Selami Dogan

Goethe-Universität Frankfurt am Main, Frankfurt, Hesse, Germany

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Publications (91)212.21 Total impact

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    ABSTRACT: Fragestellung: Die Einlungenventilation (ELV) ist Voraussetzung für koronarchirurgische Eingriffe mit dem Port-Access(PA)- System. Ziel der Untersuchung war es, den perioperativen Gasaustausch bei 20 Patienten zu untersuchen.¶   Methodik: 20 Patienten unterzogen sich einer koronaren Bypassoperation mit extrakorporaler Zirkulation (EKZ) in PA-Technik. Arterielle Blutgasanalysen wurden zu verschiedenen Zeitpunkten der Operation entnommen und auf PaO2 und Laktatgehalt untersucht. Zusätzlich zum Standardmonitoring erfolgte die Überwachung der Patienten mit einer kontinuierlichen ST-Streckenanalyse sowie transösophagealer Echokardiographie (TEE).¶   Ergebnisse: Unmittelbar nach Beginn der ELV kam es zu einem signifikanten Abfall des PaO2. Bei 4 Patienten konnte lediglich ein PaO2 zwischen 50 und 70 mmHg aufrechterhalten werden. Nach Beendigung der EKZ und Wiederbeginn der Zweilungenbeatmung erholte sich der PaO2 umgehend und erreichte wieder das Ausgangsniveau. Während der ELV blieben PaO2 und Laktatspiegel nahezu konstant. Mittels ST-Streckenanalyse und TEE konnten keine myokardialen Ischämien entdeckt werden. Ungeachtet prolongierter Anästhesie- (421±56min), Operations- (324±62min), EKZ- (141±36min) und Aortenklemmzeiten (58±14min) konnten 19 der 20 Patienten innerhalb von 24 Stunden extubiert werden.¶   Schlussfolgerung: Die ELV während Eingriffen mit dem PA-System führt zu einer signifikanten Verschlechterung der Oxygenierung und kann die Patienten über längere Zeit einem kritisch niedrigen PaO2 aussetzen. Dennoch kam es selbst bei Patienten mit extrem schlechter Oxygenierung nicht zum Auftreten von hämodynamischen Instabilitäten oder myokardialen Ischämien. Unter der Anwendung eines umfassenden und kontinuierlichen intraoperativen Monitorings können Eingriffe mit dem PA-System aus anästhesiologischer Sicht für sicher erachtet werden. Objective: Single-lung ventilation (SLV) is mandatory for coronary artery bypass grafting (CABG) with the port access (PA) technique to allow adequate exposure. This study seeks to determine perioperative gas exchange in 20 patients who underwent PA-CABG to assess patient safety.¶   Methods: 20 patients underwent minimally invasive PA-CABG with cardiopulmonary bypass (CPB). Arterial blood gas analyses were performed at various times throughout the procedure to determine PaO2 and lactate levels. In addition to standard monitoring, continuous ST-segment analysis and transesophageal echocardiography were used.¶   Results: Immediately after institution of SLV the PaO2 decreased significantly, and in 4 patients reached levels between 50 and 70 mmHg. After weaning from CPB and return to double-lung ventilation, PaO2 recovered promptly to baseline value. During SLV, PaO2 and lactate levels remained constant. ST-segment analysis and TEE findings showed no evidence of myocardial ischemia. Despite extended anesthesia (421±56 min), surgery (324±62 min), CPB (141±36 min), and aortic crossclamp time (58±14 min), all but one patient were extubated within 24 hours.¶   Conclusions: SLV for PA-CABG may be associated with significant impairment of oxygenation and may expose patients to critically low oxygenation levels for an extended period of time. Nonetheless, hemodynamic instability or myocardial ischemia did not occur, not even in patients whose oxygenation was poor. We believe, provided that continuous monitoring is employed intraoperatively, PA-CABG can be considered safe from an anesthesiologist’s point of view.
