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Cardiac Surgery in Germany during 1997
... In Deutschland unterzogen sich 1998 insgesamt 76498 Patienten einer aortokoronaren Bypassoperation (7). Obwohl die Anzahl ernster Komplikationen nach Koronarchirurgie vergleichsweise gering ist, kommt es jedoch bei 20 bis zu 40% aller Patienten postoperativ zu Arrhythmien (12), insbesondere Vorhofflimmern (VHF), unabha Èngig davon, ob sie pra Èoperativ einen Sinusrhythmus zeigten oder nicht. ...
Atrial fibrillation is the most common complication after coronary surgery. Although not being life-threatening itself, atrial fibrillation (AF) is related to a significant increase in dangerous arrhythmias and postoperative stroke. The use of β-blockers is the commonly accepted therapy, especially sotalol shows good results.
In a prospective study, we compared the prophylactic effect of three different β-blockers on the incidence of AF to that of a control group. In addition, we differentiated between two doses of sotalol.
Our results showed significant differences. Using atenolol or low-dose sotalol, the occurrence of atrial fibrillation was almost equal to the control group (atenolol 10/40, low-dose sotalol 7/40, control group 11/40), whereas the higher dose of sotalol and also metoprolol reduced the frequency of arrhythmias significantly to 0/40 and 2/40, respectively. The patients showed no side effects with the exception of three patients in the atenolol group who needed temporary pacing due to bradycardia.
We conclude that the use of sotalol and metoprolol results in an effective suppression of atrial fibrillation without serious side effects. We have therefore integrated the prophylaxis with sotalol 80mg twice a day into our daily routine.
... One major precondition therefore is an equal distribution of the investigated patients. The composition of our patient group is comparable to those of other cardiac surgical centers[19]. With more than 70%, the main diagnosis was coronary artery disease, more than two-thirds of the patients had one or more risk factors, and the patient age was normally distributed. ...
To shorten hospital stay after cardiac surgery, several risk factors have been defined to identify patients who can be discharged early. These risk factors are dependant on the patient; no studies exist on the influence of the treating physician himself on postoperative patient stay.
In a university affiliated cardiac surgical clinic we investigated patients who were postoperatively treated either on medical wards with no cardiac surgeon's presence or on a cardiac surgical ward; at both types of wards physicians had several years experience with cardiac surgical patients. Taking several risk factors for postoperative morbidity into account, postoperative length of stay and incidence of wound healing complications have been compared.
Within a 3-month period, 84 patients were treated at the cardiac surgical ward, 102 patients at the medical wards. Risk factors for postoperative morbidity were present in 87% of patients, statistically independent of postoperative wards. Although demographic data and median ICU-stay of both patient groups was comparable, the median post-ICU stay was 9 days at the surgical and 13 days at the medical wards (P < 0.0001). Incidence of wound healing complication was higher (19.6%) at the medical wards than at the surgical ward (10.7%), without reaching statistical significance.
As patients at the respective wards were statistically not different, the difference in post-ICU stay, infection and costs must depend on the treating physicians. As a consequence, postoperative care for cardiac surgical patients in all cases should include direct cardiac surgical participation.
Based on a long-standing voluntary registry founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2016 are analyzed. In 2016, a total of 103,128 heart surgery procedures (implantable defibrillator, pacemaker, and extracardiac procedures excluded) were submitted to the registry. Approximately 15.7% of the patients were at least 80 years of age, resulting in an increase of 0.9% compared with the data of 2015. For 37,614 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 4.4:1), an unadjusted in-hospital mortality of 2.9% was observed. Concerning the 33,451 isolated heart valve procedures (including 11,701 catheter-based procedures), the unadjusted in-hospital mortality was 4.3%.
This annual updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, describes advancements in heart medicine, and is a basis for internal and external quality assurances for all participants. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is appropriate and patients are treated nationwide at all times.
On the basis of a long-standing voluntary registry, which was founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all heart, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during 2015 are analyzed. In 2015, a total of 103,967 heart surgery procedures (implantable cardioverter defibrillator pacemaker and extracardiac procedures without ECC excluded) were submitted to the database. Approximately 14.8% of the patients were at least 80 years old, resulting in an increase of 0.6% compared with the data of 2014. For 38,601 isolated coronary artery bypass grafting procedures (relationship on-/off-pump: 5:1), the unadjusted inhospital mortality was 2.7%. Concerning the 32,346 isolated heart valve procedures (including 10,606 catheter-based implantations) an unadjusted inhospital mortality of 4.4% was observed.This annual updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, demonstrates advancements in heart medicine, and enables internal/external quality assurance for all participants. In addition, the registry demonstrates that the provision of heart surgery in Germany is appropriate and patients are treated nationwide in a round-the-clock service.
Georg Thieme Verlag KG Stuttgart · New York.
Our survey was intended to give an overview of current practice in anaesthesiology relating to heart surgery in Germany. All clinics (n = 77) carrying out heart surgery were sent a questionnaire, of which 55 relied in full. For preoperative diagnosis, ECG has top priority for 100% of respondents, and cardiac catheterisation for 98%. Lung function tests (64%) and echo-cardiography (46%) were ranked lower. Premedication on the evening before the operation was provided exclusively per os as monotherapy or combination therapy. The benzodiazepines flunitrazepam (51%), potassium clorazept (29%), and Lormatazepam (13%) are most frequently prescribed. On the day of operation, 52 clinics (95%) give premedication per os. Frequently used drugs are flunitrazepam (55%), midazolam (22%), and potassium clorazepat (18%). Narcosis is induced by Midazolam (64%), etomidate (56%), fentanyl (66%), sufentanil (62%), pancuronium bromide (90%) and vecuronium (24%). To maintain narcosis, 35 clinics (64%) apply narcotics continuously, 32 clinics (58%) intermittently. Intraoperative monitoring depends on the results of preoperative cardiac investigations. Transoesophageal echo-cardiography is used in only 7 - 31% of clinics (depending on operation) and monitoring of cerebral function is carried out in 14 - 18%. Thirteen clinics (24%) routinely administered catecholamines before ending extracorporeal circulation. When treating low-output syndrome, cathecholamines are applied, in particular adrenalin (73%), nitro-compounds (47%), and phosphodiesterase blockers (42%). In order to reduce the transfusion of homologous blood products and to avoid illnesses associated with transfusions, more than half of the clinics responded that they used intraoperative haemodilution (67%) or autologous blood transfusion (53%).
