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Messer S, Rushton S, Simmonds L, Macklam D, Husain M, Jothidasan A, Large S, Tsui S, Kaul P, Baxter J, Osman M, Mehta V, Russell D, Stock U, Dunning J, Saez DG, Venkateswaran R, Curry P, Ayton L, Mukadam M, Mascaro J, Simmonds J, Macgowan G, Clark S, Jungschleger J, Reinhardt Z, Quigley R, Speed J, Parameshwar J, Jenkins D, Watson S, Marley F, Ali A, Gardiner D, Rubino A, Whitney J, Beale S, Slater C, Currie I, Armstrong L, Foley J, Ryan M, Gibson S, Quinn K, Macleod AM, Spence S, Watson CJE, Catarino P, Clarkson A, Forsythe J, Manas D, Berman M. A national pilot of donation after circulatory death (DCD) heart transplantation within the United Kingdom. J Heart Lung Transplant 2023; 42:1120-1130. [PMID: 37032222 DOI: 10.1016/j.healun.2023.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/10/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. METHODS This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. RESULTS From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). CONCLUSION During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors.
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Affiliation(s)
- Simon Messer
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Golden Jubilee University National Hospital, Glasgow, Scotland
| | - Sally Rushton
- National Health Service Blood and Transplant, Bristol, UK
| | - Lewis Simmonds
- National Health Service Blood and Transplant, Bristol, UK
| | - Debbie Macklam
- National Health Service Blood and Transplant, Bristol, UK
| | | | | | - Stephen Large
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Steven Tsui
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Pradeep Kaul
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Mohamed Osman
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | | | - Derval Russell
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | - Uli Stock
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | - John Dunning
- Royal Brompton and Harefield Hospital, Harefield, Uxbridge, UK
| | | | | | - Philip Curry
- Golden Jubilee University National Hospital, Glasgow, Scotland
| | - Lynne Ayton
- Golden Jubilee University National Hospital, Glasgow, Scotland
| | | | | | | | - Guy Macgowan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Stephen Clark
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | - Zdenka Reinhardt
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | | | - Jane Speed
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - David Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sarah Watson
- National Health Service England, Highly Specialised Services, London, UK
| | - Fiona Marley
- National Health Service England, Highly Specialised Services, London, UK
| | - Ayesha Ali
- National Health Service England, Highly Specialised Services, London, UK
| | - Dale Gardiner
- National Health Service Blood and Transplant, Bristol, UK
| | - Antonio Rubino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; National Health Service Blood and Transplant, Bristol, UK
| | - Julie Whitney
- National Health Service Blood and Transplant, Bristol, UK
| | - Sarah Beale
- National Health Service Blood and Transplant, Bristol, UK
| | | | - Ian Currie
- National Health Service Blood and Transplant, Bristol, UK
| | - Liz Armstrong
- National Health Service Blood and Transplant, Bristol, UK
| | - Jeanette Foley
- National Health Service Blood and Transplant, Bristol, UK
| | - Marian Ryan
- National Health Service Blood and Transplant, Bristol, UK
| | - Sharon Gibson
- National Health Service Blood and Transplant, Bristol, UK
| | - Karen Quinn
- National Health Service Blood and Transplant, Bristol, UK
| | | | | | | | - Pedro Catarino
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | - John Forsythe
- National Health Service Blood and Transplant, Bristol, UK
| | - Derek Manas
- National Health Service Blood and Transplant, Bristol, UK
| | - Marius Berman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; National Health Service Blood and Transplant, Bristol, UK.