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 04/2012; 14(6):239-244. DOI:10.1007/s003980070002
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    ABSTRACT: Venoarterial extracorporeal membrane oxygenation is an established treatment option in patients with cardiogenic shock. This report reviews our 3-year experience with this support system with respect to early and midterm outcome, as well as predictors of survival. From January 2003 until November 2006, 45 (0.8%) of 5750 patients undergoing cardiac surgery procedures required the following: temporary extracorporeal membrane oxygenation support coronary artery bypass grafting, n = 20; implantation of a left ventricular assist device, n = 5; heart transplantation, n = 1; heart and lung transplantation, n = 1; coronary artery bypass grafting plus repair of postinfarction ventricular septal defect, n = 3; coronary artery bypass grafting plus mitral valve repair, n = 5; aortic valve replacement, n = 2; coronary artery bypass grafting plus aortic valve replacement, n = 3; and other procedures, n = 5. Extracorporeal membrane oxygenation implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta. Additional intra-aortic balloon pumps were used in 30 patients. Average patient age was 60.1 +/- 13.6 years. There were 35 male patients. Average duration of extracorporeal membrane oxygenation was 6.4 +/- 4.5 days. Twenty-five patients could be successfully weaned from extracorporeal membrane oxygenation. The 30-day mortality was 53% (24/45 patients). The in-hospital mortality was 71% (32/45 patients). Thirteen (29%) patients could be successfully discharged. After a follow-up period of up to 3 years, 10 (22%) patients were still alive. Extracorporeal membrane oxygenation offers sufficient cardiopulmonary support in adults with similar hospital and midterm survival rates to those of other mechanical support systems. Early indication, alternative peripheral cannulation techniques, and reduced anticoagulation to avoid perioperative bleeding could improve our results with increasing experience.
    The Journal of thoracic and cardiovascular surgery 03/2008; 135(2):382-8. DOI:10.1016/j.jtcvs.2007.08.007 · 4.17 Impact Factor
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    The Journal of thoracic and cardiovascular surgery 03/2008; 135(2):430-1. DOI:10.1016/j.jtcvs.2007.08.057 · 4.17 Impact Factor
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    ABSTRACT: Treatment of acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurologic morbidity and mortality. The following study investigates clinical results after modification of perfusion technique for cardiopulmonary bypass as well as temperature management. Between January 2000 and August 2006, 120 consecutive patients underwent repair of acute type A dissection. Selective antegrade cerebral perfusion through the right subclavian artery combined with mild systemic hypothermia (30 degrees C) was used in all patients. Mean cardiopulmonary bypass time was 144 +/- 53 minutes, and mean myocardial ischemic time was 98 +/- 49 minutes. Isolated cerebral perfusion was performed for 25 +/- 12 minutes. Mean core temperature amounted to 30.1 degrees +/- 2.2 degrees C. Chest tube drainage during the first 24 hours was 525 +/- 220 mL. Mean ventilation time was 54 +/- 22 hours. Elevation of serum lactate levels at 1, 12, and 24 hours postoperatively rose to 22 +/- 14, 18 +/- 11, and 19 +/- 8 mg/dL respectively. We observed new postoperative permanent neurologic deficits in 5 patients (4.2%) and TND in 3 patients (2.5%). The 30-day mortality rate was 5% (n = 6). After a mean follow-up period of 2.8 years, 104 patients (87%) were still alive. Antegrade cerebral perfusion in combination with mild hypothermia offered sufficient neurologic protection in our patient cohort, provided adequate distal organ protection, and reduced perioperative complications in surgery for type A dissection. This perfusion strategy may help in reducing perioperative complications in this particular patient population.
