[Show abstract][Hide abstract] ABSTRACT: Mechanical circulatory support (MCS) devices have been increasingly used for long-term support. We reviewed outcomes in all patients supported with a SynCardia total artificial heart (TAH) for more than one year to assess its safety in long term support.As of December 2011 all 47 patients who received the TAH from 10 centres worldwide were included in this retrospective study. Clinical data was collected on survival, infections, thromboembolic and hemorrhagic events, device failures, and antithrombotic therapy.The mean age of patients was 50 ± 1.57 year, the median support time was 554 days (range 365 - 1373 days). The primary diagnosis was dilated cardiomiopathy in 23 patients, ischemic in 15 and "other" in 9.After a minimum of one year of support, 34 patients (72%) were successfully transplanted, 12 patients (24%) died while on device support, and 1 patient (2%) is still supported. Five patients (10%) had a device failure reported. Major complications were as follows: systemic infections in 25 patients (53%), drive line infections in 13 patients (27%), thromboembolic events in 9 patients (19%) and hemorrhagic events in 7 patients (14%).SynCardia TAH has proven to be a reliable and effective device in replacing the entire heart. In patients who reached a minimum of one year of support, device failure rate is acceptable and only in two cases was the leading cause of death. Infections and hemorrhagic events were the major causes of death. Patients who remain supported beyond one year are still likely to survive to transplantation.
ASAIO journal (American Society for Artificial Internal Organs: 1992) 08/2014; · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives CD133pos cells are currently evaluated for use in cardiac cell therapy. We hypothesized that they exert their beneficial effects in a paracrine manner and investigated this in a cell culture ischaemia model. Furthermore, we checked whether purified CD133pos cells perform better than non-fractionated mononuclear cells (MNC). Methods CD133pos cells were isolated from bone marrow MNC and conditioned medium was prepared from CD133pos and non-fractionated MNC. HL-1 cardiomyocytes were subjected to simulated ischaemia in the respective conditioned media or in control medium. After treatment, total remaining cells, apoptotic cells and nuclear shrinking were quantified using an automated imaging system. Furthermore, metabolic activity and phosphorylation of kinases Akt, Erk1/2, GSK3b and transcription factor Stat3 were investigated. Results After simulated ischaemia, the rate of detached dead cells was lowest in CD133pos conditioned medium (26 ± 6%) and highest in control medium (36 ± 6%). In CD133pos conditioned medium, the fraction of non-apoptotic cells was most enhanced and nuclear shrinking as a consequence of apoptosis was reduced. Cell viability was also highest in CD133pos conditioned medium (109.4 ± 8.8% in relation to control). In both conditioned media, phosphorylation of Akt, Erk1/2, and GSK3b was lower than in control medium. Stat3 phosphorylation was sustained on the level of control. Conclusions Factors released from purified CD133pos bone marrow cells exhibit more pronounced protective effects on HL-1 cardiomyocytes under simulated ischaemia than from non-fractionated MNC. These effects are not associated with the phosphorylation of cell survival promoting kinases Akt, Erk1/2, GSK3b and transcription factor Stat3. Although the molecular mechanism of cardioprotection by CD133pos cells requires further investigation, our results reinforce the advantage of enriching CD133pos cells for cardiac cell therapy. Conflict of interest and funding No conflict of interest declared. This work was supported by the German Ministry of Education and Research [BMBF FKZ 0312138A].
Interactive Cardiovascular and Thoracic Surgery 02/2013; 16(2):S227-S236. · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patienten mit fortgeschrittener Herzinsuffizienz, vor orthotoper Herztransplantation, welchen aufgrund einer lebensbedrohlichen
ventrikulären Tachyaarrhythmie ein ICD implantiert wurde, erfahren frühzeitig eine adäquate antitachykarde ICD-Therapie. Durch
die Bewahrung dieser Untergruppe mit hohem Risiko vor dem plötzlichen Herztod durch die ICD-Therapie kann die Gesamtmortalität
auf das Niveau eines Vergleichskollektives ohne ICD verringert werden. Die Anwesenheit von Vorhoftachyarrhythmien korreliert
mit einer frühzeitigeren Abgabe einer adäquaten ICD Therapie Hämodynamische oder echokardiographische Messungen lassen sich
retrospektiv nicht zur Risikostratifizierung heranziehen. Es bedarf jedoch weiterer Studien zur Evaluierung der Assoziation
hämodynamischer Veränderungen und arrhythmischen Ereignisse in nicht selektierten Untersuchungsgruppen zur Definition von
Untergruppen, die vor Herztransplantation von einer prophylaktischen ICD Implantation profitieren könnten.