Die vorliegende Arbeit behandelt die Prinzipien und Grundlagen der koronaren Bypassoperation. Die Resultate wie Operationsrisiko, Überlebens- und Krankheitsraten sowie die Durchgängigkeitsraten der verschiedenen Grafttypen werden basierend auf dem aktuellen Stand der Literatur erläutert. Die Ätiologie und Pathogenese der Atheromatose sowie die Venengraftsklerose werden diskutiert. Bei der Sklerose der Venengrafts handelt es sich primär im Wesentlichen um einen Adaptationsprozess des Gefäßes an die arteriellen Blutdrücke (Wandstress) und Strömungsverhältnisse (Scherkraft), der sekundär durch die grundsätzlichen Mechanismen der Atheromatoseentwicklung überlagert wird. Schließlich wird das Biocompound-Verfahren vorgestellt, welches durch die Umhüllung der Graftvene mit einem hoch flexiblen Flechtschlauch aus einer Stahllegierung den Wandstress herabsetzt sowie in Folge des verringerten Graftdurchmesseres zu einem günstigen Ausmaß der Scherkraft führt und so die Graftsklerose reduziert. Abschließend folgt eine Übersicht der aktuellen Literatur über die verschiedenen medikamentösen Therapien zur Verzögerung der Graftsklerose.
Based on a voluntary registry of the German Society for Thoracic and Cardiovascular
Surgery (GSTCVS), data of all heart surgery procedures performed in 78 German cardiac
surgical units during the year 2014 are presented. In 2014, a total of 100,398 cardiac
surgical procedures (implantable cardioverter-defibrillator and pacemaker procedures
excluded) were submitted to the registry. More than 14.2% of the patients were older
than 80 years, describing an increase of 0.4% compared with the previous year. The
unadjusted in-hospital mortality for 40,006 isolated coronary artery bypass grafting
procedures (84.7% on-pump, 15.3% off-pump) was 2.6%. In 31,359 isolated valve procedures
(including 9,194 catheter-based procedures), an in-hospital mortality of 4.4% was
observed. This annual updated registry of the GSTCVS is published since 1989. It is an
important tool for quality assurance and voluntary public reporting by illustrating current
standards and actual developments for nearly all cardiac surgical procedures in Germany.
On the basis of a voluntary registry of the German Society for Thoracic and Cardiovascular
Surgery (GSTCVS), data of all cardiac surgical procedures performed in 79 German cardiac
surgical units during the year 2013 are presented. In 2013, a total of 99,128 cardiac surgical
procedures (implantable cardioverter defibrillator [ICD] and pacemaker procedures excluded)
were submitted to the registry. More than 13.8% of the patients were older than
80 years, which remains equal in comparison to the previous year. In-hospital mortality in
40,410 isolated coronary artery bypass grafting procedures (84.5% on-pump and 15.5% offpump)
was 2.9%. In 29,672 isolated valve procedures (including 7,722 catheter-based
procedures), an in-hospital mortality of 4.7% was observed. This long-lasting registry of the
GSTCVS will continue to be an important tool for quality control and voluntary public
reporting by illustrating current facts and developments of cardiac surgery in Germany.
Grundproblematik und Fragestellung: Die 30-Tage-Sterblichkeit nach chirurgischen Eingriffen ist ein allgemein akzeptiertes zentrales Qualitätsmerkmal, welches jedoch schwierig zu erfassen ist. Im Modellprojekt »30-Tage-Sterblichkeit nach Herzoperation« der Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) wurde deshalb geprüft, ob durch direkte Kommunikation einer Datenzentrale mit dem Patienten selbst der Aufwand für die Vervollständigung der Daten entscheidend reduziert werden und damit eine lückenlose Dokumentation erfolgen kann.
Patienten und Methodik: Vom 1.6.1997 bis 31.3.1998 wurden konsekutiv die Daten aller zu einer Herzoperation angemeldeter Patienten in einem Register erfaßt, an dem 85 der 132 ALKK-Kliniken teilnahmen. Neben den Daten zur Charakterisierung der Patienten und der Operationsindikation wurde im Erfassungsbogen das vom zuweisenden Kardiologen allein oder gemeinsam mit dem Kardiochirurgen geschätzte Operationsrisiko erfragt, wobei die Aufgabe eingeteilt in fünf Risikoklassen erfolgte.
Ergebnisse: Bis zum 30.9.1998 konnten die Datensätze von 11 349 Patienten (99,99 %) mit vollständigen Überlebensdaten abgeschlossen werden. 824 (7,3 %) der gemeldeten Patienten wurden nicht operiert, von ihnen starben 134. Bei den 10 525 operierten Patienten wurde die 30-Tage-Sterblichkeit zu 99,99 % vollständig ermittelt und betrug insgesamt 3,92 %. Das Operationsrisiko war bei isoliertem aortokoronaren Bypass (n = 7932) mit 3,37 % am geringsten, bei aortokoronarem Baypss mit Klappenoperation (n = 785) mit 8.04 % am höchsten. Es zeigte sich eine gute Übereinstimmung der präoperativen Einschätzung des Sterblichkeitsrisikos und der beobachteten Sterblichkeit.
Folgerungen: Die 30-Tage-Sterblichkeit nach Herzoperationen läßt sich flächendeckend und zeitnah mit vertretbarem Aufwand lückenlos ermitteln. Die Ergebnisse bestätigen, daß durch Angabe der Krankenhaussterblichkeit das gesamte Operationsrisiko deutlich unterschätzt wird. Die im vorgestellten Modell verwendete Einbeziehung des Patienten läßt sich auch für andere Anwendungsgebiete zur Erfassung klinischer Ergebnisse nutzen.
All cardiac surgical procedures performed in 78 German cardiac surgical units throughout the year 2011 are presented in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2011, a total of 100,291 cardiac surgical procedures (implantable cardioverter defibrillator and pacemakers procedures excluded) have been collected in this registry. More than 13.4% of the patients were older than 80 years compared with 12.4% in 2010. Hospital mortality in 41,976 isolated coronary artery bypass graft procedures (14.7% off-pump) was 2.9%. In 26,972 isolated valve procedures (including 5,210 catheter-based procedures), an in-hospital mortality of 5.2% has been observed.
This voluntary registry of the German Society for Thoracic and Cardiovascular Surgery will continue to be an important tool enabling quality control and illustrating current facts and the development of cardiac surgery in Germany.