    The Annals of thoracic surgery 03/2008; 85(2):465-9. DOI:10.1016/j.athoracsur.2007.10.017 · 3.85 Impact Factor

  • Journal of Thoracic and Cardiovascular Surgery 02/2008; 135(2):467-467. DOI:10.1016/j.jtcvs.2007.11.001 · 4.17 Impact Factor
  • A Zierer · S Melby · F Bakhtiary · O Dzemali · P Kleine · S Dogan · S Martens · A Moritz · M Moon ·

    The Thoracic and Cardiovascular Surgeon 01/2008; 56. DOI:10.1055/s-2008-1037956 · 0.98 Impact Factor

  • The Thoracic and Cardiovascular Surgeon 01/2008; 56. DOI:10.1055/s-2008-1038013 · 0.98 Impact Factor
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    ABSTRACT: This study investigates how different left ventricular epicardial and endocardial pacing sites influence hemodynamic performance in an animal model of heart failure (HF). In six adult sheep, dilated HF was induced by rapid pacing. Subsequently, endocardial left ventricular stimulation was performed using a 64-electrode basket catheter. Epicardial pacing was achieved with temporary electrodes. Baseline cardiac output (CO) was 2.7 +/- 0.4 l/min and improved significantly with lateral wall epicardial and endocardial stimulation (3.6 +/- 0.7 and 3.8 +/- 0.65 l/min), whereas right ventricular pacing led to lower CO (2.1 +/- 0.5 and 2.0 +/- 0.9 l/min). In the optimal pacing location arterial pressure, pulmonary capillary wedge pressure (pcwp) and LV diameters improved significantly. Right ventricular pacing impaired hemodynamics, while no change was observed in the LV inferior wall and apex pacing. Endocardial and epicardial pacing of the lateral wall led to an improvement in LV function while right ventricular pacing induced a further reduction of LV performance. As this optimal pacing site cannot always be reached via the coronary sinus, surgical implantation of epicardial electrodes should be considered in all non-responding patients.
    The Thoracic and Cardiovascular Surgeon 01/2008; 55(8):481-4. DOI:10.1055/s-2007-965713 · 0.98 Impact Factor
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    ABSTRACT: Acute left ventricular (LV) dysfunction after cardiopulmonary bypass (CBP) is a serious complication in cardiac surgery. The aim of this study was to investigate the effect of different epicardial pacing modes on LV contractility and changes of myocardial oxygen extraction (MVO(2)) following CPB in an animal model. The utility of conductance catheter measurement versus left ventricular outflow tract mean systolic acceleration (LVOT(Acc)) for quantification of LV function was evaluated. Fourteen piglets underwent median sternotomy and CPB for 90 minutes, myocardial ischemia for 60 minutes, and reperfusion for 30 minutes. Different pacing modes were obtained before and after CPB to investigate changes in LV function. LV Function was quantified by end-systolic-pressure-volume relationships (ESPVR) as measured by the conductance catheter method and by LVOT(Acc) obtained from transepicardial echocardiographic studies. LV contractility improved significantly by biventricular and atrial pacing compared with natural sinus rhythm (SR). MVO(2) remained stable or even decreased with biventricular pacing after surgery compared with SR. Right ventricular pacing resulted in poor LV-function with a rise of MVO(2). LVOT(Acc) showed a strong correlation to invasively measured ESPVR. Postoperative biventricular pacing was associated with an improved LV contractility without rise of MVO(2) compared with SR and atrial pacing. At termination of CPB, this appears to facilitate the management of LV failure and potentially may reduce the need for inotropic support, additionally protecting myocardial metabolism. The echocardiographic assessment of LVOT(Acc) was a simple and reliable as well as effective method to quantify LV contractility and showed a good correlation with the more invasive conductance catheter.
    Pacing and Clinical Electrophysiology 10/2007; 30(9):1083-90. DOI:10.1111/j.1540-8159.2007.00817.x · 1.13 Impact Factor
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    ABSTRACT: We retrospectively analyzed our experience in atrial septal defect repair with varied minimally invasive surgical approaches. From 1997 to 2006, 64 patients underwent surgical repair of atrial septal defects in our center. Patients were grouped into four groups according to the approach used; group 1 (n = 16), partial lower sternotomy; group 2 (n = 20), right anterior small thoracotomy with transthoracic clamping; group 3 (n = 4), right anterior small thoracotomy with endoaortic balloon clamping; and group 4 (n = 24), totally endoscopic approach with the use of the da Vinci surgical system (Intuitive Surgical, Mountain View, Calif). Preoperative diagnosis was a large secundum type atrial septal defect in 60 patients, primum type in 3 patients, and sinus venosus type in 1 patient. Complete atrial septal defect closure was verified by intraoperative transesophageal echocardiography in all patients. There was neither perioperative mortality nor major complication. Groups 3 and 4 had significantly longer aortic crossclamp, cardiopulmonary bypass, and skin-to-skin operative times than had groups 1 and 2 (P = .000). All groups had similar ventilation time, postoperative drainage, and intensive care unit and hospital stays. Only 2 patients in group 4 were converted to the minithoracotomy owing to endoaortic balloon failure. During the follow-up of 30 +/- 24.3 months, 1 patient in group 3 was reoperated on owing to significant residual shunting. All types of atrial septal defects can be repaired via those four different approaches as safely as can be done by the conventional technique. General complications during surgical procedures are negligible. These approaches may be considered a standard treatment and an adjunct to transcatheter treatment options in atrial septal defect repair.