[Show abstract][Hide abstract] ABSTRACT: A 57-year-old female lung transplant recipient developed tuberculosis after quadruple maintenance immunosuppression for acute cellular rejection with respiratory compromise. Deteriorating neurological status led to cerebral imaging and lumbar puncture, which showed Mycobacterium tuberculosis. Tuberculous meningitis with elevated intracranial pressure was treated for 2 weeks on a neurosurgical ward, and intensive care therapy was necessary for another 2 weeks. Complete neurological recovery was achieved after 3 months.
[Show abstract][Hide abstract] ABSTRACT: Kinder mit progredienter dilatativer Kardiomyopathie können auf der Warteliste zur Herztransplantation versterben, da bei
ihnen das Krankheitsbild besonders rasch mit Kreislauf- und Multiorganversagen fortschreitet und ein passendes kindliches
Spenderangebot nicht schnell genug verfügbar ist.
Bei 15 Kindern im Alter von vier Monaten bis 15 Jahren führten wir im Stadium des nicht mehr medikamentös therapierbaren Herzversagens
und beginnendem Multiorganversagen eine Kreislaufunterstützung mittels Kunstherz (Ventrikuläres Assist Device, „Berlin Heart”)
durch. Alle Kinder befanden sich in progredientem Schock und waren mindestens einmal reanimiert worden, bevor wir uns zur
Das Kunstherz besteht aus zwei pneumatisch angetriebenen extrakorporalen Blutpumpen, vier Silikonkanülen zur venösen und arteriellen
Verbindung zwischen Patient und Pumpe und einem elektropneumatischen pulsatilen Antrieb.
Zwölf der 15 Kinder konnten wir mit dem System während 1 bis 98 Tagen (Mittel: 24 Tage) am Leben erhalten und die Wartezeit
bis zur Herztransplantation überbrücken. Neun Kinder waren während der Unterstützungszeit extubiert und mobilisiert. Drei
Kinder verstarben vor Erreichen einer Transplantation an Blutung, Sepsis und Lungenversagen, bei einem überlebenden Kind trat
ein Infarkt der arteria cerebri media auf. Sieben transplantierte Langzeitüberlebende sind beschwerdefrei und sozial vollintegriert.
Durch modifizierte Technik ist das Kunstherz auch im Säuglings- und Kleinkindalter einsetzbar. Dadurch können wir Kinder mit
terminaler Herzinsuffizienz bei dilatativer Kardiomyopathie für Wochen und Monate am Leben erhalten und die Zeit bis zur Transplantation
In children with dilated cardiomyopathy the disease may progress so rapidly that they die during the waiting period before
a suitable donor organ is found.
Fifteen children of 4 months to 15 years of age had been in congestive heart failure with multiorgan failure due to dilated
cardiomyopathy, where intensive medical treatment had failed. After resuscitation, a miniaturized pulsatile ventricular assist
device for the mechanical replacement of heart function was implanted. The biventricular assist device (“Berlin Heart”) consists
of two extracorporeal pneumatically driven polyurethane blood pumps, with a multi-layer flexible membrane that separates a
blood and an air chamber. Four silicon cannulae connect the blood pumps to the patient. A three-leaflet valve prevents blood
reflux. The pumps are driven by a pulsatile electropneumatic system.
In 12 of the 15 children the bridging to transplantation was successful with a support time of 1 to 98days (mean 24 days).
Nine of them were extubated and mobilized while assisted. Three children died during the support time due to hemorrhage, sepsis,
and pulmonary failure. In addition, there was one infarction of the arteria cerebri media. To date seven of the transplanted
children are in good condition on follow-up.
The beneficial effects of ventricular assist device use are well known in adult patients and with special devices it can be
transfered to infants and children in whom longer need for support is anticipated. Even in small infants it is an effective
method for bridging to cardiac transplantation.
Schlüsselwörter Kunstherz – Kinder – ventikuläres Assist Device – terminales Herzversagen – dilatative KardiomyopathieKey words Mechanical heart support – children – ventricular assist device – congestive heart failure – dilated cardiomyopathy
Zeitschrift für Kardiologie 04/2012; 89(11):1039-1045. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.
To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.
A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005-2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.
Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70-4.96, P < 0.001). Women were older than men (+4.7 years, P < 0.001), had lower self-assessed preoperative physical functioning (-16 points on a scale from 0 to 100, P < 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %, P = 0.01), respiratory insufficiency (9.4 vs. 5.3 %, P = 0.006) and resuscitation (5.2 vs. 1.8 %, P = 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77-2.41, P = 0.29).
Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.