Background: Cardiac surgery and interventional cardiology, in the industrialized countries, is taken for granted. Less industrialized countries like Suriname are deprived of such specialized care, although stenotic coronary artery disease and rheumatic valve disease are the major causes of cardiac death. Especially middle-aged persons who still participate and contribute to the economic, social, and material welfare of Suriname, are affected. The need to treat these diseases was recognized. This report describes the assistance provided by the Bergbauberufsgenossenschaft University Hospital Bergmannsheil (BBG-BMH) in Bochum, Germany.
Methods: A cardiac surgical program was initiated in the Academic Hospital Paramaribo (AZP), Suriname, in cooperation with the BBG-BMH and the University Hospital Maastricht, the Netherlands. The aims of this cooperation were: 1) surgical treatment of at least 300 cardiac patients; 2) transfer of medical and surgical knowledge; 3) strengthening of the local logistical and medical infrastructure.
Results: Between November 1998 and February 2001, three German cardiac surgical missions were performed, treating 80 patients; 31 female and 49 male. Type of operations were CABG (n = 53), mitral valve surgery (n = 14) with CABG (n = 1), aortic valve replacements (n = 5) with CABG (n = 1), double replacements (n = 3), atrial septum corrections (n = 2) with mitral valve surgery (n = 1). The overall 30-day mortality was 6 % (5/80). The cause of death was sepsis, ventricular fibrillation, an abdominal aortic thrombosis, and in two cases multiorgan failures. The operative mortality for CABG was 5.6 % (3/53). Morbidity included bleeding (n = 3), perioperative infarction (n = 2), mediastinitis (n = 1), anaphylaxis (n = 3), pulmonary infection (n = 1). Transfer of knowledge and skills to the local operation and anaesthesia nursing assistance was considered successful because elective CABG and valve replacement procedures could be performed without German support. Adequate training of the AZP intensive care nurses and medical doctors was not achieved, due to inconsistent presence of the local nursing staff and shortage of medical doctors. A small but distinct strengthening of the AZP logistical structure (intensive care, cardiology, general surgery, neurology, haematological and chemical laboratories, physiotherapy, radiology, and blood bank) was evident.
Conclusions: Cardiac surgery was feasible in Suriname with an acceptable mortality and morbidity. A moderate improvement in the local nursing skills was achieved and the local medical infrastructure was beneficially influenced.
Objective
To evaluate the clinical results after stentless (SMV) in comparison to conventional mitral valve replacement (MVR) or mitral valve repair (MV-rep) at five years.
Methods
From 08/97 onwards 155 patients with degenerative mitral valve (MV) disease received a SMV (n=53, 68±8 yrs, 37 female), MVR (n=51, 69±9 yrs, 32 female) or MV-rep (n=51, 66±9 yrs, 32 female). The underlying MV disease was stenosis in 14/4/0, incompetence in 12/30/51 and combined lesion in 27/ 17/0 patients, respectively. NYHA functional class was 3.1±0.6/2.9±0.5/ 2.9±0.6; Euroscore 4.7±2.1/4.4±1.9/4.2±2.6; left ventricular ejection fraction 64±12%/63±16%/61±14% and cardiac index 2.1±0.8/2±0.7/2±0.8 l/min/m2. Follow-up includes 54±18 (11–79) months.
Results
Surgery was performed via conventional sternotomy (32/20/34) or right anterolateral minithoracotomy (21/31/17). Crossclamp duration was 81±33/58±24/54±23 min (p<0.05). In hospital mortality was 1/5/2 patients. Mean pressure gradients were 4.8±1.9/4.3±1.4/2.9±1.2 mmHg and valve opening areas 2.9±0.7/3.2±0.8/3.3±0.8 cm2, respectively. During follow-up repeat surgical interventions were required in 6/3/2 patients. Five year survival was 80±4%/80±5%/82±5% (p=n.s); this was comparable to an age-matched normal population.
Conclusion
At five years the stentless mitral valve compares favorably to conventional standards when taking the patients risk profile into account. The SMV with its reliable functional and hemodynamic outcome may be the mitral prosthesis of choice in future.
Zunehmend alte, multimorbide Patienten mit eingeschränkter Ventrikelfunktion und fortgeschrittener Arteriosklerose der Aorta ascendens zwingen zu Verbesserungen der Myocardprotektion in der Koronarchirurgie. Die Durchführung sämtlicher Bypassanastomosen in einer einzigen Aortenabklemmphase („Single clamp” Technik) am mit Blutkardioplegie stillgestellten Herzen verbessert die Myokardprotektion und vermeidet die Traumatisierung der Aorta durch tangentiales Ausklemmen, hat sich aber wegen verlängerter Aortenklemmzeiten bislang nicht durchsetzen können.
In einer prospektiven Studie wurden daher 277 konsekutive Koronarpatienten entweder mit „Single clamp” Technik (n=140, Gruppe I) oder mit konventioneller tangentialer Aortenausklemmtechnik (n=137, Gruppe II) operiert. In Gruppe I waren mehr instabile Patienten (12,9% versus 8%), mehr hatten eine Dreigefäßerkrankung (80,7% versus 75,9%), eine Hauptstammstenose (14,3% versus 10,9%) oder gehörten der Cleveland Risikoscoregruppe B oder C, d. h. mittlers oder hohes Risiko (26,4% versus 18,2%) an. Die mittlere Aortenabklemmzeit in Gruppe I betrug 57 Minuten versus 47 Minuten in Gruppe II (p
Ergebnisse: Die Daten von 7729 Patienten wurden erfaßt. Der intraoperative Fremdblutverbrauch für alle Operationen betrug im Mittel 0,6±1,3 Einheiten und variierte zwischen den Kliniken von 0,25±0,6 Einheiten bis 0,97±1,6 Einheiten (pppp Schlußfolgerungen: Die Inzidenz von intraoperativen Fremdblutgaben in der Herzchirurgie ist in erster Linie vom Zentrum und nicht von der zugrundeliegenden Erkrankung abhängig. In der klinischen Routine ist im Vergleich verschiedener Herzzentren kein einheitlicher Hämoglobinschwellenwert für die Transfusion auszumachen. Insbesondere bei weiblichen Patienten fand sich eine große Variationsbreite der intraoperativen Transfusionshäufigkeit. Die präoperative Eigenblutspende reduziert den intraoperativen Fremdblutverbrauch, wird aber mit unterschiedlicher Häufigkeit eingesetzt. Rückschlüsse auf den gesamten perioperativen Verlauf sind aufgrund vorliegender Daten nicht statthaft.