    The Journal of thoracic and cardiovascular surgery 10/2007; 134(3):757-64. DOI:10.1016/j.jtcvs.2007.04.004 · 4.17 Impact Factor
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    ABSTRACT: Current data suggest that individual genetic predisposition may influence the magnitude of cytokine response and the degree of organ dysfunction after cardiopulmonary bypass. Lipoprotein lipase S447X polymorphism has been shown to be protective against atherosclerosis. The aim of the study was to investigate the effect of lipoprotein lipase S447X polymorphism on cytokine release and early outcome after cardiopulmonary bypass. Forty patients who underwent coronary artery bypass grafting with cardiopulmonary bypass were included. Genotyping for lipoprotein lipase S447X polymorphism was performed by polymerase chain reaction. Levels of interleukins 6 and 8 were measured before induction and 6, 24, and 72 hours after operation by enzyme-linked immunosorbent assay. Clinical data were collected prospectively. Daily assessment of organ dysfunction was done according to the cardiac surgery scoring (CASUS) system. The allele frequency of lipoprotein lipase S447X stop codon was 17.5%. S447X carriers revealed significantly lower interleukin 8 levels at the sixth and 24th postoperative hours than the noncarrier group (P = .005 and P = .041, respectively). Patients in the S447X carrier group had significantly shorter ventilation times than the noncarrier group (P = .048). Also, the S447X carrier group revealed significantly lower postoperative 6-hour lactate levels, operative day, and postoperative day 1 organ dysfunction scores than the other group (P = .001, .005 and .002, respectively). Lipoprotein lipase S447X stop codon mutation is associated with lower levels of interleukin 8 after coronary artery bypass grafting. Identification of high-risk patients for cardiopulmonary bypass-related systemic inflammation by detecting lipoprotein lipase S447X stop codon polymorphism may improve early postoperative outcome, especially in patients with limited organ reserves.
    The Journal of thoracic and cardiovascular surgery 09/2007; 134(2):477-83. DOI:10.1016/j.jtcvs.2007.03.017 · 4.17 Impact Factor
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    ABSTRACT: Atrial fibrillation is one of the most common complications in patients undergoing coronary artery bypass grafting. The goal of this study was to investigate the impact of high thoracic epidural anesthesia on reduction of perioperative arrhythmia in patients undergoing off-pump coronary artery bypass grafting. We prospectively randomized 132 patients undergoing elective off-pump coronary bypass grafting using either general anesthesia (GA) (n = 66) or combined general and high thoracic epidural anesthesia (GA+TEA) (n = 66). Incidence of perioperative arrhythmias such as atrial fibrillation, serum epinephrine levels, heart rate variability, and hemodynamic parameters were compared between groups. The incidence of perioperative dysarrhythmias was significantly lower (P < .01) in the GA+TEA group (3%) than in the GA group (23.7%). Intraoperative sinus bradycardia occurred in 91% of the patients in the GA+TEA group versus 5.3% in the GA group. After induction of anesthesia, the mean systolic arterial pressure decreased significantly from 128 +/- 5 to 92 +/- 4 mm Hg and the heart rate from 74 +/- 9 to 52 +/- 8 beats . min(-1) in the GA+TEA group, whereas in the GA group no significant hemodynamic changes were observed (P < .001). Serum epinephrine levels were significantly lower in the GA+TEA group (69 +/- 11 to 35 +/- 7 ng/dL) than in the GA group (72 +/- 9 to 70 +/- 9 ng/dL). In our study cohort, high thoracic epidural anesthesia in combination with general anesthesia reduced significantly the incidence of perioperative arrhythmias such as atrial fibrillation. Furthermore, we observed a significant reduction of epinephrine serum levels in this patient group. The results of this study support a combination of general anesthesia with thoracic epidural anesthesia as a multidisciplinary approach, which may lead to a better patient outcome, improvement of early analgesia, and reduction of perioperative complications in off-pump coronary artery bypass procedures. The potential risks of thoracic epidural anesthesia during off-pump coronary artery bypass procedures should not be underestimated.
