A M Fabricius

University of Leipzig, Leipzig, Saxony, Germany

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Publications (17)31.01 Total impact


  • No preview · Article · Jan 2007 · The Thoracic and Cardiovascular Surgeon

  • No preview · Article · Jan 2007 · The Thoracic and Cardiovascular Surgeon
  • N Doll · A M Fabricius · J F Gummert · R Krakor · G Hindricks · H Kottkamp · F W Mohr
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    ABSTRACT: Atrial fibrillation in patients with isolated, therapy resistant, chronic or paroxysmal atrial fibrillation (AF) or AF in combination with additional valvular and non-valvular cardiac pathology can be surgically treated by different techniques. Unipolar high frequency, cryotherapy and microwave energy is a curative approach for the treatment of the left atrium for AF. The postoperative mortality and morbidity rate is comparable to other cardiac surgery procedures. It is a technically less challenging procedure as compared to the MAZE procedure and can be applied using a minimally invasive approach. Alternative techniques such as new cryotechnologies, laser application and bipolar high frequency energy need to be evaluated for effectiveness and safety.
    No preview · Article · Oct 2003 · Zeitschrift für Kardiologie
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    ABSTRACT: The purpose of this study was to test the feasibility and effectiveness of cryoablation therapy (SurgiFrost trade mark CryoCath, Endocare Inc., Irvine, California, USA) for linear epicardial treatment of atrial fibrillation in an acute off-pump sheep model. After thoracotomy, we performed epicardial cryoablation (2 min intervals at -160 degrees C) with pacing electrodes positioned at the left atrial appendage (LAA), the pulmonary veins (PVs), the right atrial appendage (RAA), and the vena cava cranialis (VCC) in 8 sheep. Circular epicardial ablations were performed with online temperature measurement in the ascending aorta and in the esophagus. The sheep were sacrificed two hours after ablation procedure, and heart, lungs, and esophagus were retrieved for histological examination. Out of all 8 sheep, histo-pathological analysis was performed on the RAA and VCC in 6 sheep and on the CAA and PV in all 8 sheep. Thin-walled structures such as PVs and VCC showed electrical isolation. No significant changes in temperature in the descending aorta and the esophagus were observed. There was evidence of extensive transmural alteration including vascular lesions, myocardial degeneration and necrosis as well as epi- and endocardial necrosis in the left atria in three of 8 cases, in the right atria in 5 of 6 cases, in the VCC in 6 of 6 cases, and in the PV in 5 of 8 cases. Mild lesions of the muscular layer of the esophagus were found in 7 of 8 cases. Epicardial cryoablation is not effective on thicker tissues like LAA and RAA due to the rewarming of the current blood flow. However, thin tissues like VCC and PV can be isolated. Further chronic studies are necessary to evaluate the potential for regeneration of adjacent structures.
    No preview · Article · Oct 2003 · The Thoracic and Cardiovascular Surgeon
  • N. Doll · A.M. Fabricius · J.F. Gummert · R. Krakor · G. Hindricks · H. Kottkamp · F.W. Mohr
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    ABSTRACT: Patienten mit alleinigem therapierefraktrem chronischen oder paroxysmalen Vorhofflimmern, oder mit begleitenden kardialen Erkrankungen, wie Herzklappendegenerationen, knnen mit verschiedenen Techniken chirurgisch behandelt werden. Mit der unipolare Hochfrequenzenergie, der Kryoapplikation und der Mikrowellenenergie ist eine erfolgreiche Behandlung des Vorhofflimmerns im Bereich des linken Vorhofes mglich. Die postoperative Mortalitt und Morbiditt ist vergleichbar mit anderen kardiochirurgischen Eingriffen. Der operative Eingriff ist weniger aufwendig als die MAZE-Operation und kann in einer minimalinvasiven Technik, auch in Zusammenhang mit Mitralklappeneingriffen, durchgefhrt werden. Alternative Techniken, wie die neue Kryotechnologien, die Laserapplikation und die bipolare Hochfrequenzenergie werden im Rahmen von Studien auf ihre Effektivitt und Sicherheit geprft.Atrial fibrillation in patients with isolated, therapy resistant, chronic or paroxysmal atrial fibrillation (AF) or AF in combination with additional valvular and non-valvular cardiac pathology can be surgically treated by different techniques. Unipolar high frequency, cryotherapy and microwave energy is a curative approach for the treatment of the left atrium for AF. The postoperative mortality and morbidity rate is comparable to other cardiac surgery procedures. It is a technically less challenging procedure as compared to the MAZE procedure and can be applied using a minimally invasive approach. Alternative techniques such as new cryotechnologies, laser application and bipolar high frequency energy need to be evaluated for effectiveness and safety.