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Riesgo Gil F, Gallone G, Morley-Smith A, Dar O, Ibero Valencia J, Monteagudo Vela M, Fiorelli F, Konicoff M, Edwards G, Raj B, Shanmuganathan M, Frea S, De Ferrari G, Panoulas V, Stock U, Bowles C, Dunning J. Assessment of the Optimal Echocardiographic Profile on Left Ventricular Assist Device Support: Consider the Right Parameters. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Gallone G, Valencia JI, Morley-Smith A, Dar O, Vela MM, Fiorelli F, Konicoff M, Edwards G, Raj B, Shanmuganathan M, Frea S, De Ferrari G, Panoulas V, Stock U, Bowles C, Dunning J, Gil FR. Association of Neurohormonal Blockade with Clinical Outcomes Among Patients with Advanced Heart Failure on Left Ventricular Assist Device Support. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ahmed H, Zeschky C, Alayyar M, Husain M, Jothidasan A, Padukone A, Bello S, Marczin N, Smail H, Stock U. Long Term Outcomes of Minimally Invasive Lung Transplantation Compared to Clamshell Approach. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Zeschky C, Ahmed H, AlAyyar M, Jothidasan A, Husain M, Stock U, Smail H. ‘Long-Term’ Use of Impella - Safe to Do? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mohite P, Umakumar K, Garcia-Saez D, Raj B, Smail H, DeRobertis F, Mahesh B, Stock U, Marczin N, Simon A. Heart Transplantation Utilizing Organs Following Donation After Circulatory Death (DCD). J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Jothidasan A, Husain M, Garcia D, Berman M, Currie I, Stock U. Direct Lung Procurement with Ongoing Abdominal Normothermic Regional Perfusion. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ahmed H, Alayyar M, Jothidasan A, Husain M, Zeschky C, Umakumar K, Padukone A, Smail H, De Robertis F, Stock U. Thermographic Imaging of Lungs Procured and Transported on Ice. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alayyar M, Hassan H, Zeschky C, Smail H, Stock U. A Novel Controlled Cold Storage System for Optimal Lung Preservation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ahmed H, Husain M, Jothidasan A, Zeschky C, Zych B, Stock U. Lung Transplant from a DCD Donor with a Previous Symptomatic COVID Infection. J Heart Lung Transplant 2022. [PMCID: PMC8988545 DOI: 10.1016/j.healun.2022.01.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a worldwide pandemic affecting more than 172 million confirmed cases. The likelihood of historic donor infection is increasing. Here we report a lung transplantation of a previously SARS-CoV-2 positive organ donor. Case Report A 49-year-old female who underwent left single lung transplantation for interstitial lung disease. The lung was obtained from a donation after cardiac death (DCD) using abdominal rerperfusion of a 23 years old female donor died of intracranial bleeding with history of covid infection 8 month prior to lung donation. According to the donor records, the symptoms were mild, and required no hospital admission. She had ongoing loss of taste and smell till time of donation. There were no respiratory symptoms. At time of retrieval, chest x ray was normal and blood gases were normal, however, bronchoscopy revealed severe inflammation of the right-side mucosa so the decision was to proceed with the left lung only as it had normal blood gases, good recruitment and no consolidation as well as non inflamed bronchial mucosa. patient had single off pump left lung transplant through left anterior thoracotomy approach. After the surgery, patient was extubated on day 1 in ICU, discharged from ICU on day 3 and discharged from the hospital after 27 days. There was no evidence for primary graft dysfunction or acute rejection. After 6 month of the surgery, FVC is 2.26 L (78.2% predicted) and FEV1 is 1.9L (70.2% predicted). Summary This case showed that it is possible to proceed with lung transplant from a donors who had previous mild covid infection. As DCD donation might limit preoperative invasive investigations such as bronchoscopies careful examination and proper radiological and functional assessment for the donor lung after donation including EVLP needs to be considered.
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Husain M, Jothidasan A, Zeschky C, Garcia D, Smail H, Padukone A, Ahmed H, Khoshbin E, Stock U. Direct Procurement of Thoracic Organs Along with Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Mohite P, Umakumar K, Khatun T, Raj B, Garcia-Saez D, Stock U, Simon A, Marczin N. Lactic Acid and Metabolic Analysis of Human Donor Hearts Preserved with Organ Care System. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ali J, Mumford L, Smith F, Stock U, Mascaro J, Curry P, Venkateswaran R, Clark S, Parameshwar J, Al-Attar N, Berman M. Impact of Donor and Recipient Age on 5-year Survival Following Heart Transplantation: A 24-year National Analysis from the United Kingdom. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sef AV, Sef D, Mohite P, Saez DG, Trkulja V, Raj B, Reed A, Doce AH, Lees N, Mahesh B, De Robertis F, McGovern I, Simon A, Stock U. Early Results after Lung Transplantation in Patients Bridged with Extracorporeal Life Support: Experience from a 7-year Period. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vela MM, Saez DG, Mohite P, Reed A, De Robertis F, Stock U, Mahesh B, Carby M, Simon A, Zych B. Mid-Term Results of Lung Transplantation (LTx) after Bridging with Extracorporeal Membrane Oxygenation - Influence of Concomitant Invasive Mechanical Ventilation (iMV). J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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García Sáez D, Zych B, Mohite P, Bowles C, De Robertis F, Mahesh B, Stock U, Bahrami T, Maunz O, Banner N, Riesgo Gil F, Dar O, Simon A. Midterm Followup of Heart Transplantation With Ex vivo Normothermic Preservation Using Extended Criteria Donor Hearts. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Smail H, Hassan H, Bowles C, Stock U, Mohite P, Benedetti G, Garcia-saez D, Zych B, Hussain M, Jothidasan A, Motagudo-vera M, Balakrishnan M, De Robertis F, Simon A. Impaired Baseline Renal Function May Not Influence Long Term Renal Function and Survival After LVAD Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Stock U, Bohuslavizki KH, Brenner W, Costard-Jaekle A, Cremer J, Clausen M, Tönshoff G. Szintigraphischer Nachweis einer stillen Aspiration nach beidseitiger Lungentransplantation. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungVorgestellt wird der Fall einer 25jährigen Patientin nach beidseitiger Lungentransplantation und rezidivierenden Pneumonien. Klinisch bestand der Verdacht auf eine stille Aspiration. Szintigraphisch gelang sowohl der Aspirationsnachweis als auch eine Differenzierung hinsichtlich der Genese: direkte oro-pulmonale Aspiration versus Aspiration nach gastro-öspohagealem Reflux.