Anlässlich des 80. Geburtstages der Facharztzeitschrift „Der Chirurg“ fasst dieser Beitrag die Entwicklung der Herzchirurgie
zusammen. Angefangen von der ersten Herznaht 1897 durch Ludwig Wilhelm Carl Rehn über die erste Katheteruntersuchung des Herzens
durch Werner Forssmann 1923 bis zum Jahr 2008, in dem in Deutschland fast 100.000 Eingriffe am Herzen durchgeführt wurden,
davon knapp 90.000 unter der Verwendung der Herz-Lungen-Maschine. Der Beitrag berichtet von der Gründung der Deutschen Gesellschaft
für Thorax-, Herz- und Gefäßchirurgie im Jahre 1971 und, ausgehend von Bemühungen zur Vereinheitlichung der Weiterbildungsstruktur
(„common trunk“), von der Reintegration in die Deutsche Gesellschaft für Chirurgie. Bei diesem Prozess, der aktiv von beiden
Gesellschaften getragen wird, gilt das Prinzip „Eigenständigkeit, wo nötig, Gemeinsamkeit wo möglich“.
On the occasion of the 80th anniversary of the journal „Der Chirurg“ (The Surgeon) this article summarizes the development
of cardiac surgery. Beginning from the first cardiac suture in 1897 by Ludwig Wilhelm Carl Rehn, through the first catheter
investigation of the heart by Werner Forssmann in 1923 to the year 2008 when nearly 100,000 cardiac interventions were carried
out in Germany and of these some 90,000 using a heart-lung machine. The article describes the founding of the German Society
for Thorax, Heart and Vascular Surgery in the year 1971 and the reintegration in the German Society for Surgery, stemming
from efforts for the unification of the structure of further education (common trunk). The motto for this process, which was
actively supported by both societies, was“Independence when necessary, cooperation when possible”.
Clinical symptoms and diagnostic findings in patients with mitral stenosis are usually determined by the extent of the stenosis. Compared to a normal mitral valve area (MVA) of > 4 cm2, MVA in patients with severe mitral stenosis is usually reduced to < 1.5 cm2. In older patients symptoms are frequently influenced by concomitant diseases (e. g. atrial fibrillation, arterial hypertension or lung disease). An important diagnostic element besides anamnesis, auscultation, ECG and chest X-ray is echocardiography, which is required in order to measure non-invasively and reliably the mitral valve gradient (MVG), the MVA and morphologic changes to the valves, as well as concomitant valvular disease, ventricular functions and, where appropriate, left-atrial thrombi.
In addition to the surgical treatment of patients with severe mitral stenosis, which has been an established procedure for 50 years, percutaneous balloon mitral valvuloplasty (MVP) has recently established itself as an alternative option. At the current time, the Inoue technique seems to display the most advantages. Following transseptal puncture, the Inoue balloon is guided transvenously into the left atrium and then into the left ventricle using a special support wire. The balloon is short and soft. Its special unfolding character enables it to be placed securely in the mitral valve without any risk of ventricular perforation (Figure 1). As with surgical commissurotomy, balloon valvuloplasty leads to a separation of fused commissures. This results in a significant reduction of MVG, accompanied by an increase in the MVA (Figure 2). The results and success of MVP are influenced by the morphology of the valves and the changes to the subvalvular apparatus. In randomized studies, the results of surgical commissurotomy were comparable with those of balloon mitral valvulotomy.
In our hospital, an increase in MVA from 1.0 to 1.8 cm2 could be achieved in 899 patients (mean age 56±3 years). In younger patients with less significantly changed valves, the results were correspondingly more favorable than in older patients (Figure 3). Provided valve morphology is suitable, a relapse following previous surgical commissurotomy is not a contraindication for MVP. The MVP complication rate is very low in skilled hands: mortality is below 1%; mitral insufficiency occurs in 3 to 10% of interventions; we observed a severe mitral insufficiency in 5% of our patient group. Thromboembolic complications may be prevented after exclusion of atrial thrombi by transesophageal echocardiography. The occurrence of a hemodynamically significant atrial septum defect is a very rare event. The mid-term results (5 to 10 years) and the low restenosis rate following MVP in patients with suitable valves are comparable with those of surgical commissurotomy.
In older patients with considerably changed, calcified and fibrotic valves, restenosis may be expected within 1 to 5 years. In these patients MVP represents no more than a palliative intervention in order to prolong the point of surgery, for example in patients where a concomitant aortic valve disease in itself is not yet an indication for surgery. Special indications are to be found in young patients with severe mitral stenosis yet few symptoms, in pregnant females and in emergency situations, as well as in patients with Grade II mitral stenosis with intermittent atrial fibrillation.
Catheter therapy is much less invasive than surgery. In case of failure the patient still has the option of surgical therapy. Patients with morphologically significantly altered valves usually receive a valve replacement since an unsuccessful reconstruction would lead to a second operation within a very short time interval.
Contraindications for MVP are thrombi in the left atrium, a previously existing > Grade II mitral regurgitation and marked, degenerative destruction of the subvalvular apparatus or extensive calcification of the valves. MVP thus represents a significant addition to the spectrum of percutaneous treatments for cardiologic clinical pictures.
Background: Complete arterial coronary artery bypass grafting seems to be an alternative surgical approach in the treatment of coronary artery disease. Complications in the long-term follow-up due to degeneration of venous grafts may be reduced using arterial conduits. Prolonged operating times and increased trauma due to harvesting of multiple arterial grafts have been arguments for the conventional operative approach. We present our experience using new operative techniques, such as skeletonization of arterial grafts and the T-graft configuration.¶ Material and methods: Between 3/96 and 7/99, 405 patients with multiple coronary artery disease underwent complete arterial revascularization at our institution. The operations were performed using only two skeletonized grafts, both internal thoracic arteries in 105 patients (25.9%), internal thoracic artery and radial artery in 299 patients (73.8%) and 1 radial artery in 1 patient (0.3%).¶ Results: In 346 patients (85.4%) a T-graft configuration was used. A mean of 4.1±0.9 coronary anastomoses were performed per patient. In hospital mortality was 2%. Sternal dehiscence or infection occured in 0.8% of patients. Harvesting of the radial artery was performable with a low morbidity. One week postoperatively, coronary angiography showed 96.7% of coronary anastomoses free of stenosis >50%.¶ Conclusion: Complete arterial coronary revascularization using skeletonized grafts and the T-graft approach is a safe technique in the treatment of multiple coronary artery disease. Low perioperative morbidity and mortality make its usage on a routine basis possible.
