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Publications (209)
Background
Sleep-disordered breathing (SDB) is frequently associated with atrial arrhythmias, but diagnostic markers that predict the propensity for atrial arrhythmias are missing. Abnormal P-wave terminal force in lead V1 (PTFV1) has been associated with atrial structural/electrical remodeling and arrhythmias.
Purpose
Here we investigate the asso...
Aims:
Recent clinical trials have proven gliflozins to be cardioprotective in diabetic and non-diabetic patients. However, the underlying mechanisms are incompletely understood. A potential inhibition of cardiac Na+ /H+ exchanger 1 (NHE1) has been suggested in animal models. We investigated the effect of empagliflozin on NHE1 activity in human atr...
Heart transplantation is often an unrealizable therapeutic option for end-stage heart failure, which is why mechanical left ventricular assist devices (LVADs) become an increasingly important therapeutic alternative. Currently, there is a lack of information about molecular mechanisms which are influenced by LVADs, particularly regarding the pathop...
Pediatric heart transplantation (pHTx) represents only a small proportion of cardiac transplants. Due to these low numbers, clinical data relating to induction therapy in this special population are far less extensive than for adults. Induction is used more widely in pHTx than in adults, mainly because of early steroid withdrawal or complete steroi...
Donor-specific antibodies (DSA) are integral to the development of antibody-mediated rejection (AMR). Chronic AMR is associated with high mortality and an increased risk for cardiac allograft vasculopathy (CAV). Anti-donor HLA antibodies are present in 3-11% of patients at the time of heart transplantation (HTx), with de novo DSA (predominantly ant...
Background:
Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere.
Methods:
This i...
Aims
Veno-arterial extracorporeal life support (ECLS) is an established method to stabilize acute circulatory failure. Parameters and data on when to ideally wean circulatory support are limited. Bilirubin is a marker of end-organ damage. Therefore, the purpose of this large study was to evaluate the impact of dynamic changes of elevated bilirubin...
Introduction: Veno- arterial extracorporeal life support (ECLS) is an established method to stabilize acute circulatory failure by providing immediate gas exchange and peripheral tissue perfusion. Parameters and data on when to ideally wean circulatory support are limited.
Hypothesis: Bilirubin levels may serve as indicator for readiness to wean EC...
OBJECTIVES
A silicone interface at skin level of left ventricular assist device (LVAD) may reduce the risk of driveline (DL) exit site infections when compared with other materials (e.g. velour). The purpose of this study was to evaluate the rate of DL exit site infection according to the presence of silicone or velour at the exit site with the red...
There is currently no consensus regarding the dose or duration of rabbit antithymocyte globulin (rATG) induction in different types of heart transplant patients, or the timing and intensity of initial calcineurin inhibitor (CNI) therapy in rATG-treated individuals. Based on limited data and personal experience, the authors propose an approach to rA...
Cerebral thromboembolism builds the Achilles heel for patients on left ventricular support (LVAD). Thrombolytic therapy is usually contraindicated considering the increased risk of intracranial hemorrhage in LVAD patients under therapeutic oral anticoagulation with concomitant platelet inhibition. We report on an alternative approach to this dilemm...
Purpose: The MANDELA study (NCT00862979) is designed to assess
the benefit of either CNI-free or CNI-minimized EVR-based regimen
after early conversion from standard treatment in de novo heart trans-
plant recipients (HTxR).There is growing evidence on the beneficial use
of everolimus (EVR) in heart transplantation supporting reduction or
withd...
Anti-endothelial cell antibodies (AECA) may be involved in the development of heart allograft rejection. Its detection might be a cheap and noninvasive method to identify high-risk patients. An indirect immunofluorescence method on human umbilical vein endothelial cells was used to investigate the presence of AECAs in 260 pre- and post-transplant s...
Objectives: Donor selection remains a critical yet poorly standardized aspect of heart transplantation (HTx). The aim of this study was to determine whether elevated donor cardiac serum marker troponin I (cTnI) is associated with graft failure after HTx. Methods: Between January 1999 and August 2013, cTnI serum concentration was measured in samples...
Patients with left ventricular assist devices (LVADs) who develop stage IV sacral pressure sores (SPS) have an increased procedural risk. We present the complications, including severe intra- and postoperative bleeding, diarrhea with metabolic acidosis, volume loss and acute on chronic renal failure, flap dehiscence and late LVAD outflow cannula th...
Clinical data relating to rabbit antithymocyte globulin (rATG) induction in heart transplantation are far less extensive than for other immunosuppressants, or indeed for rATG in other indications. This was highlighted by the low grade of evidence and the lack of detailed recommendations for prescribing rATG in the International Society for Heart an...
Background
Objective of this study was to evaluate the impact of age on comparative early outcomes after coronary artery bypass graft surgery (CABG) with minimized (MECC) and conventional extracorporeal circulation (CECC).
