151
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Paluszkiewicz L, Schulte-Eistrup S, Körtke H, Morshuis M, Gummert J. Thrombosis of the LVAD inflow cannula detected by transthoracic echocardiography: 2D and 3D thrombus visualization. Echocardiography 2011; 28:E194-5. [PMID: 21854432 DOI: 10.1111/j.1540-8175.2011.01480.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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152
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Frerichs O, Morshuis M, Schoenbrodt M, Gummert J, Fansa H. [Reconstructive surgery in patients with a ventricular assist device (VAD)--an interdisciplinary challenge]. HANDCHIR MIKROCHIR P 2011; 44:97-102. [PMID: 21755490 DOI: 10.1055/s-0031-1279763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Ventricular assist devices (VAD) are implanted with a growing frequency in patients with end-stage heart failure. In spite of technical and therapeutic advances, there is still a high incidence of device infections and healing disturbances with a considerable mortality. Reconstructive plastic surgery is able to provide help in erradicating infections and covering defects. PATIENTS AND METHODS 11 patients with device infections and soft tissue defects were treated in our institution. All cases were treated with local myocutaneous or muscle flaps. RESULTS Three patients had postoperative haematomas which had to be revised surgically. One patient had a persistent fistula of mediastinal origin but without clinical symptoms of infection. One patient exhibited an enterocutaneous fistula after defect coverage. CONCLUSION Patients with VADs have a high possibility of perioperative complications. Therefore a close interdisciplinary approach with plastic and cardiovascular surgeons is absolutely essential.
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153
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Reiss N, Schulz U, Wlost S, Schulte-Eistrup S, Morshuis M, Gummert J. Heart transplantation with and without previous VAD support - influence of different support systems on posttransplant outcome. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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154
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Erkilet G, Schulte-Eistrup S, Morshuis M, Bohms B, Röfe D, Gummert J, Milting H. Plasma galectin 3 is increased in terminal heart failure patients and is elevated in patients not surviving mechanical circulatory support. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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155
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Arusoglu L, Reiss N, Morshuis M, Schoenbrodt M, Hakim-Meibodi K, Gummert J. The Thoratec system implanted as a modified total artificial heart: the Bad Oeynhausen technique. Heart Surg Forum 2010; 13:E391-3. [PMID: 21169150 DOI: 10.1532/hsf98.20101142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The CardioWest™ total artificial heart (SynCardia Systems, Tuscon, AZ, USA) is the only FDA-approved total artificial heart determined as a bridge to human heart transplantation for patients dying of biventricular heart failure. Implantation provides immediate hemodynamic restoration and clinical stabilization, leading to end-organ recovery and thus eventually allowing cardiac transplantation. Occasionally, implantation of a total artificial heart is not feasible for anatomical reasons. For this patient group, we have developed an alternative technique using the paracorporeal Thoratec biventricular support system (Thoratec, Pleasanton, CA, USA) as a modified total artificial heart. A detailed description of the implantation technique is presented.
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156
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Schwientek P, Ellinghaus P, Steppan S, D'Urso D, Seewald M, Kassner A, Cebulla R, Schulte-Eistrup S, Morshuis M, Röfe D, El Banayosy A, Körfer R, Milting H. Global gene expression analysis in nonfailing and failing myocardium pre- and postpulsatile and nonpulsatile ventricular assist device support. Physiol Genomics 2010; 42:397-405. [DOI: 10.1152/physiolgenomics.00030.2010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mechanical unloading by ventricular assist devices (VAD) leads to significant gene expression changes often summarized as reverse remodeling. However, little is known on individual transcriptome changes during VAD support and its relationship to nonfailing hearts (NF). In addition no data are available for the transcriptome regulation during nonpulsatile VAD support. Therefore we analyzed the gene expression patterns of 30 paired samples from VAD-supported (including 8 nonpulsatile VADs) and 8 nonfailing control hearts (NF) using the first total human genome array available. Transmural myocardial samples were collected for RNA isolation. RNA was isolated by commercial methods and processed according to chip-manufacturer recommendations. cRNA were hybridized on Affymetrix HG-U133 Plus 2.0 arrays, providing coverage of the whole human genome Array. Data were analyzed using Microarray Analysis Suite 5.0 (Affymetrix) and clustered by Expressionist software (Genedata). We found 352 transcripts were differentially regulated between samples from VAD implantation and NF, whereas 510 were significantly regulated between VAD transplantation and NF (paired t-test P < 0.001, fold change ≥1.6). Remarkably, only a minor fraction of 111 transcripts was regulated in heart failure (HF) and during VAD support. Unsupervised hierarchical clustering of paired VAD and NF samples revealed separation of HF and NF samples; however, individual differentiation of VAD implantation and VAD transplantation was not accomplished. Clustering of pulsatile and nonpulsatile VAD did not lead to robust separation of gene expression patterns. During VAD support myocardial gene expression changes do not indicate reversal of the HF phenotype but reveal a distinct HF-related pattern. Transcriptome analysis of pulsatile and nonpulsatile VAD-supported hearts did not provide evidence for a pump mode-specific transcriptome pattern.
