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Wallukat G.,Max Delbruck Centrum fur Molekulare Medizin | Wallukat G.,Aptares AG | Haberland A.,Charité - Medical University of Berlin | Berg S.,Institute For Diabetes Gerhardt Katsch | And 9 more authors.
Circulation Journal | Year: 2012

Background: Application of immunoapheresis to eliminate pathogenic autoantibodies targeting the second extracellular loop of the β1-receptor (β1-AABs) is currently investigated in patients with cardiomyopathy. Aptamers (single short DNA or RNA strands) are a new class of molecules that bind to a specific target molecule. This property qualifies aptamers for potential use in the apheresis technique. We recently identified an aptamer that specifically binds to β1-AABs, so in the present study we tested whether this aptamer could be used as a binder to prepare an apheresis column suitable for clearing β1-AABs from rat's blood. Methods and Results: An apheresis column was designed containing the β1-AAB-targeting-aptamer coupled to sepharose. As tested in vitro, this column (1) binds β1-AABs highly specifically without marked interference with common IgGs, (2) has a capacity for clearing of approximately 1L of β1-AAB-positive serum and (3) can be completely regenerated for subsequent use. Using the column for extracorporeal apheresis of spontaneously hypertensive rats (SHR) positive for both β1-AABs and muscarinic 2-receptor autoantibodies (M2-AABs), only β1-AABs were removed. In a follow-up of 9 weeks, recurrence of β1-AABs in the blood of SHR could not be detected. Conclusions: For the first time, a newly designed apheresis column with a β1-AAB specific aptamer as a binder was successfully used to eliminate β1-AABs from SHR blood.


PubMed | Universitats Herzzentrum Freiburg, University Hospital of Tuebingen, Herzzentrum Leipzig GmbH, Deutsches Herzzentrum Munich des Freistaates Bayern and 10 more.
Type: Journal Article | Journal: The Thoracic and cardiovascular surgeon | Year: 2014

Surgical aortic valve replacement is still considered the first-line treatment for patients suffering from severe aortic valve stenosis. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as an alternative for selected high-risk patients. According to the latest results of the German external quality assurance program, mandatory by law, the initially very high mortality and procedural morbidity have now decreased to approximately 6 and 12%, respectively. Especially in Germany, the number of patients treated by TAVI has increased exponentially. In 2013, a total of 10.602 TAVI procedures were performed. TAVI is claimed to be minimally invasive. This is true concerning the access, but it does not describe the genuine complexity of the procedure, defined by the close neighborhood of the aortic valve to delicate intracardiac structures. Hence, significant numbers of life-threatening complications may occur and have been reported. Owing to the complexity of TAVI, there is a unanimous concordance between cardiologists and cardiac surgeons in the Western world demanding a close heart team approach for patient selection, intervention, handling of complications, and pre- as well as postprocedural care, respectively. The prerequisite is that TAVI should not be performed in centers with no cardiac surgery on site. This is emphasized in all international joint guidelines and expert consensus statements. Today, a small number of patients undergo TAVI procedures in German hospitals without a department of cardiac surgery on site. To be noted, most of these hospitals perform less than 20 cases per year. Recently, the German Cardiac Society (DGK) published a position paper supporting this practice pattern. Contrary to this statement and concerned about the safety of patients treated this way, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) still fully endorses the European (ESC/EACTS) and other actual international guidelines and consensus statements. Only the concomitance of departments for cardiac surgery and cardiology on site can provide optimal TAVI care. This commentary by the DGTHG delineates the data and resources upon which its opinion is based.