A negative relationship between coronary stenting before coronary artery bypass graft (CABG) surgery and the perioperative mortality and morbidity has been shown in diabetic patients. We tried to assess this relationship in a 2-institution database.
In the years 2005 and 2006, 1125 of 3311 patients undergoing CABG surgery had diabetes mellitus (33.9%), and 185 (16.4%) of the diabetic patients had at least 1 previous stent. There was no evidence of any clinically significant difference in the preoperative and intraoperative parameters between diabetics with or without previous stents.
Thirty-day mortality (no-stent group, 3.86%; stent group, 1.62%) and postoperative major adverse cardiovascular and cerebrovascular events (MACCEs; mortality, stroke, myocardial infarction, renal failure) (no-stent group, 12.2%; stent group, 5.9%) occurred more often in diabetic patients without coronary stents. Logistic regression for 30-day mortality using possible confounders including preoperative stent showed a significant positive effect of preoperative coronary stenting (OR, 0.157; 95% CI limits, 0.033-0.737). Taking percutaneous coronary intervention out of the calculation model, this positive effect was no longer significant (OR, 0.344; CI, 0.091-1.298). Logistic regression for perioperative MACCE, with as well as without percutaneous coronary intervention as a confounder, also showed a significant positive effect of preoperative coronary stenting (OR, 0.231; 95% CI, 0.091-0.590).
Coronary stenting before CAGB in diabetic patients does not predispose to a higher perioperative risk regarding mortality and morbidity after CABG surgery.
All cardiac surgical procedures performed in 79 German cardiac surgical units throughout the year 2010 are presented in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2010 a total of 95,734 cardiac surgical procedures (ICD and pacemaker procedures excluded) have been collected in this registry. More than 12.4% of the patients were older than 80 years compared to 11.8% in 2009. Hospital mortality in 42,804 isolated CABG procedures (14.2% off-pump procedures) was 2.8%. In 25,127 isolated valve procedures (including 3660 transcatheter-valve implantations) a mortality of 4.9% has been observed. This voluntary registry of the German Society for Thoracic and Cardiovascular Surgery will continue to be an important tool enabling quality control and illustrating the development of cardiac surgery in Germany.
All cardiac surgical procedures performed in 80 German cardiac surgical units throughout the year 2009 are presented in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2009 a total of 96 129 cardiac surgical procedures (excluding ICD and pacemaker procedures) were collected in this registry. More than 11.8 % of the patients were older than 80 years compared to 10.3 % in 2008. Hospital mortality in 45 171 isolated CABG procedures (13.1 % off-pump) was 2.8 %. In 23 556 isolated valve procedures (including 2216 catheter-based procedures) a mortality of 4.7 % was observed. This voluntary registry of the German Society for Thoracic and Cardiovascular Surgery continues to be an important tool for quality control and illustrates the development of cardiac surgery in Germany.
BACKGROUND: Intraoperative graft patency verification is of major clinical importance for quality control after coronary artery bypass grafting (CABG), especially if surgery is performed on the beating heart. This is one of the first reports of fluorescence coronary angiography (FCA) using the dye indocyanine green (ICG), a noninvasive technology for direct visualization of coronary arteries and myocardial perfusion.
METHODS: Twenty-five domestic pigs underwent FCA of the left anterior descending coronary artery (LAD). In the first group (n = 6 pigs), FCA was used to visualize the native coronary vessels and myocardial perfusion. In the second group (n = 8 pigs), 14 stenoses of various degrees and 4 total vessel occlusions were created by snares on different segments of the LAD, and FCA was used to visualize the effects of these obstructions. In the third group (n = 11 pigs) defined stenoses (25%; 50%, 75%, 100% flow reduction) on the distal part of the LAD were created by a custom-made screw occluder and determined using TTFM (transit-time-flow measurement). ICG was intravenously applied, and the heart was illuminated with near-infrared light emitted by laser diodes. The fluorescence emission was detected by an adapted charge-coupled device camera system. The images were displayed in real time on a high-resolution monitor. Subsequently, images obtained with FCA were correlated with fluorescent microspheres data (n = 11 pigs).
RESULTS: In all cases, high-quality FCA images of coronary arteries and myocardial perfusion were obtained. All stenoses resulted in an impairment of the myocardial perfusion visualized by FCA. Occlusion of the LAD or the diagonal branch resulted in a total perfusion defect of the corresponding anterior myocardial wall with immediate reperfusion after releasing the snare. Correlation between FCA and fluorescent microspheres in determination of myocardial perfusion was excellent.
CONCLUSION: With the fluorescence technique using ICG, visualization of blood flow in coronary vessels and myocardial perfusion, is feasible. FCA is a highly sensitive and reproducible method and an excellent technique for intraoperative quality control in CABG.