    The Journal of thoracic and cardiovascular surgery 08/2007; 134(2):460-4. DOI:10.1016/j.jtcvs.2007.03.043 · 4.17 Impact Factor

  • The Journal of thoracic and cardiovascular surgery 07/2007; 133(6):1637-9. DOI:10.1016/j.jtcvs.2007.01.034 · 4.17 Impact Factor
  • P S Risteski · T Aybek · O Dzemali · M Doss · M Scherer · S Dogan · A Moritz ·
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    ABSTRACT: This paper reports on the mid-term clinical and echocardiographic results of mitral valve repair with chordal replacement. Sixty-nine patients (mean age 61 +/- 14 years) underwent mitral valve repair with chordal replacement. The etiology was degenerative in 53 (77 %), rheumatic in 7 (10 %), ischemic in 6 (9 %) and infective in 3 (4 %). Mean ejection fraction was 58 +/- 14. In 35 patients (51 %), a minimally invasive approach was used. Mean follow-up time was 45 +/- 27 months. Anterior leaflet chordae were replaced in 58 (84 %) patients. There were 3 operative deaths. Freedom from non-trivial recurrent mitral regurgitation (MR) was 81.3 +/- 8.7 % at 97 months. Follow-up echocardiographic controls showed mild recurrent MR in 5 (8 %) patients and moderate in 2 (3.2 %). These two patients required reoperation due to mitral annulus redilation after suture annuloplasty. Competent neochordae were found at reoperation. Freedom from reoperation at 97 months was 96.6 +/- 2.4 %. Four patients died during follow-up resulting in an actuarial survival of 87 +/- 6.2 %. The replacement of chordae tendineae with ePTFE sutures during mitral valve repair has shown good mid-term results. The implantation of the neochordae can be also performed safely using minimally invasive procedures.
    The Thoracic and Cardiovascular Surgeon 07/2007; 55(4):239-44. DOI:10.1055/s-2006-955947 · 0.98 Impact Factor
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    ABSTRACT: A 50-year-old man was referred to the Department of Thoracic and Cardiovascular Surgery at the Johann Wolfgang-Goethe University (Frankfurt, Germany) with angina on exertion. An evaluation revealed critical stenosis involving the proximal portion of the left anterior descending artery and the first diagonal branch. The patient underwent successful sequential grafting of the left internal mammary artery to the left anterior descending artery and the diagonal branch using a totally endoscopic coronary artery bypass grafting technique on the beating heart with a new version of the da Vinci Surgical System (Intuitive Surgical, USA). To the authors' knowledge, this is the first report in literature to describe sequential arterial off-pump grafting of two anterior wall target vessels using a totally endoscopic technique on the beating heart.
    The Canadian journal of cardiology 05/2007; 23(5):391-2. DOI:10.1016/S0828-282X(07)70774-2 · 3.71 Impact Factor
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    ABSTRACT: One-lung ventilation is used during a variety of surgical procedures, even in patients with pre-existing coronary artery disease. The study purpose was to elucidate if myocardial metabolism crosses the anaerobic threshold under hypoxemia during one-lung ventilation. Therefore, we determined myocardial metabolism as a marker for anaerobic myocardial metabolism in patients with significant multi-vessel coronary artery disease undergoing one-lung ventilation during minimally-invasive coronary artery bypass grafting. Twenty patients with multi-vessel coronary artery disease underwent minimally-invasive revascularisation on cardiopulmonary bypass. One-lung ventilation was used for at least 45 min prior to cardiopulmonary bypass. Blood samples were drawn from arterial and coronary sinus blood at various times throughout the procedure to determine myocardial metabolism. After institution of one-lung ventilation arterial partial pressure of oxygen decreased significantly, down to levels between 50 and 70 mmHg. During one-lung ventilation, pH and lactate levels in both arterial and coronary sinus blood remained constant. Significant changes of pH and lactate levels were observed only after cardiopulmonary bypass. No clinically significant signs of myocardial ischemia occurred in any patient. Aerobic myocardial metabolism was unaffected during one-lung ventilation in all patients. Therefore, one-lung ventilation can be applied to patients with multi-vessel coronary artery disease with an acceptable risk of turning myocardial metabolism to an anaerobic state.
