Mirko Kaluza

Universitätsklinikum Jena, Jena, Thuringia, Germany

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Publications (11)23.97 Total impact

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    ABSTRACT: Background: Posttraumatic respiratory failure remains a life-threatening complication with a high mortality rate. However, the usefulness of extracorporeal membrane oxygenation (ECMO) remains controversial. Patients and methods: We report 3 cases of polytraumatized patients with severe lung contusions requiring treatment with veno-arterial ECMO due to deterioration of pulmonary function. Results: All patients survived the ECMO-support of 114 ± 27 hours, spent 37 ± 23 days in the intensive care unit, and could be transferred to rehabilitation centers. Following ECMO institution oxygenation increased from 46.2 ± 5.1 to 113.7 ± 37.8 mmHg and 189.7 ± 47.4 mmHg after 2 and 24 hours, respectively. The mean oxygenation index was 238.3 ± 27.2 mmHg by ending the ECMO support. Conclusions: For patients with posttraumatic respiratory failure the institution of ECMO may be life-saving and beneficial. The use of heparin-coated circuitry and a subtherapeutic anticoagulation lead to reduction of ECMO related complications.
    No preview · Article · Dec 2007 · Kardiotechnik
  • A Lauten · U Franke · J T Strauch · M Kaluza · T Wahlers
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    ABSTRACT: We report a case of a patient with severe aortic stenosis, who underwent replacement of the aortic valve as a Ross procedure. Postoperatively the patient suffered postcardiotomy failure. Despite prolonged reperfusion and other methods of circulatory support, the patient could not be weaned from cardiopulmonary bypass (CPB). Therefore, an Impella intravascular flow pump was implanted, which is technically easy and has good weaning attributes. For implantation, a vascular prosthesis was sewn to the ascending aorta and the microaxial flow pump was placed under echocardiographic guidance across the pulmonary autograft into the left ventricle. With this support, the patient could be weaned from CPB. The report evaluates the Impella microaxial hemopump as a device that is technically easy to implant with no injury to the pulmonary autograft in patients after Ross operation. Surgeons should consider the device as a short-term support in borderline indications.
    No preview · Article · Oct 2007 · The Thoracic and Cardiovascular Surgeon
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    ABSTRACT: Despite recent advances in critical care management, the mortality of acute respiratory distress syndrome (ARDS) remains high. The final rescue therapy for patients with severe hypoxia refractory to conventional therapy modalities is the extracorporeal gas exchange. We report the management of three polytraumatized patients with life-threatening injuries, severe blunt thoracic trauma, and consecutive ARDS treating by extracorporeal membrane oxygenation (ECMO). Two patients suffered a car accident with severe lung contusion and parenychmal bleeding. Bronchial rupture and mediastinal emphysema was found in one of them. Another patient developed ARDS after attempted suicide with multiple fractures together with blunt abdominal and thoracic trauma. All patients were placed on ECMO and could be rapidly stabilized. They were weaned from ECMO after a mean of 114 +/- 27 hours of support without complications, respectively. Mean duration of ICU stay was 37 +/- 23 days. Quick encouragement of ECMO for the temporary management of gas exchange may increase survival rates in trauma patients with ARDS.
    No preview · Article · May 2007 · Journal of Cardiac Surgery
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    ABSTRACT: To effectively perform an anastomosis on a coronary artery under beating heart conditions, the anastomotic site must be cleared of blood to allow visualization for accurate suturing. We describe a simple, cost effective, on-site assembled blower-mister system.