In der Abteilung für Herzchirurgie des städtischen Krankenhauses München Bogenhausen wurde von Januar 1993 bis Oktober 2000 bei 1092 Patienten entweder die Aorten- und oder die Mitralklappe mit einer Zweiflügelprothese vom Typ Sorin Bicarbon ersetzt. 325 Patienten, die zusätzlich einen aortocoronaren Bypass, bei gleichbestehender KHK, erhielten, wurden von der Auswertung ausgeschlossen. Bei 767 Patienten wurde ein einfacher oder kombinierter prothetischer Klappenersatz durchgeführt. Nach Implantation mechanischer Herzklappenprothesen ist eine dauerhafte Antikoagulation unumgänglich. Ziel der vorliegenden Studie war die Evaluierung der Inzidenz klinischer Komplikationen, insbesondere der Blutungs- und Thromboembolierate nach Implantation, dieser mechanischen Herzklappenprothese im mittelfristigen Verlauf. Bei 553 Patienten wurden Daten hinsichtlich Mortalität, Morbidität und Lebensqualität bzw. NYHA-Klassifikation retrospektiv im Mittel 49 Monate postoperativ erfasst. Zusätzlich wurden die Patienten schriftlich bzw. telephonisch bezüglich ihres postoperativen Verlaufs und jedweder aufgetretener Komplikationen befragt. 131 Patienten mussten von der Auswertung ausgeschlossen werden, da sie weder direkt noch indirekt erreichbar waren. Das untersuchte Patientenkollektiv bestand aus 354 (64%) männlichen und 199 (36%) weiblichen Patienten. Insgesamt wurde in 387 Fällen ein Aortenklappenersatz (AKE) oder bei 118 Patienten ein Mitralklappenersazt (MKE) bzw. in 48 Fällen ein Doppelklappenersatz (DKE=AKE+MKE) durchgeführt. Präoperativ befanden sich 9 Patienten (1,6%) im NYHA- Stadium I, 61 Patienten (11%) im Stadium II, 439 Patienten (79,4%) im Stadium III und 44 Patienten (7,95%) im Stadium IV. Die kumulative follow up Zeit betrug 2250 Patientenjahre (für AKE: 1574 Pj, für MKE: 458 Pj und für DKE: 218 Pj). Hinsichtlich der Ätiologie des Klappenfehlers (AI/AS, MI/MS) zeigten sich folgende Unterschiede in der Langzeitüberlebensraten: In beiden Gruppen wiesen Patienten, die aufgrund einer Insuffizienz operiert wurden eine höhere 8,5- Jahresüberlebensrate (AI: 88,2%, MI: 94%) im Vergleich zu Patienten mit führender Stenosekomponente (AS: 79,5%, MS: 92%). Postoperativ befanden sich über 79% der Patienten im NYHA- Stadium I oder II. Keiner der untersuchten Patienten zeigte eine strukturelle Prothesendysfunktion.
Die Sorin Bicarbon™ Prothese zeigte in der vorliegenden Studie bezüglich Überlebens- und postoperativer Komplikationsrate zufriedenstellende Ergebnisse, die vergleichbar mit anderen auf dem Markt befindlichen Zweiflügelprothesen waren. Weitere follow up’s sind erforderlich für einen Vergleich, der insbesondere die Langzeitergebnisse validieren kann.
Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE), it is still used as an adjunct to coronary artery bypass grafting (CABG). This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed.
Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA), angina pectoris (CCS) and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis.
Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 +/- 9 years. A total of 396 vessels were bypassed (4 +/- 0.9 vessels per patient). In 98% left internal thoracic artery (LITA) was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA) (n = 55), on left anterior descending artery (LAD) (n = 52) and circumflex artery (RCX) (n = 7). Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%). Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5). During follow-up (24.5 +/- 13.4 months), which is 96% complete (4 patients were lost caused by unknown address) 8 patients died (cardiac failure: 3; stroke: 1; cancer: 1; unknown reasons: 3). NYHA-classification significantly improved after CABG with CE from 2.2 +/- 0.9 preoperative to 1.7 +/- 0.9 postoperative. CCS also changed from 2.4 +/- 1.0 to 1.5 +/- 0.8
Early results of coronary endarterectomy are acceptable with respect to mortality, NYHA & CCS. This technique offers a valuable surgical option for patients with endstage coronary artery disease in whom complete revascularization otherwise can not be obtained. Careful patient selection will be necessary to assure the long-term benefit of this procedure.
All cardiac surgical procedures performed in 79 German cardiac surgical units throughout the year 2008 are illustrated in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2008 a total of 99 176 cardiac surgical procedures (ICD and pacemakers procedures excluded) have been collected. More than 10.3 % of the patients were older than 80 years compared to 9.8 % in 2007. Hospital mortality in 47 337 isolated CABG procedures (11.3 % off-pump) was 2.8 %. In 22 243 isolated valve procedures a mortality of 4.7 % has been observed. This voluntary registry of the German Society for Thoracic and Cardiovascular Surgery continues to be an important tool enabling quality control and illustrating the development of cardiac surgery in Germany.
All cardiac surgical procedures performed in 80 German cardiac surgical units throughout the year 2007 are presented in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2007 a total of 99,990 cardiac surgical procedures (ICD and pacemaker procedures excluded) have been collected in this registry. More than 9.8% of the patients were older than 80 years compared to 9.6% in 2006. Hospital mortality in 49,788 isolated CABG procedures (10.1% off-pump) was 2.7%. In 21,312 isolated valve procedures a mortality of 5.1% has been observed. This voluntary registry of the German Society for Thoracic and Cardiovascular Surgery will continue to be an important tool enabling quality control and illustrating the development of cardiac surgery in Germany.
This study intends to provide a detailed overview of the types and rates of peri-operative complications after surgical correction of an isolated ASD II. The transvenous approach to the occlusion of atrial septal defects has yielded promising results during its first 5 years of clinical trials, but before it can be established as a routine measure, definite proof is needed to demonstrate that its rate of serious complications does at least not exceed that of the surgical closure. Between 1985 and 1992, 232 consecutive patients underwent surgical closure of a secundum atrial septal defect. Among the patients 118 were children (< 18 years; 79 girls and 39 boys) with a mean age of 8.9 +/- 5.2 years (4 months-17 years) and 114 adults (74 women and 40 men) with a mean age of 28.5 +/- 10.8 years (18-69 years). Pre-operatively eight children (6.8%) and eight adults (7%) were treated for right heart failure. Mean pulmonary artery pressure was 20.4 +/- 10.4 mmHg for the children and 19.3 +/- 7 mmHg for the adults. The average pulmonary artery to systemic flow ratios were 2.9:1 and 3:1 for children and adults, respectively. Thirty children (25.4%) and 15 adults (13.2%) underwent patch closure while direct suture was the method used for the remaining patients. Average cardiopulmonary bypass time was 35.7 +/- 17.9 min for the children and 41.5 +/- 19.9 min for the adults. The length of the procedure (skin to skin) was a mean of 116 min in the young group, and 141 min in the adult group.(ABSTRACT TRUNCATED AT 250 WORDS)
Aortic valve replacement with cryopreserved human pulmonary or aortic valves (homografts) is an attractive alternative to the implantation of mechanical valves or bioprostheses, as anticoagulation can be avoided and a near-normal anatomy restored. However, few reports exist on the long-term follow up of patients with this type of valve.
