Martin Grapow

Universitätsspital Basel, Bâle, Basel-City, Switzerland

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Publications (63)134.47 Total impact

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    ABSTRACT: -The independent predictive value of troponin T (TNT) after on-pump cardiac surgery was established in several studies. However, adjustment was limited to preoperative risk factors without considering perioperative complications. Data on the prognostic value of postoperative B-type natriuretic peptide (BNP) are scarce. Our aim was to assess independent value of TNT and BNP to predict 12-month outcome after cardiac surgery after adjustment considering preoperative risk estimates and postoperative complications and to report risk stratification gains when considering the EuroSCORE combined with postoperative biomarkers.
    Circulation 08/2014; · 15.20 Impact Factor
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    ABSTRACT: Background We hypothesized that patients treated with prasugrel compared with those treated with clopidogrel before coronary artery bypass graft (CABG) surgery are at increased risk of hemorrhagic complications needing transfusions and are more likely to need surgical reexploration. Patients and Methods Preoperative and postoperative clinical data were collected prospectively on 143 consecutive patients treated preoperatively with prasugrel (n = 59) or clopidogrel (n = 84) before undergoing isolated CABG at our institution from January 2011 to October 2012. Results Patients receiving prasugrel showed a slightly higher additive EuroSCORE I compared with those treated with clopidogrel (7 vs. 5, p = 0.001), and more often underwent urgent/emergent CABG (47 vs. 27%, p = 0.01). Patients treated with prasugrel were more likely than those treated with clopidogrel to need perioperative platelet transfusions (25 vs. 12%, p = 0.04). The numbers of transfusions of red blood cells, fresh-frozen plasma, or fibrinogen were high in both groups but showed no statistical differences. Patients treated with prasugrel, however, more often needed surgical reexploration for bleeding complications (8 vs. 1%, p = 0.03). Logistic regression revealed that preoperative therapy with prasugrel (RR 2.9, p = 0.01) and urgent/emergent surgery (RR 2.2, p = 0.04) were predictors for the composite endpoint "need for perioperative platelet transfusion and/or surgical reexploration." Conclusion Pretreatment with prasugrel, compared with clopidogrel, in patients undergoing isolated CABG is associated with an increased need for platelet transfusions and a higher risk of surgical reexploration for bleeding complications.
    The Thoracic and cardiovascular surgeon. 05/2014;
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    ABSTRACT: Coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC) is still the gold standard. However, alternative techniques have been developed to avoid ECC and its potential adverse effects. These encompass minimal extracorporeal circulation (MECC) or off-pump coronary artery bypass grafting (OPCAB). However, the prevailing potential benefits when comparing MECC and OPCABG are not yet clearly established.
    Swiss medical weekly. 01/2014; 144:w13978.
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    ABSTRACT: OBJECTIVES To determine the difference in sternal infection and other infectious events between conventional wire and cable-tie-based closure techniques post-sternotomy in a collective of patients after cardiac surgery.METHODS The sternal ZipFix™ (ZF) system consists of a biocompatible poly-ether-ether-ketone (PEEK) cable-tie that surrounds the sternum through the inter costal space and provides a large implant-to-bone contact. Between 1 February 2011 and 31 January 2012, 680 cardiac operations were performed via sternotomy at our institution. After the exclusion of operations for active endocarditis and early mortality within 7 days, 95 patients were exclusively closed with ZF and could be compared with 498 who were closed with conventional wires (CWs) during the same period. A multivariable logistic regression analysis, including body mass index, renal impairment and emergency as suspected confounders and inverse propensity weights was performed on the infection rate.RESULTSTotal infection rate was 6.1%, with a total of 36 diagnosed sternal infections (5 in ZF and 31 in CW). Comparing ZF with CW with regard to sternal infection, there is no statistically significant difference related to the device (odds ratio: 0.067, confidence interval: 0.04-9.16, P = 0.72). The propensity modelling provided excellent overlap and the mean propensity was almost the same in both groups. Thus, we have observed no difference in receiving either ZF or CW. No sternal instability was observed with the ZF device, unlike 4/31 patients in the CW group. The overall operation time is reduced by 11 min in the ZF group with identical perfusion and clamping times.CONCLUSIONS Our study underlines a neutral effect of the sternal ZipFix™ system in patients regarding sternal infection. Postoperative complications are similar in both sternal closure methods. The cable-tie-based system is fast, easy to use, reliable and safe.