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Beiras-Fernandez A, Rothkopf J, Kreth S, Kornberger A, Stock U, Beiras A, Moritz A, Werner I. Myocardial Expression of Neuregulin-1 and Its Receptor ErbB4 in Patients with Chronic Heart Failure. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Papadopoulos N, Zierer A, Stock U, Miscovic A, Karimian-Tabrizi A, Moritz A. Fifteen Years of Minimally Invasive Mitral Valve Surgery: Single Centre Results in 1006 Patients. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wöhrle A, Bingold T, Keller H, Kornberger A, Beiras-Fernandez A, Moritz A, Stock U. Long-Term Outcome of Inter-Hospital ECMO Transport for Severe Respiratory and Cardiac Failure. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Werner I, Brunner S, Meybohm P, Moritz A, Stock U, Beiras-Fernandez A. Levosimendan Protect Human Hepatocytes from Ischemia/Reperfusion Injury: A Second Benefit for Patients with Acute Heart Failure? Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Papadopoulos N, Marinos S, Stock U, Beiras A, Moritz A, Zierer A. The Early Benefit of Intra-Aortic Balloon Counterpulsation in Patients with Limited Pulse Pressure during Extracorporeal Life Support for Post-Cardiotomy Cardiogenic Shock. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Werner I, Kina V, Lupinski M, Walter V, Stock U, Moritz A, Beiras-Fernandez A. Relaxin-2 as New Therapeutic Alternative for Patients with Chronic Heart Failure? Role of Systemic and Local Expression Profile. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Risteski P, von Spreti E, Sipahi F, Stock U, Doss M, Moritz A, Zierer A. Durability of mitral valve reconstruction using the cosgrove edwards annuloplasty band at 5 years. J Cardiothorac Surg 2013. [PMCID: PMC3844755 DOI: 10.1186/1749-8090-8-s1-o290] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- P Risteski
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - E von Spreti
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - F Sipahi
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - U Stock
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - M Doss
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - A Zierer
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Kiessling AH, Wedde S, Keller H, Reyher C, Stock U, Beiras-Fernandez A, Moritz A. Pre-filling of the extracorporeal circuit with autologous blood is safe, but not effective in optimizing biocompatibility in high-risk patients. Perfusion 2012; 27:371-7. [PMID: 22635965 DOI: 10.1177/0267659112447654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass circuit represents a major risk factor for blood transfusions in high-risk cardiac surgery patients. We designed this study to evaluate the effects of antegrade autologous priming (AAP) on reducing perioperative blood transfusion and markers of the inflammatory response in older patients (>75 years). METHODS Seventy-two patients undergoing first-time coronary bypass and/or aortic valve replacement were prospectively randomised to a cardiopulmonary bypass (CPB) with or without AAP. AAP was performed by adding the patient's own blood to the prime solution (mean 280 ml). Perfusion and anaesthetic techniques were as usual. The haematocrit was maintained at a minimum of 21% during CPB. Patients were well matched for all preoperative variables, including established transfusion risk factors. The primary endpoint was the requirement of red cell transfusion. The surrogate endpoints were renal function, inflammatory response and ischaemic parameters. Blood samples were drawn pre- and intraoperatively and at intervals of 6 hours till POD 6. RESULTS Current analysis shows no differences in patients receiving homologous packed red cell transfusions. Also, markers of the inflammatory response (IL6, IL8), renal function (cystatin C, creatinine) and myocardial ischaemia (troponin T, CK-MB) were comparable in both groups (p>0.05). Clinical outcomes were similar with respect to pulmonary, renal and hepatic function, length of ICU stay and hospital stay. CONCLUSION These data suggest that antegrade autologous priming is a safe procedure, but an ineffective way for improving biocompatibility and reducing the need for blood transfusion in older patients.