Clinical Research in Cardiology 04/2012; 101(9):745-51. · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die historische Entwicklung der extrakorporalen Zirkulation begann mit den isolierten Organperfusionen der Physiologen des
19. Jahrhunderts. Diese Experimente führten zur Entwicklung der Grundlagen der Perfusionstechnik, wie der Bubble- und Film-Oxygenation,
sowie pulsatilen Pumpensystemen und dem geschlossenen extrakorporalen Kreislauf. Die Vorstellung, dass die extrakorporale
Zirkulation im Zusammenhang mit herz- oder gefäßchirurgischen Eingriffen genutzt werden könnte, entstand schon zu Beginn des
Historic development of extracorporeal circulation began with the perfusion of isolated organs by physiologists in the 19th century. Those experiments led to the development of the basic principles of the perfusion technique, such as bubble-oxygenation
and film-oxygenation, systems for pulsatile pumping and the closed extracorporeal circuit. The idea for using extracorporeal
circulation for cardiovascular surgery was born at the beginning of the 20th century.
Zeitschrift für Herz- Thorax- und Gefäßchirurgie 04/2012; 14(3):93-99.
[Show abstract][Hide abstract] ABSTRACT: Patients receiving implantation of ventricular assist devices (VAD) suffer a high incidence of heparin induced thrombocytopenia (HIT); the occurrence of this condition is associated with increased complications and worse outcomes. We report our experience in the management of patients who were diagnosed with HIT either before (HITpre) or after (HITpost) implantation of VAD with argatroban, a direct thrombin inhibitor.
This retrospective analysis assessed data of VAD patients diagnosed with HIT at Deutsches Herzzentrum Berlin between November 2005 and April 2009. Argatroban dose requirements, anticoagulation efficacy and adverse events (death, thromboembolism, bleeding) were recorded. Procedural success (discharge from the hospital, heart transplantation, or recovery of the failing heart) was also assessed.
Twenty-seven patients were identified (11 HITpre, 16 HITpost). Argatroban was effective in obtaining adequate anticoagulation with a reduced dose regimen (0.02-0.42 mcg/Kg/min starting dose; 0.02-1.5 mcg/Kg/min maintenance dose). We noted 5 thromboembolic complications (18%), 6 cases of major bleeding (22%) and 5 deaths (18%), all cause composite adverse end point occurring in 40% of patients. Procedural success was obtained in 81% of patients (92% HITpre, 69% HITpost). As compared to historical controls of patients treated with lepirudin in the period 2000-2005, results were significantly improved.
Argatroban anticoagulation is feasible in patients with HIT after VAD implantation, without increasing bleeding risk. Its impact in terms of survival should be reviewed also in the light of the technological improvements of assist devices.
[Show abstract][Hide abstract] ABSTRACT: Ever since the early days of homograft implantation in 1956, and the introduction into clinical practice by Ross and Barrat Boyes, homograft heart valves have proven to have many advantages. Its disadvantages became evident during long-term follow up. Factors, such as donor and recipient morbidity, tissue banking techniques, and the often complex surgical technique required to implant, are of great influence on the long term results. Because of European Directives, legally binding quality assurance regulations have been introduced in homograft banks. However, still not all processing methods have been scientifically sub-structured on their effects on the final product and its durability. The donor shortage has stimulated researchers and industries to develop and improve mechanical and biological valve substitutes such as the stentless bioprostheses. In general, candidates for homograft valve implantation include patients with: endocarditis, congenital defects and women who wish to become pregnant. For each category of patients different implantation techniques are required. The results of homograft banking and homograft transplantation in the German Heart Institute Berlin are satisfactory. Freedom of re-infection rate after homograft implantation is 91.9% +/- 3.6% after 15 years. Current developments show an increased interest in tissue engineered as well as in de- and re-cellularization of heart valve homografts. The advantages and disadvantages of the several processing techniques have not yet been proven in long term clinical results. For homograft bankers these developments pose as a challenge to join forces and to initiate cooperate projects aimed at scientific and organizational development.
HSR proceedings in intensive care & cardiovascular anesthesia. 01/2012; 4(2):97-108.
[Show abstract][Hide abstract] ABSTRACT: The development and improvement of cardiopulmonary bypass technology is an ongoing process. During the past decade, a number of publications on improvements and best practices have appeared, especially in the areas of biocompatibility, materials sciences, instrumentation, monitoring of physiological parameters and knowledge base (education and evidence-based medicine). Biocompatibility may be defined not only as an inherent property of a particular composition of matter, but also as a set of properties concerning shape, finish, fabrication techniques and choice of application. Materials in use for cardiopulmonary bypass have changed and coated components have been used frequently. Improvements in the area of instrumentation were achieved by adaptation of conventional cardiopulmonary bypass circuits. Miniaturization and re-design of cardiopulmonary bypass circuits (so-called minimized perfusion circuits or minimal extracorporeal circulation circuits) have made cardiopulmonary bypass technology less traumatic. A team approach, including the cardiac surgeon, the anesthesiologist and the cardiovascular perfusionist, was deemed beneficial in order to achieve further improvements. Next to choice of technology and material for a given operation, adjunct measures such as pharmaceutical treatment and blood conservation strategies need to be taken into consideration. Monitoring of variables during cardiopulmonary bypass has made some progress, while the knowledge base has expanded due to studies on best practices. For the immediate future, sound scientific knowledge and intelligent monitoring tools will allow cardiopulmonary bypass to be tailored to individual patients' needs.