    No preview · Article · Oct 2006 · The Annals of thoracic surgery
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    Full-text · Article · Jan 2006 · The Journal of thoracic and cardiovascular surgery
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    ABSTRACT: Objective: Closed circuit extracorporeal circulation (CCECC) has been developed to reduce deleterious effects of standard cardiopulmonary bypass (CPB). This study compares the effects of CCECC (CORx system), CPB, and off-pump coronary artery bypass grafting (OPCAB) on red blood cell damage, coagulation activation, fibrinolysis and cytokine expression. Methods: Thirty patients underwent coronary artery bypass grafting (CABG). Twenty of them were randomized into two groups: CCECC (n=10), CPB (n=10). While not randomized, OPCAB (n=10) served as a separate reference group. CCECC and CPB patients received cardioplegic arrest. Interleukin 6 (IL-6), free hemoglobin (fHb), von Willebrand factor activity (vWf), thrombin–antithrombin-III-complex (TATc), prothrombin fragment 1.2 (F 1+2) and plasmin–antiplasmin complex (PAPc) were assessed preoperatively, perioperatively and 24h postoperatively. Results: CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1± 5.7μmol/l; CPB, 16.8±11.4μmol/l; P=0.025; OPCAB, 3.4±1.1μmol/l). Perioperatively, CCECC exhibited significantly lower activation of coagulation and fibrinolysis than CPB, but did not differ from OPCAB (vWf: CCECC, 133±52%; CPB, 241±128%; P=0.052; OPCAB, 153±58%; TATc: CCECC, 4.7±0.9ng/ml; CPB, 31.1±15.8ng/ml; P≪0.001; OPCAB, 2.4±0.6ng/ml; PAPc: CCECC, 214±30ng/ml; CPB, 897±367ng/ml; P≪0.001; OPCAB, 253±98ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458±98ng/ml; CPB, 159±128ng/ml; P≪0.001; OPCAB, 262±174ng/ml; IL-6: CCECC, 123.4±49.8pg/dl; CPB, 18.8±13.1pg/dl; P≪0.001; OPCAB, 31.6±26.2pg/dl). Conclusions: CCECC for CABG is associated with a significant reduction of red blood cell damage and activation of coagulation cascades similar to OPCAB when compared with conventional CPB while a delayed fibrinolytic and inflammatory activity was observed. These findings require further investigation to verify the promising concept of CCECC.
    Full-text · Article · Aug 2005 · European Journal of Cardio-Thoracic Surgery
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    ABSTRACT: Objective: Cardiopulmonary bypass (CPB) is known to cause part of the postoperative systemic inflammatory reaction and hemodilution. In order to reduce these problems a novel technique based on a single disposable, compact arterio-venous loop with an integrated centrifugal blood pump and oxygenating, air removal and gross filtration capabilities (CardioVention GmbH, Seevetal, Germany) has been developed. The applicability of this system and patients outcome was investigated in our clinic. Methods: Five consecutive patients (59,6 ± 8,3 y) with good left ventricular function (ejection fraction > 50 %) underwent coronary bypass surgery with the new CardioVention CORx system. Specific evaluation of handling, priming volume, hematocrite- and hemoglobine values were performed. Serial blood samples were taken prior to the onset, after initiation, before weaning of the CPB and 6 hours postoperatively. Results: The peri- and postoperative course of all patients was completely uneventful. Postoperatively stay on ICU was 16,6 ± 1,7 hours. Priming volume in all cases was 820 ml. On pump the minimun hematocrite level was 37,2 ± 3,2 %. The mean hemoglobine level after surgery was 6,3 ± 1,5 mmol/l versus 9,1 ± 0,7 mmol/l. No transfusion of blood or blood- products were needed in any patient. Conclusions: In our initial experience the CardioVention CORx system is suitable to maintain total extracorporal circulation with a 50% reduction of the priming volume. The likewise reduced foreign surface of 25 % compared to standard CPB may be accompanied by less inflammatory response.