Markewitz A.,Klinik fur Herz und Gefasschirurgie | Trummer G.,Universitats Herzzentrum Freiburg Bad Krozingen | Pilarczyk K.,University of Duisburg - Essen | Beckmann A.,Deutsche Gesellschaft fur Thorax
Thoracic and Cardiovascular Surgeon | Year: 2014

Background This report summarizes the results of a voluntary survey designed to assess the current situation of cardiac surgical intensive care medicine in Germany in 2013. Methods A standardized questionnaire concerning detailed information about structural characteristics of cardiac surgical intensive care units (ICUs) was sent to all German departments performing cardiac surgery. Results Participation quota resp. response rate was 100%. Compared with previous surveys since 1998, the total number of available intensive care capacities for patients after cardiac surgery increased to 1,404 beds, whereas the proportion of cardiac surgical ICUs decreased to 59% with a simultaneous increase of interdisciplinary ICUs. The proportion of cardiac surgeons acting as director of an ICU declined to 36%. The physicians' teams were predominantly interdisciplinary (74%). More than half of the directors were board-certified intensivists (54%), with a peak of 81% in ICUs run by cardiac surgeons. Human resources development in the ICU showed divergent trends with an increase of physicians and a decrease of nurses. Half of all ICUs (50%) and two-thirds of cardiac surgical ICUs (65%) offer an accredited training program for intensive care medicine. Conclusion The results of this survey corroborate that intensive care medicine represents a substantial and important part of cardiac surgery. However, efforts are necessary to keep this attitude alive for the future. © Georg Thieme Verlag KG.


PubMed | Universitats Herzzentrum Freiburg Bad Krozingen, Deutsche Gesellschaft fur Thorax, Klinik fur Herz und Gefasschirurgie and University of Duisburg - Essen
Type: Journal Article | Journal: The Thoracic and cardiovascular surgeon | Year: 2014

This report summarizes the results of a voluntary survey designed to assess the current situation of cardiac surgical intensive care medicine in Germany in 2013.standardized questionnaire concerning detailed information about structural characteristics of cardiac surgical intensive care units (ICUs) was sent to all German departments performing cardiac surgery.Participation quota resp. response rate was 100%. Compared with previous surveys since 1998, the total number of available intensive care capacities for patients after cardiac surgery increased to 1,404 beds, whereas the proportion of cardiac surgical ICUs decreased to 59% with a simultaneous increase of interdisciplinary ICUs. The proportion of cardiac surgeons acting as director of an ICU declined to 36%. The physicians teams were predominantly interdisciplinary (74%). More than half of the directors were board-certified intensivists (54%), with a peak of 81% in ICUs run by cardiac surgeons. Human resources development in the ICU showed divergent trends with an increase of physicians and a decrease of nurses. Half of all ICUs (50%) and two-thirds of cardiac surgical ICUs (65%) offer an accredited training program for intensive care medicine.The results of this survey corroborate that intensive care medicine represents a substantial and important part of cardiac surgery. However, efforts are necessary to keep this attitude alive for the future.


Coronary-subclavian steal syndrom (CSS) is defined as a reversal of flow in a previously constructed internal mammary artery coronary conduit, producing myocardial ischemia. The most often cause is a proximal subclavian artery stenosis or closure. For the first time was CSS described in 1974 and initially was believed to be rare. However, today is the internal mammary artery to the left anterior descending coronary artery used in cardiosurgery as a standard and we can see increasing documentation of this phenomenon. A case report is presented and possibilities of management are discussed in the article.


Mitral valve regurgitation is one of the most important and frequent valve diseases in the western hemisphere. Primary mitral valve regurgitation is due to pathological alterations of the valve structure itself, whereas secondary mitral valve regurgitation is due to pathology of the left ventricle which ultimately leads to deterioration of mitral valve functioning and mitral regurgitation. The diagnostic pathway requires various cardiovascular examinations. Central diagnostic tool resembles echocardiography which provides besides visual impressions semi quantitative and quantitative parameters. Treatment options in patients with mitral valve regurgitation are based on interdisciplinary discussion between cardiologists and heart surgeons in the heart team. Besides the conservative treatment including medical and device heart failure therapy, surgical and interventional procedures are to be discussed in order to reduce mitral valve regurgitation. The decision making is greatly influenced by the nature of mitral valve regurgitation and by the concomitant comorbidities. © 2013 Springer-Verlag Berlin Heidelberg.


