free without Class I and III AADs compared with 10/21 (48%) patients with exit block not tested (p = 0.01, Fisher's exact test). Both open-chest and port-access procedures yielded decreases in left-atrial size from baseline to 6 months' followup. Patients undergoing port-access procedures also observed an increase in left-ventricular ejection fraction, which was also significant at 6 months. Conclusion: Patients in whom exit block was confirmed following an ablation procedure were more likely to have successful clinical outcomes. Since testing for exit block must be performed on a beating heart, total epicardial beating-heart ablation may provide an important treatment for AF, providing intra-operative feedback indicative of long-term outcomes. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source


Francke A.,Herzzentrum Dresden Gmbiversitatsklinik | Weinert S.,Universitatsklinik For Kardiologie | Strasser R.H.,Herzzentrum Dresden Gmbiversitatsklinik | Braun-Dullaeus R.C.,Universitatsklinik For Kardiologie | Herold J.,Universitatsklinik For Kardiologie
American Journal of Translational Research | Year: 2013

Therapeutic augmentation of collateral artery growth (arteriogenesis) is of tremendous clinical interest. Since monocytes home to areas of arteriogenesis and create a local arteriogeneic milieu by secreting a wide range of growth factors, we followed the idea of utilizing these cells for augmentation of collateral growth. For that purpose, we adoptively transferred both syngeneic (same strain) and allogeneic (different strain) bone marrow derived monocytes (BMDMs) into balb/c mice 24 h after femoral artery ligation. Restoration of hind-limb perfusion was determined by Laser Doppler Perfusion Imaging and histological workup. While syngeneic cell transplantation did not augment arteriogenesis in comparison to non-transplanted animals (PI = 0.56 ± 0.06 vs. 0.48 ± 0.09, respectively, ns), allogeneic monocytes massively promoted the collateralization (PI = 0.85 ± 0.14, p < 0.001). Homed monocytes were visualized near growing collateral vessels by staining the cells with the lipophil fluorochrome DiI prior to transplantation. To analyze whether the effect of allogeneic BMDM transplantations is due to local inflammation triggered by a host-versus-graft reaction, transplant recipients were pre-treated with the immunosuppressive drug cyclosporine A, which completely prevented the effect of allogeineic monocyte transplantation (PI = 0.45 ± 0.06, p < 0.001). Here, we have demonstrated murine allogeneic monocytes to be an attractive way to trigger local inflammatory responses near growing collateral vessels and stimulate their adaption, overcoming the endogenous restriction of collateral vessel growth. Source


Bajenaru L.,Polytechnic University of Bucharest | Berger D.,Polytechnic University of Bucharest | Miclea L.,Carol Davila University of Medicine and Pharmacy | Miclea L.,Herzzentrum Dresden Gmbiversitatsklinik | And 5 more authors.
Journal of Biomedical Materials Research - Part A | Year: 2014

Mesostructured silica is frequently used in biomedical applications, being considered nontoxic and biocompatible material, suitable for the development of drug delivery systems (DDS). Four functionalized MCM-41 silica materials with hydrophobic (methyl and vinyl) and hydrophilic (3-aminopropyl and 3-mercaptopropyl) groups were obtained by post-synthesis functionalization and characterized by smallangle X-ray diffraction, infrared spectroscopy, thermal analysis, and nitrogen adsorption-desorption isotherms. The main structural and textural parameters of the obtained silica were determined. The effect of the functionalized silica on fibroblast (NIH3T3) and melanocyte cells (B16F10) was studied with respect to the proliferation rate and the levels of reactive oxygen species (ROS). It was found that the textural properties of all samples influenced the levels of intracellular ROS and consequently, the proliferation rate. Both, healthy and malignant cells exhibited linear dependence of ROS levels with the specific surface area values, but with different response. The contribution of the methyl functionalized silica to the ROS level is apart to the general trend. © 2014 Wiley Periodicals, Inc. Source


Kappert U.,Herzzentrum Dresden Gmbiversitatsklinik | Joskowiak D.,Herzzentrum Dresden Gmbiversitatsklinik | Tugtekin S.M.,Herzzentrum Dresden Gmbiversitatsklinik | Matschke K.,Herzzentrum Dresden Gmbiversitatsklinik
Clinical Research in Cardiology Supplements | Year: 2011

Calcified aortic stenosis is the predominant valve disease in the western world. Currently, surgical aortic valve replacement is the gold standard procedure for symptomatic severe aortic stenosis that can be performed with low morbidity and mortality. The prevalence of aortic stenosis increases with age, and the incidence of several comorbidities also unavoidably elevates the risk of surgical treatment. Therefore, the most adequate and gentle treatment is needed especially for this population. Since the first transcatheter aortic valve implantation (TAVI) was performed in 2002, the main implanting routes are the transfemoral, retrograde access through the common femoral artery, and the antegrade, transapical approach via anterolateral minithoracotomy. Meanwhile, TAVI has become an alternative treatment for patients who are not suitable candidates for surgical therapy in some centers. The initial clinical results are promising and have confirmed the feasibility of this technique. Due to the restricted long-term data, conventional aortic valve replacement still remains the standard for the treatment of aortic stenosis. Selection of the suitable therapy approach (surgical replacement, transfemoral or transapical aortic valve implantation) must consider each patient's specific risk profile and individual indication. Prospective, randomized trials will be necessary to assess the individual survival benefit of TAVI for various risk populations and to extend the indication. © 2011 Springer-Verlag. Source


Knaut M.A.,Herzzentrum Dresden Gmbiversitatsklinik | Wilbring M.,Herzzentrum Dresden Gmbiversitatsklinik | Alexiou K.,Herzzentrum Dresden Gmbiversitatsklinik | Jung F.,Herzzentrum Dresden Gmbiversitatsklinik
Zeitschrift fur Herz-, Thorax- und Gefasschirurgie | Year: 2013

Atrial fibrillation is a frequent and potentially life-threatening condition, which affects a significant proportion of the general population. The pathogenetic mechanisms, such as loss of atrial transport function and decreased cardiac output are reasons for an increased risk for thromboembolic events and reduction in the quality of life. Conversion to stable sinus rhythm is associated with improvement in quality of life and decreased mortality rates. Although medical therapy is the major component of treatment, surgical therapy for concomitant atrial fibrillation provides excellent clinical results in selected patients. The original and technically demanding cut and sew Cox maze procedure has been continuously refined over the past 25 years. New and innovative line concepts in combination with modern energy sources have made the present Cox maze IV procedure available to many cardiac surgeons. An overview of current line concepts as well as energy sources and associated clinical results is provided. In summary concomitant surgical ablation for treatment of atrial fibrillation is associated with negligible procedural morbidity and provides excellent conversion rates into a stable sinus rhythm. © 2013 Springer-Verlag Berlin Heidelberg. Source

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