    No preview · Article · Aug 2003 · Zeitschrift für Kardiologie
  • A.M. Fabricius · N. Doll · J. Onnasch · F.W. Mohr
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    ABSTRACT: The case presented is that of a woman, who was undergoing aortic valve replacement with subsequent pulmonary artery rupture due to pulmonary artery catheter replacement. Massive hemorrhage through the endotracheal tube began while weaning from extracorporal bypass. Immediate bronchoscopy revealed a hemorrhage deriving from the middle lobar branch. The lobe was resected and failure to wean the patient off cardiopulmonary bypass secondary to lung failure and poor left ventricular performance necessitated implantation of an extracorporal membrane oxygenation. After weaning off extracorporal membrane oxygenation the patient had a long recovery on the intensive care unit.
    No preview · Article · Jan 2003
  • Alex M Fabricius · Martin Krüger · Michaela Hanke · Friedrich W Mohr
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    ABSTRACT: In a 73-year-old woman admitted with pulmonary embolism, a thrombus wedged across a patent foramen ovale was revealed by transesophageal echocardiography. After systemic anticoagulation, cardiac embolectomy and closure of the atrial septal defect were considered. Before surgery, repeat transesophageal echocardiography revealed only a small patent foramen ovale with no residual thrombus. We assumed dissolution of the thrombus as the patient had no sign of systemic or recurrent pulmonary embolism.
    No preview · Article · Jan 2003 · Asian cardiovascular & thoracic annals
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    ABSTRACT: The development of simple, safe and curative strategies for the treatment of atrial fibrillation will remain one of the major challenges for invasive electophysiologists during the upcoming years. Our growing pathophysiological understanding of the arrhythmia itself has developed from surgical therapeutic strategies like the MAZE procedure and from intraoperative mapping-studies. Despite being highly effective the MAZE concept has never been practised widely due to the complexicity and the duration of the operation. During the late 1990s there was growing evidence that left atrial anchor-reentry circuits play a predominant role in precipitating atrial fibrillation. Based on the assumption that the pulmonary vein area might provide the anatomical substrate for maintainance of these anchor-reentry circuits, new surgical therapies for the curative treatment of atrial fibrillation were developed. Thus, the IRAAF concept (Intraoperative Radiofrequency Ablation of Atrial Fibrillation) covered the largest patient cohort. With the intraoperative placement of continuous left atrial lesions using radiofrequency energy, a new and highly effective therapy was established. By using a minimally invasive approach, the operation also became feasible and acceptable for the treatment of patients with lone atrial fibrillation. In this cohort the success rate in restoring sinus rhythm reached well above 95%. Because of rare but nevertheless severe complications (mainly esophageal lesions), the application of radiofrequency energy intraoperatively had to be stopped. New energy sources (e.g., cryoenergy) are currently being studied experimentally and clinically in order to enable the future use of this highly effective therapy concept for the purpose of the primary indication in atrial fibrillation again.
    No preview · Article · Nov 2002 · Herzschrittmachertherapie & Elektrophysiologie
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    ABSTRACT: Surgical therapy for aortic stenosis leads to reverse remodeling, with normalization of left ventricular hypertrophy (LVH). The aim of this study was to examine Renin-Angiotensin system (RAS) gene expression in this setting. Growing sheep (n=44) underwent supracoronary aortic banding for controlled induction of LVH at the age of 6 to 8 months (A=baseline). Surgical revision to completely release the pressure gradient was performed 8.3+/-1 months later (B). The animals were sacrificed after another 10.1+/-2 months (C). Along with hemodynamic measurements, subtractive hybridization and competitive polymerase chain reaction were applied to quantify mRNA expression for angiotensin-converting enzyme (ACE) and angiotensin receptors 1 and 2 (AT1-R and AT2-R). Left ventricular mass index was 82+/-21 g (A), 150+/-33 g (B), and 78+/-18 g (C), P<0.01. Left ventricular function and cardiac index remained stable. Myocardial fiber diameter was 11.3+/-0.8 (A), 15.9+/-1.2 (B), and 11.4+/-1 (C) microm, P<0.01. Gene expression was as follows: ACE 0.8+/-0.05 (A), 1.3+/-0.08 (B), and 0.9+/-0.06 (C), P<0.01; AT1-R 0.7+/-0.06 (A), 0.9+/-0.07 (B), and 0.3+/-0.04 (C), P<0.01; AT2-R 0.5+/-0.05 (A), 0.2+/-0.04 (B), and 0.5+/-0.05 (C), P<0.01. LVH in aortic stenosis coincides with significant alterations of the RAS. Surgical therapy leads to reverse remodeling, which is paralleled by regression of RAS gene expression.