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Affiliation(s)
- A-H Kiessling
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
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Siegel-Axel D, Rittig K, Dolderer J, Stefan N, Schaller HE, Stock U, Häring HU. Fetuin-A beeinflusst das erhöhte angiogenetische Potential humaner perivaskulärer Fettzellen. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Siegel-Axel D, Dolderer J, Rittig K, Balletshofer B, Machann J, Staiger H, Machicao F, Stock U, Häring HU. Das besondere angiogenetische und inflammatorische Potential perivaskulärer Fettzellen im Vergleich zu subkutanen und viszeralen Fettzellen. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fritze O, Romero B, Schleicher M, Jacob MP, Oh DY, Schenke-Layland K, Bujan J, Stock U. Elastic ageing in the cardiovascular system. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Metzner A, Stock U, Boldt J, Fischer G, Baehr T, Cremer J, Lutter G. Percutaneous pulmonary valve replacement: CD133+ tissue-engineered valved stent implantation. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rylski B, Südkamp M, Beyersdorf F, Nitsch B, Hoffmann I, Blettner M, Moritz A, Mohr FW, Carrel T, Karck M, Beyer M, Vahl CF, Harringer W, Stock U, Dapunt O, Reichenspurner H, Laufer G, Reichart B, Jakob H, Matschke K, Diegeler A, Sievers HH, Walther T, Schäfers HJ, Däbritz S, Warnecke H, Kellner HJ, Scheld HH, Gummert J, Autschbach R, Welz A, Rieß FC, Leyh R, Posival H, Massoudy P, Ennker J, Weinhold C, Steinhoff G, Cremer J, Franke U, Dörge H, Kuntze T, Fischlein T, Hausmann H, Wimmer-Greinecker G, Silber RE, Doenst T, Doll N, Hammel D, Weigang E. Differences in management and outcomes between young and elderly patients with acute aortic dissection type A: Results from the German Registry for Acute Aortic Dissection type A (GERAADA). Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schleicher M, Hansmann J, Elkin B, Kluger PJ, Liebscher S, Huber AJ, Fritze O, Schenke-Layland K, Schille C, Müller M, Walles H, Wendel HP, Stock U. In vivo endothelialization of cardiovascular structures using oligonucleotides and diX AM surface coating. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Conzelmann L, Hoffmann I, Blettner M, Moritz A, Mohr FW, Beyersdorf F, Carrel T, Karck M, Beyer M, Vahl CF, Harringer W, Stock U, Dapunt O, Reichenspurner H, Laufer G, Reichart B, Jakob H, Matschke K, Diegeler A, Sievers HH, Walther T, Schäfers HJ, Däbritz S, Warnecke H, Kellner HJ, Scheld HH, Gummert J, Autschbach R, Welz A, Rieß FC, Leyh R, Posival H, Massoudy P, Ennker J, Weinhold C, Steinhoff G, Cremer J, Franke U, Dörge H, Kuntze T, Fischlein T, Hausmann H, Wimmer-Greinecker G, Silber RE, Doenst T, Doll N, Hammel D, Weigang E. Risk factors for new postoperative neurological disorders in patients with acute aortic dissection type A - data from the German Registry for Acute Aortic Dissection type A (GERAADA). Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lisy M, Schmid E, Nagy Z, Kind R, Wildhirt S, Khalil M, Nohé B, Haeberle H, Stock U. On-pump aortic valve replacement without allogeneic blood product transfusion. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Easo J, Weigang E, Hölzl P, Horst M, Moritz A, Mohr FW, Carrel T, Karck M, Beyer M, Vahl CF, Harringer W, Stock U, Reichenspurner H, Laufer G, Reichart B, Jakob H, Matschke K, Diegeler A, Sievers HH, Walther T, Schäfers HJ, Däbritz S, Warnecke H, Kellner HJ, Scheld HH, Gummert J, Autschbach R, Welz A, Rieß FC, Leyh R, Posival H, Massoudy P, Ennker J, Weinhold C, Steinhoff G, Cremer J, Franke U, Dörge H, Kuntze T, Fischlein T, Hausmann H, Wimmer-Greinecker G, Silber RE, Doenst T, Doll N, Hammel D, Hoffmann I, Blettner M, Dapunt O. Influence of operative strategy for Debakey Type I Aortic Dissection-Analysis of the GERAADA Registry. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fischer UM, Klass O, Cox CS, Stock U, Antonyan A, Brixius K, Fischer JH, Mehlhorn U, Bloch W. Regulation of endothelial nitric oxide synthase (eNOS) in myocardium subjected to cardioplegic arrest. Thorac Cardiovasc Surg 2009; 57:379-85. [PMID: 19795322 DOI: 10.1055/s-0029-1185873] [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: 10/20/2022]
Abstract
BACKGROUND Nitric oxide (NO) production by both coronary endothelial cells and cardiomyocytes is thought to play a significant role in myocardial pathophysiology following ischemia/reperfusion (I/R). METHODS In thirteen pigs subjected to 1 hour cardioplegic arrest (CA) on CPB, left ventricular (LV) biopsies were collected prior to CPB (baseline), at 60 min CPA, at 15 and 30 min reperfusion on CPB, and at 120 min post CPB. LV specimens were immunocytochemically stained against phospho-eNOS (Ser1177), phospho-eNOS (Thr495), phosphorylated ERK1/2, and AKT/PKB. Four additional pigs without CA served as controls. Cardiomyocytes were quantitatively investigated using TV densitometry (gray units: U). RESULTS After 60 min CA phosphorylation of eNOS (Ser1177) increased significantly and remained elevated until 30 min of reperfusion. In contrast, eNOS (Thr495) phosphorylation remained unchanged during CA and throughout reperfusion. In control animals, eNOS phosphorylation remained unchanged. Akt/PKB activity significantly increased after 60 min CA and decreased thereafter. ERK1/2 activity remained unchanged during ischemia but increased during reperfusion. CONCLUSIONS ENOS activation during ischemia occurs through phosphorylation at Ser1177 mediated by Akt/PKB. ERK1/2 does not seem to be involved in myocardial eNOS regulation especially not via phosphorylation at eNOS (Thr495).