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157
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Arusoglu L, Morshuis M, Reiss N, Schönbrodt M, Hakim-Meibodi K, Gummert J. Modified implantation technique of the CardioWest total artificial heart – surgical tipps and tricks. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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158
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Schulte-Eistrup S, Schulz U, Morshuis M, Schönbrodt M, Zittermann A, Milting H, Arusoglu L, Gummert J. Probability of survival after orthotopic heart transplantation versus non-pulsatile left ventricular support. A comparative single center analysis. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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159
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Gaertner A, Kassner A, Schulte-Eistrup S, Morshuis M, El-Banayosy A, Gummert J, Milting H. 182: Regulation of Collagen and Prolyl-4-Hydroxylase during Ventricular Assist Device (VAD) Support: Collagen Regulation during VAD-Support Depends on the Degree of Remodelling at the Time of VAD-Implantation. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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160
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Reiss N, Arusoglu L, Morshuis M, Börgermann J, Hakim-Meibodi K, Gummert J. Implantation technique of the thoratec system as a modified total artificial heart. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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161
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Erkilet G, Schulte-Eistrup S, Morshuis M, Bohms B, Roefe D, Gummert J, Milting H. 181: Plasma Galectin 3 Is Increased in Terminal Heart Failure Patients and Is Elevated in Patients Not Surviving Mechanical Circulatory Support. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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162
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Schönbrodt M, Özpeker C, Morshuis M, Cantow J, Arusoglu L, Gummert J. Kunstherzimplantation als ultima ratio bei fulminantem kardiogenem Schock. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2010. [DOI: 10.1007/s00398-009-0760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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163
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Kassner A, Bohms B, Morshuis M, Schulte-Eistrup S, Gummert J, Milting H. 555: DNA-Methylation of the Human b1-Adrenergic Receptor Core Promoter Pre and Post VAD-Support and Its Putative Role for Gene Silencing in the Terminal Failing Myocardium. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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164
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Strueber M, Jansz P, Wieselthaler G, O'Driscoll G, Morshuis M, Khaghani A, Schueler S, Hetzer R, Hoffmeier A, Duveau D. 291: Evaluation of the Minimally Invasive HeartWare® Ventricular Assist System as a Long Term Support Device. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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165
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Bechtel JFM, Wellhöner P, Charitos EI, Bucsky B, Morshuis M, Sievers HH. Localizing an occult gastrointestinal bleeding by wireless PillCam SB capsule videoendoscopy in a patient with the HeartMate II left ventricular assist device. J Thorac Cardiovasc Surg 2009; 139:e73-4. [PMID: 19660366 DOI: 10.1016/j.jtcvs.2008.08.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 08/16/2008] [Accepted: 08/16/2008] [Indexed: 01/08/2023]
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166
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Morshuis M, El-Banayosy A, Arusoglu L, Koerfer R, Hetzer R, Wieselthaler G, Pavie A, Nojiri C. European experience of DuraHeart magnetically levitated centrifugal left ventricular assist system. Eur J Cardiothorac Surg 2009; 35:1020-7; discussion 1027-8. [PMID: 19233673 DOI: 10.1016/j.ejcts.2008.12.033] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 12/14/2008] [Accepted: 12/16/2008] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The DuraHeart (Terumo Heart, Inc., Ann Arbor, Michigan, USA) is the world's first approved magnetically levitated centrifugal left ventricular assist system designed for long-term circulatory support. We report the clinical outcomes of 68 patients implanted with the DuraHeart as a bridge to cardiac transplantation in Europe. METHODS Sixty-eight patients with advanced heart failure (six females), who were eligible for cardiac transplantation were implanted with the DuraHeart between January 2004 and July 2008. Median age was 58 (range: 29-74) years with 31% over 65 years. Thirty-three of these patients received the device as a part of the European multi-center clinical trial. Survival analyses were conducted for 68 patients and other safety and performance data were analyzed based on 33 trial patients. RESULTS Mean support duration was 242+/-243 days (range: 19-1148, median: 161) with a cumulative duration of 45 years. Thirty-five patients (51%) remain ongoing, 18 transplanted, 1 explanted, and 14 died during support with a median time to death of 62 days. The Kaplan-Meier survival rate during support was 81% at 6 months and 77% at 1 year. Of the 13 patients (21%) supported for >1 year, 4 supported for >2 years, 1 supported >3 years, 2 transplanted, 2 died, and 9 ongoing with a mean duration of 744+/-216 days (range: 537-1148, median: 651). Major adverse events included driveline/pocket infection, stroke, bleeding, and right heart failure. There was no incidence of pump mechanical failure, pump thrombosis, or hemolysis. CONCLUSIONS The DuraHeart was able to provide safe and reliable long-term circulatory support with an improved survival and an acceptable adverse event rate in advanced heart failure patients who were eligible for transplantation.