    No preview · Article · Oct 2002 · Circulation
  • Alex M Fabricius · Lothar Heidrich · Uwe Gutz · Friedrich W Mohr
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    ABSTRACT: Endothelial papillary fibroelastomas represent a rare entity in cardiac pathology that at times may be associated with embolisation, angina, and sudden death. We report on a case of a 46-year-old woman with a papillary fibroelastoma originating on the chordae of the tricuspid valve. The tumour was discovered incidentally using transthoracic two-dimensional echocardiography. The patient had an uneventful recovery and remained free of symptoms after six months.
    No preview · Article · May 2002 · Cardiovascular journal of South Africa: official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners
  • S Brose · A M Fabricius · V Falk · R Autschbach · H Weidenbach · F W Mohr
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    ABSTRACT: We used an ultrasonic scalpel (USS) and an argon beam coagulator (ABC) to test their effectiveness and feasibility in comparison to conventional electrocautery for Internal Thoracic Artery (ITA) takedown, time for takedown, number of clips, thermal impact, along with morphological integrity assessed by histology. Ninety-three patients undergoing elective coronary bypass surgery were prospectively randomized into three groups. In thirty-one patients, either an ultrasonic scalpel (USS, group A), an argon-beam coagulator (ABC, group B) or conventional electrocautery (CEC, group C) was used for ITA harvesting. Harvest times for ITA takedown using CEC (16.7 +/- 6 min) was significantly faster compared to ABC (21.6 +/- 8.1 min; p = 0.02) and USS (24.1 +/- 8.1 min; p < 0.001). There was no significant difference comparing harvest times of USS and ABC (p = 0.1). The number of hemostatic clips used was significantly lower when using USS (5.5 +/- 4.6 clips) compared to both CEC (16.6 +/- 6.2 clips; p < 0.001) and ABC (20.4 +/- 6.5 clips; p < 0.001) and significantly lower using CEC compared to ABC (p < 0.007). There were no significant differences in bleeding points within the tissue bed among the groups (ABC 11/31 patients, CEC 11/31 patients and USS 12/31 patients). This study demonstrates that dissection of the ITA pedicle can be safely done with USS, ABC, and CEC. However, USS is associated with less hemostatic clip demand but prolonged harvest time compared it to ABC and CEC; histological assessment revealed no significant difference when comparing groups and equipment used. A variety in design of the hooks may probably ease ultracision practicability.
    No preview · Article · Apr 2002 · The Thoracic and Cardiovascular Surgeon
  • A M Fabricius · M Krueger · V Falk · M Hanke · F W Mohr
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    ABSTRACT: The case presented is that of a 29-year-old man with a history of hemophilia A who was admitted with recurrent onsets of transient cerebrovascular ischemia; he had undergone a transvenous closure of an atrial septal defects with an occluder device (Cardioseal Starflex) two months ago. Due to a factor-VIII deficiency, no further anticoagulation therapy was initiated. On admission, transesophageal echocardiography revealed a floating thrombus on the left atrial side of the umbrella. The device was explanted via a right minithoracotomy, and the atrial septal defect was closed. The patient had an uneventful recovery.
    No preview · Article · Nov 2001 · The Thoracic and Cardiovascular Surgeon
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    A M Fabricius · W Gerber · M Hanke · J Garbade · R Autschbach · F W Mohr
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    ABSTRACT: To assess the impact of immediate angiography in patients with defined clinical and laboratory criteria of perioperative myocardial infarction after coronary artery bypass operation. Between January 1999 and December 1999 2052 patients underwent coronary artery bypass grafting in our institution. Out of this cohort 131 (6.4%) patients met the criteria of perioperative myocardial ischemia, which was defined as: (a) increase in the isoenzyme ratio of creatinine phosphokinase (CK/CK-MB] above 10%; (b) ischemic electrocardiographic episodes (defined as a new onset of elevated ST-segment change lasting at least 1 min and involving a shift from baseline of greater than or equal to 0.1 mV of ST-depression and a new association of a postoperative Q; (c) recurrent episodes of, or sustained ventricular tachyarrhythmia as well as ventricular fibrillation; (d) hemodynamic deterioration despite adequate inotropic support. Angiography was performed in 108 patients (5.3%, group A) whereas 23 patients (1.1%, group B) were immediately re-operated due to severely compromised hemodynamics. Angiographic results in group A showed regular grafts in 45 patients (2.2%); 63 patients (3.1%) had either an occlusion (n=41), incorrect anastomosis (n=29), graft stenosis (n=14), graft spasm (n=6), displaced graft (n=6), poor distal run-off (n=5) or incomplete revascularization (n=2). In group A 43 patients underwent a re-operation (34 patients) or an early angioplasty (nine patients). Due to poor coronary artery status no intervention was performed in the remaining 20 patients with angiographic findings. Operative findings in group B showed graft occlusion in ten patients (43.5%), incorrect anastomosis in five patients (21.7%), bleeding, stretched graft, venous graft spasm and displaced graft in one patient (4.3%) each, and no patho-morphological finding in 4 patients (17.4%). Thirty-day mortality rate was ten patients in group A (9.3%), all of them with angiographic findings, as opposed to nine patients (39.1%) in group B. ST-change and elevated CK/CK-MB enzyme ratio is highly indicative for possible graft failure and should be followed early angiographic control to assess the need for reintervention.