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Affiliation(s)
- U M Fischer
- Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas, United States of America
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Brechtel K, Kalender G, Heller S, Schmehl J, Stock U, Scheule AM, Claussen CD, Tepe G. Endovascular repair of infrarenal abdominal aortic aneurysm associated with a horseshoe kidney and graft thrombosis in early follow-up. Acta Radiol 2009; 50:624-8. [PMID: 19452338 DOI: 10.1080/02841850902902565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular aneurysm repair (EVAR) is a well-established alternative to open surgery. The presented case underwent endovascular therapy of an abdominal aortic aneurysm (AAA) with the anatomical prerequisite of a horseshoe kidney. We describe the technique used, including the embolization of aortic side branches, to avoid endoleaks, and the management of thrombotic complications during follow-up.
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Affiliation(s)
- K. Brechtel
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
| | - G. Kalender
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - S. Heller
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
| | - J. Schmehl
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
| | - U. Stock
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - A. M. Scheule
- Department of Thoracic and Cardiovascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - C. D. Claussen
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
| | - G. Tepe
- Department of Interventional and Diagnostic Radiology, University of Tuebingen, Tuebingen, Germany
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Lutter G, Metzner A, Jahnke T, Boldt J, Hagemann A, Abdelhadi M, Cremer J, Stock U. Percutaneous tissue engineered pulmonary valved stent implantation. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lisy M, Pennecke J, Brockbank K, Fritze O, Schleicher M, Schenke-Layland K, Kaulitz R, Riemann I, Weber C, Braun J, Mueller K, Scheunert T, Gruber A, Albes JM, Ziemer G, Stock U. Vitrification of heart valve allografts – optimal preservation of extracellular matrix translates into improved in vivo function. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schummer W, Schummer C, Paxian M, Stock U, Richter K, Bauer M. Extravasale Lage von zentralen Venenkathetern bei korrekter EKG-Ableitung. Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40:91-6. [PMID: 15714399 DOI: 10.1055/s-2004-826142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Does the electrocardiographic method for central venous catheter positioning distinguish between a correct intravasal and a malpositioned extravasal position? METHODS 24 cardiac surgical patients were enrolled in this prospective observational study. In 18 patients the left, in another 6 patients the right internal jugular vein was cannulated. Using a J-wire within a triple-lumen catheter the amplitude of the P-wave was measured at 3 different intravasal sites: Intra-1: (intravasal baseline electrocardiogram), i. e. 10 cm marking of the catheter on skin level; Intra-2: clear rise of the P-wave amplitude upon further insertion of the catheter; Intra-3: maximum P-wave amplitude. At this position the control of the catheter tip was achieved by means of transoesophageal echocardiography (TOE). Intraoperatively, another J-wire within a triple-lumen catheter was placed by the heart surgeon on 3 extravasal sites and the ECG was recorded: Extra-1: extravasal at the left innominate vein above the pericardial reflection; Extra-2: extravasal on the superior vena cava below the pericardial reflection; Extra-A: extravasal on ascending aorta below the pericardial reflection. The catheter was suture fixed with its tip in position Intra-3. Post surgery a chest radiograph was taken. RESULTS All catheter tips were visualised at the basis of the Crista terminals (border between right atrium and superior vena cava) by TOE control. The rise of the P wave amplitude at Intra-2, Extra-2 and Extra-A was highly significant compared to the base line at Intra-1 (Intra-1/Intra-2, Intra-1/Extra-2, Intra-1/Extra-A: p in each case < 0.001). The P wave amplitudes of the corresponding intra- and extravasal positions of the left innominate vein (Intra-1/Extra-1, n = 18, p = 0.096)) as well as those of the superior vena cava (Intra-2/Extra-2, n = 24, p = 0.859) did not differ. CONCLUSION The electrocardiographic method can not differentiate between intra- and extravasal position of a central venous catheter, and thus, presumably fails to identify malpositioning as a result of vascular perforation.
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Affiliation(s)
- W Schummer
- Klinik für Anästhesie und Intensivtherapie, Friedrich-Schiller Universität Jena.