    Interactive Cardiovascular and Thoracic Surgery 04/2013; · 1.11 Impact Factor
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    ABSTRACT: Background We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative risk and does not add to the morbidity in elective procedures.Methods A total of 178 patients with a mean (± SD) age of 62 (± 10) years underwent HCA for elective aortic surgery from April 2008 to September 2011. Pre- and postoperative clinical data were collected prospectively.Results Hemiarch replacement was performed in 97% patients. Mean logistic Euroscore I was 17% (± 15). HCA was performed at 26°C bilateral tympanic temperature. Mean HCA duration was 17 (± 8) min. Mean cross-clamp time was 106 (± 39) min. Overall 30-day mortality was 2% and stroke occurred in 4% of patients. Overall 6-month survival was 96%. Cox regression analysis for 6-month survival revealed four variables with significant influence: the logistic Euroscore I (p = 0.008), age (p = 0.04), cross-clamp time (p = 0.008), and reoperation for bleeding complications (p = 0.04).Conclusions HCA with open distal anastomosis for elective aortic repair can be performed with low operative mortality, even in the elderly, and seems not to add to the morbidity of the procedure.
    The Thoracic and Cardiovascular Surgeon 01/2013; · 0.93 Impact Factor
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    ABSTRACT: OBJECTIVES To offer surgical treatment in patients with aortic valve stenosis and contraindications for aortic valve replacement (e.g. ostial encroachment and previous mitral valve replacement). The aim of this study was to prove the feasibility and efficacy of this novel innovative off-pump apico-aortic conduit technique.METHODS The bipartite conduit consists of an 18-mm prosthetic tube graft containing a stentless porcine aortic valve as well as a flexible semi-rigid and curved ventricular connector. Via left anterior lateral thoracotomy, the valved conduit is sutured to the descending aorta. The left ventricular connector is implanted with a gun-like applicator into the apex without cardiopulmonary bypass and with minimal blood loss.RESULTSBetween March and December 2011, 7 patients (5 females/2 males) with a mean age of 82 (79-89 years) were operated on. The mean logistic EuroSCORE I was 36.4 ± 23.7 (median 36.7%). The mean ejection fraction was 37 (25-65%) and the mean preoperative transaortic gradient was 38 (22-53 mmHg). Three patients had previous mechanical mitral valve replacement, 1 had a porcelain aorta and 3 had unfavourable distances between the aortic annulus and ostia (ostial encroachment). Implantation was uneventful in all patients, with need for limited cardiopulmonary bypass in only 1 patient. Postoperative mean transaortic gradient was 14 (11-25 mmHg). Approximately 70% of stroke volume was bypassed as measured in postoperative magnetic resonance. One patient died in hospital due to respiratory failure. New York Heart Association class in the other patients diminished from 3.6 to 1.6. No rhythmic disturbances or heart block were encountered.CONCLUSIONS With this novel conduit, we observed excellent haemodynamic results. We feel that this additional surgical approach to aortic stenosis in elderly, high-risk patients can augment conventional on-pump and interventional treatments of aortic stenosis.
    Interactive Cardiovascular and Thoracic Surgery 01/2013; · 1.11 Impact Factor
  • Asian cardiovascular & thoracic annals 12/2012; 20(6):741.
  • Article: Reply.
    Bernhard Winkler, Martin T R Grapow
    The Annals of thoracic surgery 08/2012; 94(2):688-9. · 3.45 Impact Factor
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    ABSTRACT: Wire closure still remains the preferred technique despite reasonable disadvantages. Associated complications, such as infection and sternal instability, cause time- and cost-consuming therapies. We present a new tool for sternal closure with its first clinical experience and results. The sternal ZipFix(TM) System is based on the cable-tie principle. It primarily consists of biocompatible Poly-Ether-Ether-Ketone implants and is predominantly used peristernally through the intercostal space. The system provides a large implant-to-bone contact for better force distribution and for avoiding bone cut through. 50 patients were closed with the ZipFix(TM) system. No sternal instability was observed at 30 days. Two patients developed a mediastinitis that necessitated the removal of the device; however, the ZipFix(TM) were intact and the sternum remained stable. In our initial evaluation, the short-term results have shown that the sternal ZipFix(TM) can be used safely and effectively. It is fast, easy to use and serves as a potential alternative for traditional wire closure.