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167
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Gezelbash S, Niehaus K, Neuweger H, Schwientek P, Morshuis M, Schulte-Eistrup S, Koerfer R, Milting H. 50: Metabolomic Profiling of the Terminal Failing Human Myocardium Pre and Post Mechanical Unloading by Ventricular Assist Devices. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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168
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Schulte-Eistrup S, Morshuis M, Bohms B, Röfe D, Körfer R, Milting H. Plasma galectin 3 is increased in terminal heart failure patients and is predictive for the survival of mechanical circulatory support. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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169
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Morshuis M, Arusoglu L, Schönbrodt M, Koerfer R. A single centre experience using the VentrAssist™ LVAD in 32 patients with end stage heart failure. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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170
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Kizner L, Reiss N, Morshuis M, Körfer R. The Centrimag support system – experiences with 227 implantations in adults. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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171
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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172
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El-Banayosy A, Arusoglu L, Morshuis M, Kizner L, Cobaugh D, Koerfer R. 290: Safety of Managing Rotary Blood Pumps with a Mild Anticoagulation Regimen. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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173
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Cakar H, Stühler K, Grzendowski M, Hawranke E, Meyer H, Morshuis M, Röfe D, Körfer R, El Banayosy A, Milting H. 100: Proteomics Analysis of the Terminal Failing Heart Supported by Ventricular Assist Devices. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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174
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Tjang YS, Blanz U, Hornik L, Tenderich G, Morshuis M, Stenlund H, Bairaktaris A, Körfer R. Heart Transplantation in Children: Clinical Outcomes in a Single Center. Ann Thorac Surg 2007; 84:1640-4. [DOI: 10.1016/j.athoracsur.2007.05.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 05/24/2007] [Accepted: 05/29/2007] [Indexed: 10/22/2022]
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175
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Morshuis M, Reiss N, Arusoglu L, Tenderich G, Körfer R, El-Banayosy A. Implantation of Cardio West Total Artificial Heart for Irreversible Acute Myocardial Infarction Shock. Heart Surg Forum 2007; 10:E251-6. [PMID: 17525048 DOI: 10.1532/hsf98.20070706] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients who develop cardiogenic shock after acute myocardial infarction have a very high mortality rate despite early reperfusion therapy. Hemodynamic stabilization can often only be achieved by implanting a mechanical circulatory support system. When, in cases representing expansive myocardial impairment without any chance of recovery, pharmacological therapy and the use of percutaneous assist devices have failed, the implantation of a total artificial heart is indicated. We report our first experiences with this extensive and innovative method of managing irreversible cardiogenic shock patients. The CardioWest total artificial heart was implanted in 5 patients (male; mean age, 50 years). All patients were in irreversible cardiogenic shock despite maximum dosages of catecholamines, an intra-aortic balloon pump and/or a femoro-femoral bypass. In all patients early reperfusion therapy was performed. After implantation of the Cardio West system, all dysfunctional organ systems rapidly recovered in all patients. Four of 5 patients underwent successful heart transplantation after a mean support time of 156 days. One patient died because of enterocolic necroses caused by an embolic event after termination of dicumarol therapy. In summary, our first experiences justify this extensive management in young patients who would otherwise have died within a few hours.
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