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Stock U, Müller T, Bienek R, Krause H, Hartrumpf M, Albes J. Deairing of the venous drainage in standard extracorporeal circulation results in a profound reduction of arterial microbubbles. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fischer U, Klass O, Kanani G, Geissler H, Stock U, Fischer J, Bloch W, Mehlhorn U. Regulation of endothelial Nitric Oxide Synthase (eNOS) activity in myocardium subjected to cardioplegic arrest. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schummer W, Schummer C, Schelenz C, Brandes H, Stock U, Müller T, Leder U, Hüttemann E. Central venous catheters—the inability of ‘intra-atrial ECG’ to prove adequate positioning. Br J Anaesth 2004; 93:193-8. [PMID: 15220179 DOI: 10.1093/bja/aeh191] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The classic increase in P wave size, known as 'P-atriale', is a widely accepted criterion for determination of proper positioning of central venous catheter tips. Recent transoesophageal echocardiography (TOE) studies did not confirm intra-atrial position despite advancing the central venous catheter further than indicated by ECG guidance. We postulate that the pericardial reflection rather than the entry into the right atrium corresponds to the ECG changes. In order to test our hypothesis we sought to determine the anatomical substrate for the electrical changes in an animal study. Subsequently, a modified version of the study was undertaken in man and is also reported. METHODS In six juvenile pigs the left external jugular vein and right carotid artery were cannulated. A triple-lumen central venous catheter was positioned by ECG guidance using a Seldinger wire as an exploring electrode. The venous and arterial catheters were suture fixed 2 cm beyond the onset of an increase in P wave size. The corresponding anatomical catheter tip position was determined by open exploration of the vessels and the heart. Subsequently the catheter tip position (during advancement) of a pulmonary artery catheter and the corresponding electrical ECG changes were examined in 10 patients during open chest cardiac surgery. RESULTS All catheters-arterial and venous, in animals and humans-revealed an increase in size of the P wave as well as the QRS complex. All venous catheters were positioned in the superior vena cava, beyond the pericardial reflection but outside the right atrium. All arterial catheters were positioned in the ascending aorta thus also beyond the pericardial reflection. CONCLUSIONS The start of an increase in P wave size does not correspond with the entrance of the right atrium. The anatomic equivalent for the electrophysiological changes of the ECG is the pericardial reflection. ECG guidance is unable to distinguish between venous and arterial catheter position.
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Affiliation(s)
- W Schummer
- Clinic for Anaesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Erlanger Allee 103, D-07747 Jena, Germany.
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Fischer UM, Klass O, Stock U, Tossios P, Geissler HJ, Fischer JH, Bloch W, de Vivie ER, Mehlhorn U. Cardiac myocyte regulatory proteins: Potential new targets for myocardial preservation in cardiac surgery? Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hagl C, Stock U, Haverich A, Steinhoff G. Evaluation of different minimally invasive techniques in pediatric cardiac surgery: is a full sternotomy always a necessity? Chest 2001; 119:622-7. [PMID: 11171746 DOI: 10.1378/chest.119.2.622] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES A variety of minimally invasive techniques have been recently introduced in adult cardiac surgery. Experiences with children and newborns are, however, limited. In this report, we present our first experiences with different methods of ministernotomies for closure of atrial septum defect (ASD) and ventricular septum defect (VSD) in pediatric cardiac patients. Also, the current literature for different surgical approaches is reviewed. PATIENTS AND METHODS Twenty-five pediatric patients (range, 4 months to 12 years old) underwent elective ASD or VSD closure. Surgical access was either without division of the sternum (group A, n = 5), with partial inferior sternotomy (group B, n = 5), total sternotomy with limited skin incision (group C, n = 5), or total sternotomy with full skin incision (group D, n = 10). RESULTS There were no severe intraoperative complications regarding exposure, cannulation, or bleeding. Conversion to full sternotomy was not necessary in any patient. Bypass time and cross-clamp time in groups A, B, and C were comparable to the standard operation (group D). However, preparation time was significantly increased in one minimally invasive group (group A vs group D, p<0.05). Despite general feasibility, the transxiphoidal access without sternotomy compromises exposure of the ascending aorta, resulting in impaired administration of cross-clamping, cardioplegia, and especially de-airing. CONCLUSIONS Transatrial pediatric cardiac operations can be performed without or with limited sternotomy. The partial sternotomy allows uncompromised exposure of the great vessels and should be favored over the transxiphoidal approach. The operative access and perioperative risk is comparable to a classical standard surgical approach. Advantages include improved cosmetic results in combination with a high degree of safety.