Between 1990 and 1997, a total of 64 homografts were implanted in 62 adults (mean age 42 +/- 12 years) with non-endocarditic valve lesions (insufficiency, n = 16; stenosis, n = 20; combined lesions, n = 12; redo, n = 16). In total, 23 pulmonary grafts (PG) and 41 aortic grafts (AG) were used. Valves were obtained from the European Homograft Bank in Brussels. Two patients with aortic homografts were lost to follow up; the others were examined clinically and echocardiographically at yearly intervals (mean 3.6 +/- 2.0 years). Children aged less than 16 years (n = 21), and patients receiving a homograft due to endocarditis (n = 28) or during a Ross procedure (n = 16) were excluded from the study.
Three patients (5%) died due to early postoperative complications (two with AG, one with PG). Three PG had to be explanted due to primary malfunction, and five (total 35%) during further follow up due to severe aortic insufficiency (at a mean of 3.3 +/- 1.8 years). In contrast, all AG were functioning at the end of the observation period (log rank test, p = 0.0001, chi-square test 13.9). The mean echocardiographic degree of regurgitation for PG was significantly higher than for AG (2.2 +/- 1 vs. 0.75 +/- 0.7, p <0.0001). The peak transvalvular gradient did not differ between groups (PG 12.3 +/- 9 mmHg vs. AG 16.7 +/- 10 mmHg, p = NS). In respect of perioperative parameters, patients with PG showed a significantly higher body temperature during the first seven postoperative days (37.3 +/- 0.6 degrees C vs. 36.8 +/- 0.3 degrees C, p = 0.003). All three patients with acute graft malfunction in long-term follow up had a perioperative febrile response without overt bacterial infection.
In contrast to grafts of aortic origin, pulmonary homograft valves should not be used for aortic valve replacement because of their high rate of malfunction, both acutely and chronically. Higher postoperative body temperatures should lead to further investigations of possible enhanced immunoreactions against pulmonary homografts.
Replacement of the aortic valve and the ascending aorta with a conduit consisting of a mechanical valve and a Dacron tube has become a fairly common procedure. Commercially available conduits employing xenografts are rarely used for the same purpose, because if a reoperation becomes necessary due to degeneration of the valve prosthesis, usually the entire conduit must be replaced. A composite graft with a stentless valve, such as we describe in this article, avoids this problem, because in case of reoperation only the valve cusps need to be resected and the tube graft may be left in place.
Surgical technique of replacement of the aortic valve and the ascending aorta with a stentless composite graft and early results of the procedure are presented.
Hemodynamics of the graft soon after surgery were excellent, with an average systolic gradient of 8 mm Hg and no regurgitation across the valve. There were two reoperations for bleeding in the early postoperative period.
The stentless composite graft we describe provides excellent hemodynamics, has no need for anticoagulation, and is expected to offer a benefit in case of reoperation.
Complete arterial revascularization may be unsafe in patients with a high operative risk. In patients with varicose ectatic veins, the biocompound technique, which uses unsuitable autologous veins, enables the surgeon to influence the bypass graft wall stress levels and diameter. This report summarizes the 3-year patency of 53 patients, the survival rate of 200 patients, and operative technical considerations.
Biocompound grafts were used for aortocoronary bypass in 200 patients who were considered inappropriate subjects for complete arterial revascularization and who had unsuitable saphenous veins.
The mortality rate (30 days) of 200 patients was 3.5%. The 3-year survival rate was 88.5%. The patency rate of the left internal thoracic artery (LITA) after 3 years was 97.3%, of the native vein was 68.7%, and of the biocompound graft was 68.3%. The LITA showed a superior patency rate (p = < 0.05).
The LITA is the first choice in coronary bypass operation. The biocompound technique is a reliable method to achieve complete revascularization in patients with a lack of suitable saphenous veins.
Protein-losing enteropathy (PLE) is a late complication of the Fontan type surgery for univentricular heart characterized by massive enteric protein loss. The pathogenesis of PLE is not fully understood, and it is unclear why the onset of PLE varies widely and occurs months or even years after surgery. Besides characteristic laboratory findings, a typical cellular feature concerns the almost selective loss of CD4(+) lymphocytes at an only slightly changed CD8(+) lymphocyte count. The present pilot study aimed to test whether immunological or laboratory parameters differ in patients at risk for PLE.
From children (n = 15) with Fontan type circulation, extensive cellular, humoral, and clinical laboratory data were analyzed. Patients without enteric protein loss (group I, n = 8), with transient phases of enteric protein loss in the absence of gastric infections (group II, n = 6), and one PLE patient (group III) were distinguished. The 90 data columns obtained in phases with normal serum protein levels were compared.
Clear differences were apparent between patients prior to PLE onset (group III), patients that in at least one occasion exhibited PLE signs (group II), and patients without detectable PLE signs (group I). The most discriminatory parameters between the three patient groups were NK and CD8(+)TCRalphabeta(+), CD8(+)TCRgammadelta(+) cell counts, including sL-selectin, IgE, and Ca(2+) (average recognition index = 91.5%, negative/positive prediction/sensitivity/specificity > 83%).
The results of this study seem to provide access to the early detection of PLE patients.
It was the aim of the present study to elaborate criteria for the assessment of rapid hemodynamic progression of valvar aortic stenosis. These criteria are of special importance when cardiac surgery is indicated for other reasons but the established criteria for aortic valve replacement are not yet fulfilled. Such aspects of therapeutic planing were mostly disregarded in the past so that patients had to undergo cardiac reoperation within a few years.
Hemodynamic, echocardiographic, and clinical data of 169 men and 88 women with aortic stenosis, aged 55.2 +/- 15.7 years at their first and 63.4 +/- 15.6 years at their second cardiac catheterization, were analyzed.
The progression rate of aortic valve obstruction was found to be dependent on the degree of valvar calcification ([VC] scoring 0 to III) and to be exponentially correlated with the aortic valve opening area (AVA) at initial catheterization. Neither age nor sex of the patient nor etiology of the valvar obstruction significantly influence the progression of aortic stenosis. If AVA decreases below 0.75 cm(2) with a present degree of VC = 0, or AVA of 0.8 with VC of I, AVA of 0.9 with VC of II, or AVA of 1.0 with VC of III, it is probable that aortic stenosis will have to be operated upon in the following years.
The present data indicate that for clinical purposes and planning of valvar surgery the progression of asymptomatic aortic stenosis can be sufficiently predicted by the present aortic valve opening area and the degree of valvar calcification.
The changes in coronary revascularization in Europe in general and in the DACH countries (Deutschland, Austria, Switzerland) in particular between 1991 - 2002 were studied.