Eicken A.,Klinik fur Kinderkardiologie und Angeborene Herzfehler | Schubert S.,Klinik fur Kinderkardiologie und Angeborene Herzfehler | Hager A.,Klinik fur Kinderkardiologie und Angeborene Herzfehler | Horer J.,Klinik fur Herz und Gefasschirurgie | And 4 more authors.
Circulation: Cardiovascular Interventions | Year: 2015

Background - Severe tricuspid valve (TV) dysfunction may lead to surgical TV replacement with a biological valve prosthesis in patients with congenital heart disease. To expand the lifetime of this valve and reduce the number of surgeries, percutaneous TV implantation (PTVI) may be an effective alternative to repeated surgery. We report on our 2-center experience with PTVI. Methods and Results - Between 2008 and 2014, 17 percutaneous valves were implanted in 16 patients with TV bioprosthesis dysfunction (9 females) from 2 centers. Median age and weight were 31.3 years (5-77.2) and 65.2 kg (17.7-107); 14 patients had congenital heart disease (univentricular heart with a right atrial to right ventricle bioprosthesis in 3, Ebstein's anomaly of the TV in 5, and other in 6), and 2 had acquired TV dysfunction. All procedures were successful (Melody n=7, Sapien 26 mm valve n=4, Sapien XT 29 mm valve n=6). One valve showed early dysfunction. It was replaced surgically and shortly after that a repeated PTVI was performed. The median duration of follow-up was 2.1 years (3 days to 6.3 years). The percutaneous valve was performing well in 15 of 16 patients. Conclusions - PTVI was safe and effectively improved TV function in all but 1 patient at midterm follow-up. We think that PTVI is a good alternative to repeated surgical TV replacements and that it may reduce the total number of open heart surgeries in these patients. © © 2015 American Heart Association, Inc.


Bleiziffer S.,Klinik fur Herz und Gefasschirurgie
Zeitschrift fur Herz-, Thorax- und Gefasschirurgie | Year: 2010

This article outlines the current proportion of women in cardiac surgery in Germany in different positions ranging from medical school to chief of department. The special features of the cardiac surgeon's profession are reviewed from the female author's personal point of view. © 2010 Springer-Verlag.


Hartig I.,Klinik fur Rheumatologie und Immunologie | Kraatz E.-G.,Klinik fur Herz und Gefasschirurgie | Beurich H.-W.,Klinik fur Kardiologie und Angiologie | Moosig F.,Klinik fur Rheumatologie und Immunologie
Zeitschrift fur Rheumatologie | Year: 2014

Atrial myxomas are detectable in 0.3∈% of all autopsies and women are affected three times more often than men. The overall incidence of myxoma is relatively rare with 0.5 per one million inhabitants per year. Clinical signs, such as palpitations, dyspnea, dizziness and syncope or thromboembolic events may be found. Microembolic infarction or a higher expression of interleukin 6 may lead to misdiagnosis, such as vasculitis. This article presents the case of a 25-year-old woman with arthralgia, dysesthesia, staggering vertigo, cutaneous nodules and disturbed vision. Diagnostic procedures did not reveal a reason for these complaints. A therapeutic test with prednisolone did not improve the symptoms. Finally echocardiography showed a large space-occupying lesion in the left atrium which oscillated into the left ventricle during diastole. The patient was transferred to the department of cardiac surgery where the atrial myxoma could be removed without any complications and the patient ultimately made a complete recovery. © 2014 Springer-Verlag Berlin Heidelberg.


Rastan A.J.,Klinik fur Herz und Gefasschirurgie
Zeitschrift fur Herz-, Thorax- und Gefasschirurgie | Year: 2013

Indications, procedural concepts and technical details of the coronary artery bypass graft (CABG) operation are continuously reassessed by cardiac surgeons and cardiologists. In particular, CABG in patients presenting with complex coronary artery disease is continuously challenged by interventional cardiology. However, considering current comparative studies, CABG remains the first line therapy for patients presenting with coronary three-vessel disease and/or left main stem stenosis. This is even more important for severely diseased coronary arteries or in complex lesions. However, cardiac surgeons now more than ever before need a profound knowledge of their own and the cardiologists' work scope to be a strong partner in heart team discussions and a reliable guardian of the patient. The current educational paper aims at presenting important and well accepted aspects of coronary artery bypass surgery. Technical aspects as well as updated study results on early and late patient outcome will be discussed. © 2013 Springer-Verlag Berlin Heidelberg.

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