    Journal of Cardiothoracic Surgery 06/2012; 7:59. · 0.90 Impact Factor
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    ABSTRACT: Established hemostatic devices can injure vessel wall integrity. LeGoo (Pluromed, Woburn, MA), a novel poloxamer gel with reverse thermosensitive properties, is a new device for temporary occlusion of blood vessels. The present study investigated the effects of LeGoo on vascular function and morphology. The distal end of the human internal thoracic artery was used to assess vascular function of LeGoo-applied segments in organ bath experiments and by scanning electron microscopy. After LeGoo application, both maximal contractile responses to noradrenaline and endothelium-dependent relaxant responses to acetylcholine were significantly reduced. Scanning electron microscopy showed areas of injured endothelium with exposure of subendothelial structures being in line with the functional changes. Data suggested that application of LeGoo induced significant endothelial injury and deterioration of the smooth muscle in human internal thoracic arteries.
    The Annals of thoracic surgery 12/2011; 92(6):2235-9. · 3.45 Impact Factor
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    ABSTRACT: An increasing number of aortic valve replacements are performed through a ministernotomy. Due to the small incision and partial fixation of the caudal sternum, the traditional wire closure can be complicated and even harmful to the surrounding tissue. In such cases, we recommend the use of nitinol clips for sternal closure. This technique, which we have used in 48 patients, is simple, safe, and fast, and results in excellent outcomes.
    Asian cardiovascular & thoracic annals 10/2011; 19(5):367-9.
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    ABSTRACT: Synovial sarcoma metastasis affecting the heart and infiltrating the mitral valve is a very rare pathology. We report the case of a 44-year-old male treated with chemotherapy for atypical synovial sarcoma of the oral mucosa who presented to our clinic after cardiac decompensation with a presumptive diagnosis of myxoma of the left atrium. A large necrotic tumour positive for CK 22, EMA, CD 99 and BCL-2 but negative for translocation in COBRA-FISH analysis by break-apart probe could be excised and revealed a very rare subtype of synovial sarcoma metastasis arising from the endocard of the left atrium. The tumour was resected and the mitral valve reconstructed through ring annuloplasty.
    The Thoracic and Cardiovascular Surgeon 03/2011; 60(1):84-6. · 0.93 Impact Factor
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    ABSTRACT: Despite significant improvements in pharmacological therapy heart failure is still one of the leading causes for death in the Western World. The gold standard treatment of end-stage heart failure remains cardiac transplantation, but there is a great excess of eligible candidates compared with the low number of suitable donor organs. The variety of surgical organ preserving treatment strategies has significantly increased during the last 20 years, intenting either to delay or even to prevent the need for cardiac transplantation. An individually tailored surgical concept should be considered as an alternative in any heart failure patient who has reached the limits of pharmacologic therapy. This article gives an overview about current and potential future therapeutic options in end-stage heart failure.
    Therapeutische Umschau 02/2011; 68(2):95-102.
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    ABSTRACT: Dahl salt-sensitive (DS) and salt-resistant (DR) inbred rat strains represent a well established animal model for cardiovascular research. Upon prolonged administration of high-salt-containing diet, DS rats develop systemic hypertension, and as a consequence they develop left ventricular hypertrophy, followed by heart failure. The aim of this work was to explore whether this animal model is suitable to identify biomarkers that characterize defined stages of cardiac pathophysiological conditions. The work had to be performed in two stages: in the first part proteomic differences that are attributable to the two separate rat lines (DS and DR) had to be established, and in the second part the process of development of heart failure due to feeding the rats with high-salt-containing diet has to be monitored. This work describes the results of the first stage, with the outcome of protein expression profiles of left ventricular tissues of DS and DR rats kept under low salt diet. Substantial extent of quantitative and qualitative expression differences between both strains of Dahl rats in heart tissue was detected. Using Principal Component Analysis, Linear Discriminant Analysis and other statistical means we have established sets of differentially expressed proteins, candidates for further molecular analysis of the heart failure mechanisms.
    Journal of proteomics 02/2011; 74(5):672-82. · 5.07 Impact Factor
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    ABSTRACT: We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73×74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.