Methods
A retrospective age-, gender- and operation-matched cohort analysis between January 2005 and December 2010 with a tota...
Background
LVAD speed adjustment according to a functioning aortic valve has hypothetic advantages but could lead to submaximal support. The consequences of an open aortic valve policy on exercise capacity and hemodynamics have not yet been investigated systematically.
Methods
Ambulatory patients under LVAD support (INCOR®, Berlin Heart, mean supp...
In lung transplantation, acute rejection episodes increase the risk of chronic rejection. Therefore treatment of acute rejection needs to be optimized for better long-term outcome of lung-transplantation and patient survival.
The aim was to verify whether an inhibitor of the mammalian target of rapamycin (Everolimus) contained the extent of persist...
Preoperative anemia and low hematocrit during cardiopulmonary bypass have been associated with worse outcome in patients undergoing cardiac surgery. The minimized extracorporeal circulation (MECC) allows a reduction of the negative effects associated with conventional extracorporeal circulation (CECC). In this study, the impact of the MECC on outco...
This study evaluated the pharmacokinetics of tacrolimus (Tac) in a novel self-microemulsifying drug delivery system (SMEDDS) for improved oral administration. SMEDDS Tac consisted of ethyl oleate as the oily phase, Solutol HS 15 as the surfactant and glycofurol as the co-surfactant and contained 0.5mg/mL tacrolimus. Blood and tissue concentrations...
Bronchiolitis obliterans (BO) is a progressive and fatal disease after lung transplantation (LTX). Dysregulated growth factor-induced proliferation of myofibroblasts seems to be responsible for the development of BO. The aim was to confirm the efficacy of both inhibitors of receptor tyrosine kinases (RTKI) and of mammalian target of rapamycin (mTOR...
The innate receptor "triggering-receptor-expressed-on-myeloid-cells-1" (TREM-1) enhances downstream signaling of "pattern recognition receptor" (PRR) molecules implicated in inflammatory responses. However the mechanistic role of TREM-1 in chronic heart rejection has yet to be elucidated. We examined the effect of TREM-1+ antigen-presenting cells (...
Chronic rejection (CR) in terms of bronchiolitis obliterans (BO) and vascular sclerosis (VS) still represents the major obstacle for pulmonary graft survival in the medium and long term course after lung transplantation (LTX). Aside from nonspecific stimuli, early acute rejection (AR) seems to be causative especially in cases of a late diagnosis or...
In an open-label, 24-month trial, 721 de novo heart transplant recipients were randomized to everolimus 1.5 mg or 3.0 mg with reduced-dose cyclosporine, or mycophenolate mofetil (MMF) 3 g/day with standard-dose cyclosporine (plus corticosteroids ± induction). Primary efficacy endpoint was the 12-month composite incidence of biopsy-proven acute reje...
Effects of exercise during LVAD support are still a matter of research. This study aimed to evaluate exercise in this particular patient population by different diagnostic tools in a systematic fashion.Methods and MaterialsAmbulatory patients (n = 9, age 45±13 y, NYHA 2) on LVAD support (Berlin Heart INCOR®, mean support time 465±257d, mean support...
The evidence base relating to the use of everolimus in heart transplantation has expanded considerably in recent years, providing clinically relevant information regarding its use in clinical practice. Unless there are special considerations to take into account, all de novo heart transplant patients can be regarded as potential candidates for immu...
The evidence base relating to the use of everolimus in heart transplantation has expanded considerably in recent years, providing clinically relevant information regarding its use in clinical practice. Unless there are special considerations to take into account, all de novo heart transplant patients can be regarded as potential candidates for immu...
Cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECLS) system has been successfully used to support patients with in- and out-of-hospital cardiac arrest (IHCA, OHCA) when conventional measures have failed. The purpose of the current study is to report on our experience with extracorporeal CPR in non-postcardiotomy patients.
We...
Extracorporeal life support system has been successfully used in patients with cardiac failure after open heart surgery, as a bridge to transplantation, and in patients with prolonged cardiogenic shock or cardiopulmonary arrest. This report presents our early experience with the new system Cardiohelp in coronary artery bypass grafting (CABG). Betwe...
Immunosuppressive therapy required to treat rejection after lung transplantation (LTx) contributes significantly to the pathogenesis of cytomegalovirus (CMV) infection and disease. In a weak allogeneic left LTx model in the rat (Fisher 344 [F344] to Wistar Kyoto [WKY] rats) we analyzed the influence of acute CMV infection on postoperative day (POD)...
Chronic allograft rejection and bronchiolitis obliterans (BO) limited successful long-term outcome after lung transplantation (LTX). Reliable animal models are needed to study the pathogenesis of BO and to develop effective therapeutic strategies. The relevance of an available experimental LTX model without immunosuppression-the Fischer (F344)-Wist...