The databases of different national surgical societies, registries, and governments and international organizations and collegial responses were analyzed.
The population of Europe (excluding Russia, CIS, and Turkey) increased by 2.29 % from 1991 to 521.84 million in 2002 and by 4.7 %, 3.4 %, and 7.4 % in Austria (AT), Germany (DE), and Switzerland (CH), respectively. The DACH countries contributed 18.76 % to the European population in 2002. During this period the cardiac surgery (CS) output increased in Europe, AT, DE, CH by 108 % to 428 477 (821/million population), by 72 % to 7035 (859/million), by 244 % to 125 341 (1521/million), and 61 % to about 8600 (1175/million), respectively. Coronary artery surgery (CAS) output increased by 108 % to 241 567 (463/million), by 83 % to 4559 (557/million), by 159 % to 73 929 (897/million), and by 37 % to about 5000 (684/million), respectively. DACH contributed 34.6 % of CAS volume in Europe in 2002. CAS average volume/center/year rose from 301 in 1991 to 392 in 2002 in Europe, 312 --> 506 in AT, 538 --> 936 in DE, and changed to 331 --> 278 in CH. The percentage of CAS in CS hardly changed from 56.2 % in 1991 to 56.4 % in 2002 in Europe but changed from 61 % --> 64.8 % in AT, 67.5 % --> 58.98 % in DE, and 68.1 % --> 58.2 % in CH. Acceptance of OPCAB remains low at 5 - 18 % of CAS. The increase in percutaneous coronary interventions (PCI) volume was more impressive: the 2002 average of PCI/million was 1244 in Europe, 1659 in AT, 2524 in DE, and 1708 in CH; 36 % of the total number of European PCI was done in DACH. In 2002, coronary stenting was done in 83 % of PCI in Europe: with 1039/million in Europe, 1399/mill (84 %) in AT, 1994/mill (79 %) in DE, and 1435/mill (84 %) in CH. The average European total coronary revascularization activity (PCI + CAS) increased from 1991 by 257 % to 1707/million in 2002; in DACH it increased by 261 % to 3243/million.
Coronary revascularization productivity in Europe during the last decade has continued to grow (mostly in the PCI sector) but has lagged behind that in the USA. The pattern of coronary artery surgery remains fairly consistent in DACH while CAS productivity is far ahead of the rest of Europe despite recent plateauing. The trend towards PCI was equally pronounced in AT, DE, and CH.
All cardiac surgical procedures performed in 79 German cardiac surgical units throughout the year 2005 are presented in this report, based on a voluntary registry, which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2005, a total of 98 860 cardiac surgical procedures (ICD and pacemaker procedures excluded) were collected in this registry. More than 8.4 % of the patients were older than 80 years, compared to 7.8 % in 2004. Hospital mortality in 54 126 isolated CABG procedures (9.7 % off-pump) was 2.9 %, while a mortality of 4.5 % was observed in 19 203 isolated valve procedures. This registry is an important tool of the German Society for Thoracic and Cardiovascular Surgery to ensure a continuous and voluntary quality assurance and illustrate the development of cardiac surgery in Germany.
A 58 year old man underwent 6 surgical interventions for various complications of massive biventricular myocardial infarction over a period of 2 years following acute occlusion of a possibly "hyperdominant" left anterior descending coronary artery. These included concomitant repair of apicoanterior post-infarction VSD and right ventricular free wall rupture, repeat repair of recurrent VSD following inferoposterior extension of VSD in the infarcted septum 5 weeks later, repair of delayed right ventricular free wall rupture 4 weeks subsequently, repair of a bleeding left ventricular aneurysm eroding through left chest wall 16 months thereafter, repair of right upper lobe lung tear causing massive anterior mediastinal haemorrhage, mimicking yet another cardiac rupture, 2 months later, followed, at the same admission, 2 weeks later, by sternal reconstruction for dehisced and infected sternum using pedicled myocutaneous latissimus dorsi flap. 5 years after the latissimus myoplasty, the patient remains in NYHA class 1 and is leading a normal life.
All cardiac surgical procedures performed in 81 German cardiac surgical units throughout the year 2006 are presented in this report, based on a voluntary registry which is organized by the German Society for Thoracic and Cardiovascular Surgery. In 2006 a total of 97,123 cardiac surgical procedures (ICD and pacemakers procedures excluded) have been collected in this registry. More than 9.6 % of the patients were older than 80 years compared to 8.4 % in 2005. Hospital mortality in 51,273 isolated CABG procedures (10.1 % off-pump) was 3.1 %. In 20,028 isolated valve procedures a mortality of 4.9 % has been observed. This registry will continue to be an important tool of the German Society for Thoracic and Cardiovascular Surgery enabling a continuous and voluntary quality assurance and illustrating the development of cardiac surgery in Germany.
To analyze the midterm clinical results after stentless mitral valve (SMV) replacement.
Fifty one patients (68.3+/-8.4 years, 35 female) with severe mitral valve disease (stenosis 25, incompetence 17, mixed lesion 9) received a chordally supported SMV (Quattro, St. Jude Medical Inc.) since August 1997. Preoperative New York Heart Association class was 3.1+/-0.6; left ventricular ejection fraction 64+/-13%, and cardiac index 2.1+/-0.8 l/min/m2. Additional intraoperative ablation therapy was performed on 19 patients with chronic atrial fibrillation. Mean follow-up is 35.4+/-19.2 months (range 5 to 63). SMV implantation was performed using a conventional (32) or a minimally invasive (19) approach, valve size was 29+/-1.5 mm, cross-clamp duration was 81+/-33 minutes. Atrial rhythm was reestablished in 16 of 19 patients. Five patients required reoperation early in this series, two for paravalvular leakage, two for functional stenosis, and one with underlying rheumatoid disease. Mortality was one perioperative (1.96%, non-valve-related), one after reoperation as a result of multiple organ failure (MOF), and five during late follow-up (30+/-7 months postoperatively) for noncardiac causes. Regular echocardiographic control revealed good SMV function (Vmax 1.7+/-0.2m/s, P(mean) 3.9+/-1.2 mm Hg) and well-preserved ejection fraction postoperatively and at most recent follow-up.
Midterm results after SMV implantation are promising. Preservation of the annuloventricular continuity leads to stable left ventricular function and combined with ablation therapy to physiological hemodynamics. Long-term durability remains to be proven.
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