    Journal of Cardiothoracic Surgery 01/2011; 6:64. · 0.90 Impact Factor
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    ABSTRACT: Zusammenfassung Thrombotische Mikroangiopathien sind durch Thrombozytenaktivierung, Endothelzellschädigung, Hämolyse und mikrovaskuläre Okklusionen gekennzeichnet. Es handelt sich hierbei um eine Gruppe von Erkrankungen, deren Hauptvertreter die thrombotische thrombozytopenische Purpura (TTP) und das hämolytisch-urämische Syndrom (HUS) sind. Klinisch bestehen bei den Patienten eine mikroangiopathische hämolytische Anämie mit Thrombozytopenie und okklusionsbedingte Organischämien in variabler Ausprägung. Die Symptomatik der einzelnen Krankheitsbilder überschneidet sich häufig, sodass eine eindeutige Zuordnung anhand klinischer Kriterien oft schwierig ist. Aufgrund einer hohen Mortalität, insbesondere der TTP, sind eine schnelle Diagnostik und Therapie erforderlich. Es wird über 2 Patienten mit thrombotischen Mikroangiopathien nach kardiochirurgischen Eingriffen berichtet. Da TTP, HUS und eine medikamentöse Ätiologie weitgehend ausgeschlossen wurden, wurde ein Zusammenhang zwischen der extrakorporalen Zirkulation während dem herzchirurgischen Eingriff und der thrombotischen Mikroangiopathie vermutet.
    Der Anaesthesist 01/2011; 60(5):451-456. · 0.85 Impact Factor
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    ABSTRACT: Thrombotic microangiopathies are characterized by platelet activation, endothelial damage, hemolysis and microvascular occlusion. This group of diseases is primary represented by thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Patients present with microangiopathic hemolytic anemia and thrombocytopenia as well as occlusion-related organ ischemia to a variable degree. A deficiency of the metalloprotease ADAMTS-13 is a major risk for acute disease manifestation as this is a regulator of unusually large von Willebrand factor (vWF) multimers, which are extremely adhesive and secreted by endothelial cells. In classical TTP an ADAMTS-13 activity below 5% is specific, whereas in other forms of thrombotic microangiopathies activity of ADAMTS-13 ranges from very low to normal. Symptoms of different forms of thrombotic microangiopathy are frequently overlapping and a clear classification according to clinical criteria is often difficult. Due to a high mortality, particularly of TTP, immediate diagnosis and therapy are essential. In this article two cases of thombotic microangiopathy after cardiac surgery are reported. After exclusion of TTP and HUS as well as other etiologies of thrombotic microangiopathy a relationship between the use of extracorporeal circulation and the pathogenesis of thrombotic microangiopathy is assumed.
    Der Anaesthesist 12/2010; 60(5):451-6. · 0.85 Impact Factor
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    ABSTRACT: Deep sternal wound infection (DSWI) is a severe complication after cardiac surgery, mostly caused by staphylococci. Little is known about the optimal antibiotic management. A 10 year retrospective analysis of 100 patients with staphylococcal DSWI after cardiac surgery in a tertiary hospital. Treatment failure was defined as sternal wound dehiscence or fistula at the end of the prescribed antibiotic therapy, 12 months later, or DSWI-related death. Most patients were male (83%) and the median age was 72 years [interquartile range (IQR) 63-76]. Coronary artery bypass was the most frequent preceding procedure (93%). The median time to diagnosis of DSWI was 13 days (IQR 10-18) after surgery. Clinical presentation consisted of wound discharge in 77% of patients. Coagulase-negative staphylococci were isolated in 54 and Staphylococcus aureus in 46 patients. All patients received antibiotics and 95% underwent surgical debridement. The median duration of antibiotic treatment was 47 days (IQR 41-78). During follow-up, 21 out of 100 patients experienced treatment failure. Of these, 8/21 patients (38%) died from DSWI after a median of 12 days (IQR 8-30). In the multivariate analysis, a rifampicin-containing antibiotic regimen was the only factor associated with lower risk of treatment failure (hazard ratio 0.26, 95% confidence interval 0.10-0.64, P = 0.004). Prolonged treatment (12 weeks instead of 6 weeks) did not alter outcome (P = 0.716) in patients without prosthetic valve endocarditis. Treatment of rifampicin-susceptible staphylococcal DSWI with a rifampicin-containing antibiotic regimen may improve the outcome. After surgical debridement an antibiotic treatment of 6 weeks may be adequate for staphylococcal DSWI.