Objective:
Surgery of the ascending aorta and aortic arch has been challenging since its inception as neurological complications may occur significantly affecting the quality of life (QOL).
Methods:
From January 1998 to December 2007, 79 patients mainly suffering aortic dissection (65%) or true aortic aneurysm (34%) underwent surgery on the aort...
Prevention and treatment of bronchiolitis obliterans (BO) after lung transplantation (LTX) remains disappointing. The high prevalence and the critical detection of early mild acute lung rejection aggravated optimum immunosuppressive therapy. In this study, two hypotheses were investigated: (i) mycophenolate mofetil (MMF) prevented the development o...
Objectives: Extracorporeal life support system (ECLS) has been successfully used in patients with cardiac failure after open heart surgery, as a bridge to cardiac transplantation, and in patients with prolonged cardiogenic shock or cardiopulmonary arrest. In this report, we present our early experience with coronary artery bypass grafting (CABG) wi...
Clinical experience has shown that heart failure patients can be safely supported with axial flow pumps for long periods. With the aim to find the right pump flow for LVAD- patients, we investigated the hemodynamic and clinical effects of pump flow reduction in patients during mild exercise training. 12 patients, 30–53 years old, suffering from dil...
Background:
Chronic rejection (CR) after lung transplantation (LTX) manifests pathologically by fibrotic airway remodelling and bronchiolitis obliterans (BO). The role of the mammalian target of rapamycin inhibitor everolimus in preventing this process is poorly understood.
Methods:
A rat model of left lung allo-transplantation (Fisher 344 to Wi...
Ventricular assist device (VAD) implantation using cardiopulmonary bypass (CPB) is an established procedure. However, the well-described complications of CPB may exacerbate multiple organ failure and increase blood product transfusions especially in end-stage heart failure patients.
We describe our successful experience in six consecutive patients...
Late complications can develop in patients after surgery for aortic type A dissection, mandating redo surgery on the ascending aorta and arch.
From 2006 to 2010, 23 patients (aged 41-69 years) who had late complications related to previous aortic surgery for acute type A dissection underwent redo surgery. Initial surgery included ascending aorta re...
Diabetes mellitus (DM) is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting (CABG). The minimized extracorporeal circulation (MECC) allows a reduction of the negative effects associated with conventional extracorporeal circulation (CECC). In this study, the impact of the MECC on out...
We determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine.
Treatment of the brain-dead donor with low-dose dopamine improves immediate graft function after kidney transplantation.
A cohort study of 93 heart transplants from 21 European centers was undertaken between Ma...
YC-1 (3-(5'-hydroxymethyl-2'furyl)-1-benzyl-indazole) is an allosteric activator of soluble guanylyl cyclase (sGC) and a vasodilator. This study describes a paradoxical action of YC-1 in isolated vessels of patients with coronary artery disease (CAD) that appears to trigger an endothelium-dependent vasoconstrictor pathway present in vessels with en...
We present a 51-year-old man with cardiogenic shock in whom a percutaneous extracorporeal life support system (ECLS) was inserted to restore cardiopulmonary stability. After successful stabilization, a left ventricular assist device was implanted, using the ECLS without switching to a conventional cardiopulmonary bypass system to reduce its side ef...
In this case series, we describe our successful use of a reduced hirudin dosage as an anticoagulant during cardiac surgery using minimized extracorporeal circulation in patients with heparin-induced thrombocytopenia.
Severe right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is a serious complication with a poor prognosis. The most effective therapy for these patients is an upgrade to biventricular mechanical support. However, it is well recognized that primary and secondary biventricular ventricular assist device implantatio...
Acute right ventricular (RV) failure is a life-threatening condition with a poor prognosis, and sometimes the use of mechanical circulatory support is inevitable. In this article, we describe our experience using a centrifugal pump as a temporary percutaneous right ventricular assist device (RVAD) in patients with postoperative acute refractory RV...
In 2000, the Eurotransplant Foundation changed the allocation criteria following the enactment of the German Transplantation Law (GTL). Our study investigated the impact of the new allocation system on outcomes after heart transplantation (HTx) in Germany.
We compared 2 cohorts of patients who underwent HTx at our institution in two different 3-yea...
We describe a 51-year-old man with cardiogenic shock and severe multi-organ failure in whom the new percutanoues extracoporeal life support (ECLS) system Cardiohelp (Maquet CP, Hirrlingen, Germany) was used in 3 different settings. Initially, the system was employed as venoarterial extracorporeal membrane oxygenation (ECMO) to restore cardiopulmona...
Worsening of lung function in patients awaiting lung transplantation can lead to ventilation-refractory hypoxemia or hypercapnia and respiratory acidosis. This report describes the successful use of different extracorporeal circulatory systems as a bridge to transplantation at remote centers.
