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Eide M, Jussli-Melchers J, Friedrich C, Haneya A, Lutter G, Cremer J, Schoettler J. Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery-Comparison of the Great Saphenous Vein with the Radial Artery. Thorac Cardiovasc Surg 2023. [PMID: 37506730 DOI: 10.1055/s-0043-1771358] [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: 07/30/2023]
Abstract
BACKGROUND Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. METHODS Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. RESULTS A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac-cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan-Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. CONCLUSION CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.
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Affiliation(s)
- M Eide
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Jussli-Melchers
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - C Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - A Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - G Lutter
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
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De Silva N, Salem M, Friedrich C, Diraz S, Broll A, Pommert NS, Puehler T, Schoettler J, Cremer J, Haneya A. Does Duration of Aortic Cross Clamp Affect Outcome in Patients Undergoing Surgical Repair of Acute Dissection of Aorta Type A? A Large Retrospective Cohort Study. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761659] [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: 03/22/2023]
Affiliation(s)
- N. De Silva
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M. Salem
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S. Diraz
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Broll
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - N. S. Pommert
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - T. Puehler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - J. Cremer
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A. Haneya
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Salem M, Friedrich C, Herbers L, Reimers J, Friedrichs A, Lutter G, Thiem A, Panholzer B, Puehler T, Schoettler J, Frank D, Schoeneich F, Cremer J, Haneya A. Surgical Treatment for Active Infective Prosthetic Valve Endocarditis: A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725753] [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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Kapahnke J, Huenges K, Salem M, Kolat P, Schoettler J, Schoeneich F, Puehler T, Friedrich C, Cremer J, Haneya A. The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome? Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705505] [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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Tulun A, Panholzer B, Schoeneich F, Schoettler J, Puehler T, Cremer J, Haneya A. Outcome of Postinfarction Ventricular Septal Defect Repair in the Era of Mechanical Circulatory Support. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705347] [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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Puehler T, Salem M, Huenges K, Panholzer B, Friedrich C, Schoettler J, Schoeneich F, Cremer J, Haneya A. Is Total Arch Replacement Associated with an Increased Risk for 30-day Mortality after Surgery for Acute Type A Dissection. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627889] [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)
- T. Puehler
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - M. Salem
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - K. Huenges
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - B. Panholzer
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - F. Schoeneich
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - J. Cremer
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - A. Haneya
- Department of Cardiovascular Surgery, University Schleswig-Holstein Campus Kiel, Kiel, Germany
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Salem M, Salem A, Düver S, Erdal Y, Psykalla N, Friedrich C, Panholzer B, Huenges K, Pühler T, Schoettler J, Schoeneich F, Cremer J, Haneya A. Effect of Deep Hypothermia Circulatory Arrest on Neurological Outcomes in Patients Undergoing Replacement of Ascending Aorta: A Comparison between Young and Elderly Adults. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628051] [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)
- M. Salem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A. Salem
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S. Düver
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Y. Erdal
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N. Psykalla
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - B. Panholzer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K. Huenges
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T. Pühler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - F. Schoeneich
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A. Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Grothusen C, Ohnewald E, Friedrich C, Ashbahs M, Meinert J, Huenges K, Attmann T, Haneya A, Schoettler J, Cremer J. Sex-dependent Differences after Early Operative Myocardial Revascularization in Acute Myocardial Infarction. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627489] [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)
- C. Grothusen
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - E. Ohnewald
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M. Ashbahs
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Meinert
- Klinik für Innere Medizin IV mit den Schwerpunkten Nieren- und Hochdruckkrankheiten, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K. Huenges
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T. Attmann
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A. Haneya
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J. Cremer
- Klinik für Herz-und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Grothusen C, Friedrich C, Loehr J, Meinert J, Ohnewald E, Ulbricht U, Attmann T, Haneya A, Huenges K, Cremer J, Schoettler J. Short- and Long-Term Outcome of Patients with Acute Myocardial Infarction and Coronary Artery Bypass Surgery within 48 Hours. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598764] [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)
- C. Grothusen
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - C. Friedrich
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Loehr
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Meinert
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - E. Ohnewald
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - U. Ulbricht
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - T. Attmann
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - A. Haneya
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - K. Huenges
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Cremer
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
| | - J. Schoettler
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
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Iino K, Boldt J, Lozonschi L, Metzner A, Schoettler J, Petzina R, Cremer J, Lutter G. Off-pump transapical mitral valve replacement: evaluation after one month. Eur J Cardiothorac Surg 2012; 41:512-7. [DOI: 10.1093/ejcts/ezr106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Katz RM, Friedman S, Diament M, Siegel SC, Rachelefsky GS, Spector SL, Rohr AS, Schoettler J, Dorris A. A comparison of imaging techniques in patients with chronic sinusitis (X-ray, MRI, A-mode ultrasound). Allergy Proc 1995; 16:123-7. [PMID: 7557370 DOI: 10.2500/108854195778690273] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Thirty-five patients age 9 to 67 were evaluated for chronic sinusitis by history, physical and laboratory examination, and imaging techniques (X-ray, magnetic resonance imaging (MRI) and flexible rhinoscopy). MRI was the most predictive. To establish the diagnosis of sinusitis, it was more sensitive than plain X-ray for intrasinus disease. Findings of edema, erythema, and drainage on flexible rhinoscopy were consistent with chronic sinusitis and were confirmed by MRI and sinus X-rays in 41% of the cases. Nasal smears for polymorphonuclear cells and eosinophils were suggestive of a diagnosis of chronic sinusitis, but other laboratory tests (CBC, sedimentation rate, quantitative immunoglobulins, total IgEs) were of very limited value in the diagnosis of chronic sinusitis.
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Affiliation(s)
- R M Katz
- Department of Pediatrics, UCLA School of Medicine, USA
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Arruda LK, Mimica IM, Solé D, Weckx LL, Schoettler J, Heiner DC, Naspitz CK. Abnormal maxillary sinus radiographs in children: do they represent bacterial infection? Pediatrics 1990; 85:553-8. [PMID: 2107515] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Thirty-three children with chronic tonsillitis and/or adenoid enlargement and without previous diagnosis of sinusitis were studied regarding the bacterial flora of their maxillary sinuses. Puncture of maxillary sinus was performed at surgery (adenoidectomy and/or tonsillectomy) and aspirates were cultured. Streptococcus pneumoniae was isolated from 8 of 12 (66.7%) patients whose x-rays showed completely opacified maxillary sinus. Streptococcus viridans, Streptococcus faecalis, and Staphylococcus epidermidis were recovered from 6 (28.6%) of the 21 patients with normal maxillary sinus radiographs. Bacterial titers were greater than 10(4) colonies/mL in all but one of the positive cultures. No anaerobic bacteria were isolated. History of bronchial asthma, presence of nasal purulent secretion, elevated blood eosinophils, and elevated serum IgE were found more frequently in children with complete opacification of maxillary sinus. Serum levels of IgG2 were low in 29% of the children, but no correlation was found between low IgG2 levels and positive cultures from maxillary sinus aspirates. We concluded that children with complete radiologic opacification of maxillary sinus had bacterial infection in almost 70% of the cases with symptoms that did not prompt their physicians to consider the diagnosis of sinusitis.
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Affiliation(s)
- L K Arruda
- Division of Allergy, Paulista School of Medicine, São Paulo, Brazil
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