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Affiliation(s)
- C Hagl
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Steinhoff G, Stock U, Karim N, Mertsching H, Timke A, Meliss RR, Pethig K, Haverich A, Bader A. Tissue engineering of pulmonary heart valves on allogenic acellular matrix conduits: in vivo restoration of valve tissue. Circulation 2000; 102:III50-5. [PMID: 11082362 DOI: 10.1161/01.cir.102.suppl_3.iii-50] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tissue engineering using in vitro-cultivated autologous vascular wall cells is a new approach to biological heart valve replacement. In the present study, we analyzed a new concept to process allogenic acellular matrix scaffolds of pulmonary heart valves after in vitro seeding with the use of autologous cells in a sheep model. METHODS AND RESULTS Allogenic heart valve conduits were acellularized by a 48-hour trypsin/EDTA incubation to extract endothelial cells and myofibroblasts. The acellularization procedure resulted in an almost complete removal of cells. After that procedure, a static reseeding of the upper surface of the valve was performed sequentially with autologous myofibroblasts for 6 days and endothelial cells for 2 days, resulting in a patchy cellular restitution on the valve surface. The in vivo function was tested in a sheep model of orthotopic pulmonary valve conduit transplantation. Three of 4 unseeded control valves and 5 of 6 tissue-engineered valves showed normal function up to 3 months. Unseeded allogenic acellular control valves showed partial degeneration (2 of 4 valves) and no interstitial valve tissue reconstitution. Tissue-engineered valves showed complete histological restitution of valve tissue and confluent endothelial surface coverage in all cases. Immunohistological analysis revealed cellular reconstitution of endothelial cells (von Willebrand factor), myofibroblasts (alpha-actin), and matrix synthesis (procollagen I). There were histological signs of inflammatory reactions to subvalvar muscle leading to calcifications, but these were not found in valve and pulmonary artery tissue. CONCLUSIONS The in vitro tissue-engineering approach using acellular matrix conduits leads to the in vivo reconstitution of viable heart valve tissue.
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Affiliation(s)
- G Steinhoff
- Leibniz Research Laboratories for Biotechnology and Artificial Organs Department of Thoracic and Cardiovascular Surgery, Medical School Hannover, Hannover, Germany
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Nagashima M, Nollert G, Stock U, Sperling J, Hatsuoka S, Shum-Tim D, Takeuchi K, Nedder A, Mayer JE. Cardiac performance after deep hypothermic circulatory arrest in chronically cyanotic neonatal lambs. J Thorac Cardiovasc Surg 2000; 120:238-46. [PMID: 10917937 DOI: 10.1067/mtc.2000.106984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES It is controversial whether immature cyanotic hearts are more susceptible to ischemic injury than normoxemic hearts. Acutely induced alveolar hypoxic stress before cardiopulmonary bypass has been used as a model of cyanosis and is reported to worsen recovery of immature hearts after subsequent ischemic insult by means of a free radical injury mechanism. Because of concerns about the relevance of acute alveolar repair to the chronic cyanosis encountered clinically, we assessed the effects of chronic cyanosis without alveolar hypoxia, acute alveolar hypoxia, and normoxemia on recovery of cardiac function after deep hypothermic circulatory arrest. METHODS A chronic cyanosis model was created in 8 lambs by an anastomosis between the pulmonary artery and the left atrium (cyanosis group). Eight lambs underwent sham operation (control). One week later, the animals underwent cardiopulmonary bypass with 90 minutes of deep hypothermic circulatory arrest at 18 degrees C. Another 8 lambs underwent 45 minutes of hypoxic ventilation before bypass, with arterial oxygen tension being maintained at 30 mm Hg (acute hypoxia group). Cardiac index, preload recruitable stroke work, and tau were measured. Malondialdehyde and nitrate-nitrite, nitric oxide metabolites, were also measured in the coronary sinus. Myocardial antioxidant reserve capacity at 2 hours of reperfusion was assessed by measuring lipid peroxidation in left ventricular tissue samples incubated with t-butylhydroperoxide at 37 degrees C. RESULTS Oxygen tension was 35 +/- 3 mm Hg in the acute hypoxia group versus 93 +/- 7 mm Hg in the control group. In the acute hypoxia group the recovery of cardiac index, preload recruitable stroke work, and tau were significantly worse than that found in both the control and cyanosis groups. Preload recruitable stroke work at 2 hours of reperfusion was slightly but significantly lower in the cyanosis group than in the control group. The postischemic level of nitric oxide metabolites was significantly lower in the acute hypoxia group than in the cyanosis and control groups. However, malondialdehyde levels in the coronary sinus and myocardial antioxidant reserve capacity were not significantly different among the groups. CONCLUSION Recovery of left ventricular function after deep hypothermic circulatory arrest in neonatal lambs with chronic cyanosis was slightly worse than that found in acyanotic animals. Acute hypoxia before bypass was associated with significantly worse recovery of left ventricular function, and the mechanism of injury may be related to an impairment of nitric oxide production. Free radical injury does not appear to explain any differences among cyanotic, acyanotic, and acutely hypoxic animals in recovery of left ventricular function after ischemia.