Between January 2003 and December 2009, we had 10 reques...
Bovine saphenous veins (BSV) were incubated in a perfusion bioreactor to study vessel wall metabolism and wall structure under tissue engineering conditions. Group 1 vessels were perfused for 4 or 8 days. The viscosity of the medium was increased to that of blood in group 2. Group 3 vessels were additionally strained with luminal pressure. Groups 1...
The minimized extracorporeal circulation (ECC) is a safe alternative for coronary artery bypass grafting (CABG) and allows a reduction of the negative effects associated with conventional extracorporeal circulation. Experimental and clinical data indicate that the anesthetic regime might influence the ischemia-reperfusion injury in CABG surgery. Th...
Minimized extracorporeal circulation (MECC) is a promising alternative to standard extracorporeal circulation (ECC) and its use is increasing in routine coronary bypass surgery. We analyzed the clinical outcome of patients with reduced left ventricular function who underwent coronary artery bypass surgery with MECC or with standard ECC.
From Januar...
Primary cardiac T-cell lymphoma is an extremely rare entity, with only 3 patients having been reported so far in the literature. We describe the case of a young patient with acute heart failure involving the whole myocardium. The patient successfully underwent emergency cardiectomy, custom-made total artificial heart implantation and heart transpla...
Background: Worsening of lung failure in patients awaiting lung transplantation might lead to ventilation-refractory hypercapnia and respiratory acidosis. This report describes the successful use of extracorporeal circulatory systems (ECS) as a bridge to lung transplantation in a remote transplant center.
Methods: Between January 2003 and August 2...
Hypothermia-induced changes in endothelial cell (EC) morphology and function after organ storage may influence the initial outcome and development of transplant-associated coronary artery disease.
Human saphenous vein ECs were incubated with saline (NaCl), University of Wisconsin (UW), and histidine-tryptophan-ketoglutarate (HTK) solution, with and...
Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation.
From July 2001 to Apri...
We studied the impact of minimized extracorporeal circulation (MECC) on acute kidney injury (AKI) after coronary bypass grafting. A retrospective, observational study with 1,685 patients with MECC and 3,046 patients with conventional bypass was done. Primary outcome was AKI defined as a decline > or = 50% in estimated glomerular filtration rate (eG...
Coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is the gold standard for surgical coronary re-vascularisation. Recently, minimised extracorporeal circulation system (MECC) has been postulated a safe and advantageous alternative for multi-vessel CABG.
Between January 2004 and December 2007, 244 high-risk patients (logist...
Coronary artery bypass surgery employing minimal extracorporeal circulation (MECC) was compared with standard extracorporeal circulation (ECC) and off-pump coronary artery bypass graft surgery (OPCABG) with regard to the perioperative course.
From January 2004 to December 2007, 1,674 patients (n = 558 MECC, n = 558 ECC, n = 558 OPCABG) who underwen...
Aims: Coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC) is the gold standard in heart surgery. We report on our experience, using minimized extracorporeal circulation (MECC) for multi-vessel CABG. Method: Between 01/1998 and 09/2008, n=6229 patients underwent CABG supported by MECC and ECC. Urgent, redo and emergency CABG...
Die akute Abstoßung ist ein komplexes immunologisches Phänomen — bedingt durch zelluläre Interaktionen, die durch eine ganze Reihe von Mediatoren vermittelt werden. Zahlreiche Mechanismen und Prozesse konnten im Laufe der Jahre identifiziert werden, vollständig aufgeklärt sind die Abstoßungsmechanismen aber noch nicht.
Der Begriff Kardiomyopathie wurde 1957 von Bridgen für Herzerkrankungen geprägt, die nicht die Koronarien betrafen [20]. Die erste WHO-Klassifikation der Kardiomyopathien wurde 1980 in Paris erarbeitet (Report 1980). In dieser Klassifikation wurden Kardiomyopathien als Herzerkrankungen unklarer Ursache definiert und von spezifischen Herzerkrankunge...
Die Herzinsuffizienz gehört zu den führenden Todesursachen in der westlichen Welt. Während im Alter unter 55 Jahre noch weniger als 1% der Bevölkerung an einer Herzinsuffzienz leiden, steigt der Anteil im 65–75. Lebensjahr auf 2–5% und bei über 80-Jährigen auf fast 10% an [90]. Männer sind 1,5-mal häufiger betroffen als Frauen.
Häufig taucht in der Phase vor Entlassung nach Hause die Frage auf, ob eine Erneuerung des Teppichbodens, des Zimmeranstrichs, der älteren Möbel oder des Bettzeugs erforderlich ist. Dies ist nicht so. Es werden vor Rückkehr des frisch Transplantierten nach Hause keine besonderen häuslichen baulich-hygienischen Veränderungen empfohlen. Als Richtlini...