HSR proceedings in intensive care & cardiovascular anesthesia. 01/2012; 4(4):211-6.
[Show abstract][Hide abstract] ABSTRACT: In the past 50 years, human cardiovascular tissue allografts, also called homografts, have been implanted into patients with different valvular diseases. The use of these allografts and the number of cardiovascular tissue banks and their respective techniques increased. We conducted a survey to establish the quantity of allografts processed, and issued by, European tissue banks. The survey also included the collection of other relevant statistics.
In 2011, the Foundation of European Tissue Banks collected data from 19 different cardiovascular tissue banks in 11 European countries.
From 2007 to 2010 the data show a decrease in the number of hearts received, from 1700 to 1640 in 18 tissue banks; the average number of hearts received for cardiovascular tissue processing decreased from 113 to 91. The number of heart valves issued for transplantation increased from 1272 in 2007 to 1486 in 2010. The average rate of discard because of microbiological contamination was 20.7%, while 4.2% of the grafts were not used because of positive serology. Half of the tissue banks issued arterial grafts, while 3 banks also issued veins and pericardium. An overview of decontamination methods shows considerable methodological differencesbetween 17 cardiovascular tissue banks.
From the experience in Europe, it can be concluded that cardiovascular tissue banks have an established place in the domain of cardiovascular surgery. The statistics show fluctuating data concerning the demand for human cardiovascular allografts and methodological questions. There is room for growth and improvement with respect to validation of decontamination methods.
HSR proceedings in intensive care & cardiovascular anesthesia. 01/2012; 4(4):251-60.
[Show abstract][Hide abstract] ABSTRACT: In recent years, ventricular assist devices (VAD) supporting the left (LVAD), the right (RVAD) or both ventricles (BVAD) have rapidly emerged as the standard of care for advanced heart failure patients. Both the numbers and ages of patients in which they are used are rising worldwide, especially when used as a permanent support (bridge to destination, BTD). Due to the continuing lack of donor organs, these devices now represent a viable alternative to bridge patients to transplantation (BTT), with a 1-year survival rate of 86%. BTD, especially in long-term support, might be a valid, and the sole, option for those patients in whom heart transplantation is contraindicated. Patient selection, pre- and intra-operative preparation, as well as the timing of VAD implantation are important factors critical to successful circulatory support. While BTT remains the goal in the majority of patients, the number of permanent VADs (i. e. BTD) is rising significantly. Although explantation of a VAD system as a bridge to recovery (BTR) can be considered in only a small number of patients, it represents a very special part of this therapy modality.
[Show abstract][Hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) is an important risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Despite high clinical relevance, current guidelines lack clear recommendations on the optimal approach for patients with insufficiently treated COPD and urgent need for cardiac surgery. The aim of the present study was to analyze the efficacy of short-term pulmonary conditioning (PC) in this subset of cardiopulmonary patients.
Eighteen patients with urgent need for cardiac surgery were treated with 1 mg budenoside twice a day, 1.25 mg salbutamol four times a day and 15 mg ambroxol three times a day. On average, patients received pulmonary conditioning for 5.1 ± 2.1 days. Lung function was assessed before and after treatment.
Pulmonary conditioning improved forced expiratory volume in one second (FEV1) by 16% (P<0.001). Predicted FEV1 increased from 48.3 ± 13.6% at baseline to 55.4 ± 16.1% after treatment (P<0.001). Total resistance was reduced from 0.933 ± 0.418 kPa·s/L to 0.631 ± 0.344 kPa·s/L after PC (P=0.004). The percentage of patients in GOLD stages III-IV was reduced from 55.6% at baseline to 27.8% after treatment. After surgery, patients needed mechanical ventilation for 2 ± 3.4 days. One patient (5.6%) received a tracheostomy and four patients (22.2%) developed pneumonia; 30-day mortality was 5.6%.
Short-term treatment with budenoside, salbutamol and ambroxol significantly improved lung function parameters. If surgery can be delayed for several days, pulmonary conditioning should be considered for patients with insufficiently treated COPD.
The Journal of cardiovascular surgery 04/2011; 52(4):587-91. · 1.51 Impact Factor