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Affiliation(s)
- M Nagashima
- Department of Cardiovascular Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Sodian R, Sperling JS, Martin DP, Egozy A, Stock U, Mayer JE, Vacanti JP. Fabrication of a trileaflet heart valve scaffold from a polyhydroxyalkanoate biopolyester for use in tissue engineering. Tissue Eng 2000; 6:183-8. [PMID: 10941212 DOI: 10.1089/107632700320793] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Previously, we reported the implantation of a single tissue engineered leaflet in the posterior position of the pulmonary valve in a lamb model. The major problems with this leaflet replacement were the scaffold's inherent stiffness, thickness, and nonpliability. We have now created a scaffold for a trileaflet heart valve using a thermoplastic polyester. In this experiment, we show the suitability of this material in the production of a biodegradable, biocompatible scaffold for tissue engineered heart valves. A heart valve scaffold was constructed from a thermoplastic elastomer. The elastomer belongs to a class of biodegradable, biocompatible polyesters known as polyhydroxyalkanoates (PHAs) and is produced by fermentation (Metabolix Inc., Cambridge, MA). It was modified by a salt leaching technique to create a porous, three-dimensional structure, suitable for tissue engineering. The trileaflet heart valve scaffold consisted of a cylindrical stent (1 mm X 15 mm X 20 mm I.D.) containing three valve leaflets. The leaflets were formed from a single piece of PHA (0.3 mm thick), and were attached to the outside of the stent by thermal processing techniques, which required no suturing. After fabrication, the heart valve construct was allowed to crystallize (4 degrees C for 24 h), and salt particles were leached into doubly distilled water over a period of 5 days to yield pore sizes ranging from 80 to 200 microns. Ten heart valve scaffolds were fabricated and seeded with vascular cells from an ovine carotid artery. After 4 days of incubation, the constructs were examined by scanning electron microscopy. The heart valve scaffold was tested in a pulsatile flow bioreactor and it was noted that the leaflets opened and closed. Cells attached to the polymer and formed a confluent layer after incubation. One advantage of this material is the ability to mold a complete trileaflet heart valve scaffold without the need for suturing leaflets to the conduit. Second advantage is the use of only one polymer material (PHA) as opposed to hybridized polymer scaffolds. Furthermore, the mechanical properties of PHA, such as elasticity and mechanical strength, exceed those of the previously utilized material. This experiment shows that PHAs can be used to fabricate a three-dimensional, biodegradable heart valve scaffold.
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Affiliation(s)
- R Sodian
- Department of Surgical Research, and Department of Cardiac Research, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Shum-Tim D, Stock U, Hrkach J, Shinoka T, Lien J, Moses MA, Stamp A, Taylor G, Moran AM, Landis W, Langer R, Vacanti JP, Mayer JE. Tissue engineering of autologous aorta using a new biodegradable polymer. Ann Thorac Surg 1999; 68:2298-304; discussion 2305. [PMID: 10617020 DOI: 10.1016/s0003-4975(99)01055-3] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ovine pulmonary valve leaflets and pulmonary arteries have been tissue-engineered (TE) from autologous cells and biodegradable polyglycolic acid (PGA)-polyglactin copolymers. Use of this cell-polymer construct in the systemic circulation resulted in aneurysm formation. This study evaluates a TE vascular graft in the systemic circulation which is based on a new copolymer of PGA and polyhydroxyalkanoate (PHA). METHODS Ovine carotid arteries were harvested, expanded in vitro, and seeded onto 7-mm diameter PHA-PGA tubular scaffolds. The autologous cell-polymer vascular constructs were used to replace 3-4 cm abdominal aortic segments in lambs (group TE, n = 7). In a control group (n = 4), aortic segments were replaced with acellular polymer tubes. Vascular patency was evaluated with echography. All control animals were sacrificed when the grafts became occluded. Animals in TE group were sacrificed at 10 days (n = 1), 3 (n = 3), and 5 months (n = 3). Explanted TE conduits were evaluated for collagen content, deoxyribonucleic acid (DNA) content, structural and ultrastructural examination, mechanical strength, and matrix metalloproteinase (MMP) activity. RESULTS The 4 control conduits became occluded at 1, 2, 55, and 101 days. All TE grafts remained patent, and no aneurysms developed by the time of sacrifice. There was one mild stenosis at the anastomotic site after 5 months postoperatively. The percent collagen and DNA contents approached the native aorta over time (% collagen = 25.7%+/-3.4 [3 months] vs 99.6%+/-11.7 [5 months], p < 0.05; and % DNA = 30.8%+/-6.0 [3 months] vs 150.5%+/-16.9 [5 months], p < 0.05). Histology demonstrated elastic fibers in the medial layer and endothelial specific von Willebrand factor on the luminal surface. The mechanical strain-stress curve of the TE aorta approached that of the native vessel. A 66 kDa MMP-2 was found in the TE and native aorta but not in control group. CONCLUSIONS Autologous aortic grafts with biological characteristics resembling the native aorta can be created using TE approach. This may allow the development of "live" vascular grafts.
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Affiliation(s)
- D Shum-Tim
- Department of Cardiovascular Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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