    Interactive Cardiovascular and Thoracic Surgery 05/2007; 6(2):209-13. DOI:10.1510/icvts.2006.129213 · 1.16 Impact Factor

  • The Journal of thoracic and cardiovascular surgery 03/2007; 133(2):560-2. DOI:10.1016/j.jtcvs.2006.09.036 · 4.17 Impact Factor
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    ABSTRACT: This prospective-randomized study investigated the effect of aortic valve design and patient-prosthesis mismatch (PPM) on coronary flow reserve (CFR) after mechanical or biological aortic valve replacement (AVR) in patients with aortic stenosis (AS). Coronary flow reserve may be an important parameter of long-term survival after AVR in patients with AS. Reduced CFR may contribute to more cardiovascular events and greater rates of mortality. A total of 48 patients undergoing AVR underwent magnetic resonance imaging for the measurement of coronary flow preoperatively, 5 days postoperatively, and at 6-month follow-up with measurement of CFR. Patients scheduled for mechanical AVR were randomized to a tilting disc or bileaflet prosthesis (n = 12 in each group). For biological AVR, patients were scheduled to receive a stented (n = 12) or stentless (n = 12) valve. Patients also underwent echocardiography with measurement of transvalvular pressure gradients and left ventricular mass regression. Postoperatively, coronary flow increased significantly in all groups (p < 0.001). Only stentless valves demonstrated a normal CFR (3.4 +/- 0.3 vs. 2.3 +/- 0.1 for stented biological valves, 2.1 +/- 0.2 for tilting disc, and 2.2 +/- 0.3 for bileaflet mechanical valves). Patient-prosthesis mismatch with an indexed effective orifice area <0.85 cm2/m2 led to decreased rates of CFR in the tilting disc, stentless, and stented groups. Pressure gradients were 14 +/- 3 mm Hg for tilting disc, 12 +/- 4 mm Hg for bileaflet, 19 +/- 6 mm Hg for stented, and 10 +/- 4 mm Hg for stentless valves. Normalization of CFR after AVR in patients with AS was observed only for stentless valves. Coronary flow reserve might explain the excellent long-term results for stentless valves. (Impact of Patient-Prosthesis Mismatch on Coronary Flow Reserve;; NCT00310947).
    Journal of the American College of Cardiology 02/2007; 49(7):790-6. DOI:10.1016/j.jacc.2006.10.052 · 16.50 Impact Factor
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    ABSTRACT: Cardiac resynchronization therapy (CRT) has been introduced as a new therapeutic modality in patients with chronic heart failure. However, most studies have investigated the hemodynamic effects in congestive, but not postoperative heart failure. The following study investigates hemodynamic effects of perioperative temporary biventricular pacing in patients undergoing open heart surgery. In 54 patients one left and one right ventricular epicardial wire was placed during open heart operations. Hemodynamic parameters were measured immediately after the operation and 6 as well as 24 hours postoperatively. Transesophageal echocardiography was performed 1 hour postoperatively. Of the 54 patients (59.2%), 32 responded to biventricular pacing with an increase in cardiac output; in these patients synchronized ventricular contraction could be verified echocardiographically. This hemodynamic benefit persisted 6 hours and 24 hours postoperatively. The remaining 22 patients did not show any hemodynamic improvement from biventricular stimulation. Biventricular pacing leads to significant rise in cardiac output in approximately 59% of patients with severely reduced left ventricular function and widened QRS complexes. Further studies are necessary to define clearly the clinical characteristics of patients who show remodeling by CRT.
    Pacing and Clinical Electrophysiology 01/2007; 29(12):1341-5. DOI:10.1111/j.1540-8159.2006.00545.x · 1.13 Impact Factor

  • The Thoracic and Cardiovascular Surgeon 01/2007; 55. DOI:10.1055/s-2007-967510 · 0.98 Impact Factor