    Journal of Antimicrobial Chemotherapy 08/2010; 65(8):1799-806. · 5.34 Impact Factor
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    ABSTRACT: Postoperative delirium after cardiac surgery is associated with increased morbidity and mortality as well as prolonged stay in both the intensive care unit and the hospital. The authors sought to identify modifiable risk factors associated with the development of postoperative delirium in elderly patients after elective cardiac surgery in order to be able to design follow-up studies aimed at the prevention of delirium by optimizing perioperative management. A post hoc analysis of data from patients enrolled in a randomized controlled trial was performed. A single university hospital. One hundred thirteen patients aged 65 or older undergoing elective cardiac surgery with cardiopulmonary bypass. None. MEASUREMENTS AND MAINS RESULTS: Screening for delirium was performed using the Confusion Assessment Method (CAM) on the first 6 postoperative days. A multivariable logistic regression model was developed to identify significant risk factors and to control for confounders. Delirium developed in 35 of 113 patients (30%). The multivariable model showed the maximum value of C-reactive protein measured postoperatively, the dose of fentanyl per kilogram of body weight administered intraoperatively, and the duration of mechanical ventilation to be independently associated with delirium. In this post hoc analysis, larger doses of fentanyl administered intraoperatively and longer duration of mechanical ventilation were associated with postoperative delirium in the elderly after cardiac surgery. Prospective randomized trials should be performed to test the hypotheses that a reduced dose of fentanyl administered intraoperatively, the use of a different opioid, or weaning protocols aimed at early extubation prevent delirium in these patients.
    Journal of cardiothoracic and vascular anesthesia 03/2010; 24(4):555-9. · 1.06 Impact Factor
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    ABSTRACT: Smoking not only increases the risk that coronary heart disease will develop but also morbidity and mortality in patients with known coronary atherosclerosis and after coronary artery bypass grafting. Excessive generation of reactive oxygen species (ROS) has been implicated as the final common pathway for the development of endothelial dysfunction in various cardiovascular risk factors. This study assessed the influence of smoking on two different human arteries routinely used as coronary artery bypass graft conduits. Isometric tension was recorded on discarded segments of human left internal thoracic artery (ITA) and the radial artery (RA) from smokers and nonsmokers. The contractile response to endothelin-1 was significantly stronger in arteries from smokers than in those from nonsmokers. By contrast, endothelium-dependent relaxant responses to acetylcholine were attenuated in RA rings but enhanced in ITA rings from smokers. In additional experiments, 5-(&6)-chloromethyl-2'-7'-dichlorodihydro-fluorescein diacetate (DCDHF) was used to photochemically detect ROS by confocal imaging of intact ITA and RA. Enhanced production of ROS was induced by exposure of tissues to 28 degrees C. While during exposure to 28 degrees C, basal fluorescence emission was unchanged in ITA rings, it increased significantly in RA rings, indicating enhanced formation of ROS in this peripheral artery. Data suggest that smoking induces endothelial dysfunction by increasing vascular ROS production. Different levels of endogenous antioxidant enzyme activities and the degree of atherosclerotic changes might modulate physiologic and pharmacologic vasoreactivity and be responsible for decreased graft patency of RA compared with ITA conduits, especially in active smokers.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2010; 51(2):438-44. · 3.52 Impact Factor

Publication Stats

254 Citations
134.47 Total Impact Points


  • 2005–2014
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
  • 2011
    • University of Barcelona
      • Department of Medicine
      Barcino, Catalonia, Spain
  • 2004–2007
    • Universität Basel
      Bâle, Basel-City, Switzerland
  • 2006
    • Semmelweis University
      • Department of Genetics, Cell and Immunobiology
      Budapest, Budapest fovaros, Hungary
  • 2005–2006
    • Universitäre Psychiatrische Kliniken Basel
      Bâle, Basel-City, Switzerland
  • 1998–2001
    • Martin Luther University of Halle-Wittenberg
      • Poliklinik für Herz- und Thoraxchirurgie
      Halle-on-the-Saale, Saxony-Anhalt, Germany