    Full-text · Article · Jul 2001 · European Journal of Cardio-Thoracic Surgery
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    A M Fabricius · R Autschbach · N Doll · W Mohr
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    ABSTRACT: We review the cases of two women with acute aortic dissection during their last trimester of pregnancy who underwent aortic root replacement. One patient with type A dissection had to undergo surgical intervention immediately, and required extracorporal membrane oxygenation for four days. The other patient with a pre-diagnosed Marfan's disease had suffered a type B dissection and had to undergo emergency operation after developing a type A dissection nine days later.
    Preview · Article · Mar 2001 · The Thoracic and Cardiovascular Surgeon
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    A M Fabricius · A Oser · A Diegeler · T Rauch · F W Mohr
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    ABSTRACT: Minimally invasive saphenous harvesting techniques have been shown to reduce post-operative morbidity. However, when applying new techniques of vein harvesting, endothelial integrity should be preserved in order to guarantee graft quality. We investigated the impact of two different minimally invasive saphenous vein harvesting techniques on endothelial function compared with the traditional 'open' technique by inducing endothelium-dependent in vitro relaxation. Two different minimally invasive techniques for harvesting the greater saphenous vein were used in 66 patients, either using a video-assisted dissector (ETHI, n=33) or a light coupled retractor (AUTS, n=33); other patients were treated conventionally (CONV, n=30). The physiological response was tested in vitro using an organ chamber on vein segments exposed to acetylcholine after precontraction with potassium. In both minimally invasive groups, two patients each had to be converted to the traditional open technique and dropped out of the study. The endothelial function of the other veins harvested by either of the minimally invasive techniques showed no significant difference compared with veins harvested conventionally. Reactivity was measured as the percentage relaxation of pharmacological contraction and was significant in all groups (P<0.05); ETHI, 49.1+/-4.2%; AUTS, 48.8+/-5.1%; and CONV, 51.7+/-6. 0%. The responder/non-responder ratio was similar in all groups: ETHI (two drop-outs), 28/3 (90.3%); AUTS (two drop-outs), 28/3 (90. 3%); and CONV, 27/3 (90.0%). Veins harvested by minimally invasive techniques have not shown an impaired reactivity of the endothelium compared with the conventional technique.
    Preview · Article · Nov 2000 · European Journal of Cardio-Thoracic Surgery
  • A M Fabricius · R Autschbach · L Lochhaas · S Brose · F W Mohr
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    ABSTRACT: A patient rapidly developing right heart failure due to a left-atrial leiomyosarcoma was admitted for surgery. A large tumor, originating in the left atrium and extending into both pulmonary veins, was removed. Histology showed an unusual epitheloid appearance of many cells with occasional mitoses and a strong immunexpression to desmin and actin. Six months later heart failure developed again: computer tomography demonstrated regrowth of the tumor in the left atrium with invasion of the mediastinum and the para-aortal lymph nodes. The patient died shortly after.
    No preview · Article · Nov 2000 · The Thoracic and Cardiovascular Surgeon
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    A M Fabricius · A Diegeler · W Gerber · F W Mohr
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    ABSTRACT: Minimally invasive saphenous vein harvesting techniques have been shown to reduce postoperative morbidity. Commercially available and often disposable instruments add significant costs to the operation. To lower expenses and to reduce postoperative morbidity, we used an ordinary laryngoscope fitted with a modified # 3 Heine blade for harvesting the greater saphenous vein for coronary artery bypass surgery. To assess the integrity and function of the autologous, undistended, long saphenous vein harvested by a modified laryngoscope. Morphology was examined by light and scanning electron microscopy. Endothelial function was assessed by vascular reactivity in an isolated organ bath. Veins, randomly taken and prepared traditionally, served as a control group. Contractile function was measured in response to potassium chloride. Endothelium-dependent relaxation was assessed by use of acetylcholine and calculated as percentage relaxation. There were no significant differences, in response to the constricting or dilating agent, in vein rings taken with the modified laryngoscope compared with the traditional 'open' technique (n = 10, p > 0.05 by ANOVA). Histologic examination by light and scanning electron microscopy showed no significant damage to the endothelial layer. Minimally invasive saphenous vein harvesting, using a modified laryngoscope yields morphologically and biologically intact veins.
    Preview · Article · Jan 2000 · The Heart Surgery Forum