    No preview · Article · Jan 2005
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    ABSTRACT: Efficacy of in vivo isolated lung perfusion (ILP) with cisplatin could be shown in different rodent tumor models. Despite the use of this alternative therapeutical strategy in very few patients with lung metastases, there are no systematic studies regarding the tolerance of the native lung tissue in large animal models or humans. In a novel ILP pig model, groups with two different concentrations of cisplatin (group CP150: 150 mg/m(2) cisplatin, n=5; group CP300: 300 mg/m(2) cisplatin, n=5) were compared with a control group (n=5) and a Sham group (n=5) concerning the influence on hemodynamic, ventilatory and gas exchange parameters as well as on structural integrity of the lung. In the additional CP300-HT group the potentially cumulative effect of hyperthermia and high-dose cisplatin perfusion was evaluated (300 mg/m(2) cisplatin, 41.5 degrees C, n=5). Following the ILP of the left lung for 40 min, right main bronchus and right pulmonary arteries were clamped and survival as well as lung function parameters were dependent on the previously perfused lung for the 6-h-reperfusion period. Quantification of histological acute lung injury was performed using the score of Chiang. ANOVA, ANOVA with repeated measures and Pearson's correlation estimation were applied for statistical evaluation. All animals survived ILP and the entire reperfusion period. Platinum levels of the perfusate and lung tissue showed a significant correlation with the dose given (P<0.001) but no correlation with the very low plasma levels in all groups (P=0.825). ILP resulted in a slight deterioration of most functional parameters compared to the Sham group. Although there were no differences between the perfusion groups regarding hemodynamic and ventilatory parameters, gas exchange parameters (pO(2)/FiO(2)-index, pCO(2), AADO(2)) demonstrated a trend toward dose-related functional impairment. Histological evaluation confirmed a dose-depending damage of lung tissue (P<0.001, correlation coefficient 0.670). The hyperthermic ILP with high-dose cisplatin led to improved gas exchange parameters and a reduction of morphological lung damage. In vivo ILP with high-dose cisplatin represents a safe procedure in this pig model. Hyperthermic perfusion up to 41.5 degrees C was beneficial to reduce the acute lung injury. The promising results of this study might be used for initiation of clinical trials as an alternative treatment in patients with a very poor prognosis.
    Full-text · Article · Oct 2004 · European Journal of Cardio-Thoracic Surgery
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    ABSTRACT: Conventional extracorporeal circulation results in an activation of coagulation cascades. Coating of extracorporeal circulation tubes as well as avoidance of shed blood recirculation have been shown to reduce these phenomena. We evaluated a new shed blood separation system (AVANT D 970) utilizing a coated cardiopulmonary bypass tube system (PHISIO). Forty patients (62 +/- 10 years) underwent isolated coronary revascularization. Four groups (n = 10/group) were defined: no extracorporeal circulation, conventional uncoated extracorporeal circulation, uncoated extracorporeal circulation with shed blood separation, and coated extracorporeal circulation with shed blood separation. Thrombin-antithrombin complex and free Hb were analyzed and statistically compared. Conventional extracorporeal circulation exhibited the highest intraoperative activation of coagulation (thrombin-antithrombin complex: extracorporeal circulation, 31.1 +/- 15.8 microg/L; uncoated extracorporeal circulation with shed blood separation, 15.3 +/- 7.8 microg/L; coated extracorporeal circulation with shed blood separation, 8.1 +/- 4.8 microg/L; no extracorporeal circulation, 2.4 +/- 0.6 microg/L; P <.05 extracorporeal circulation vs all others) and red blood cell damage (free Hb: extracorporeal circulation, 16.8 +/- 11.4 micromol/L; uncoated extracorporeal circulation with shed blood separation, 10.3 +/- 3.5 micromol/L; coated extracorporeal circulation with shed blood separation, 6.8 +/- 2.9 micromol/L; no extracorporeal circulation, 3.4 +/- 1.1 micromol/L; P <.05 extracorporeal circulation vs no extracorporeal circulation, coated extracorporeal circulation with shed blood separation). Coated extracorporeal circulation with shed blood separation showed only slight activation and cell trauma, which did not differ significantly from no extracorporeal circulation. Combination of coating and avoidance of shed blood recirculation maintained physiological coagulation levels and markedly reduced red blood cell trauma in extracorporeal circulation procedures. These combined modalities may therefore offer an alternative for off-pump procedures in patients with contraindications for conventional extracorporeal circulation.
    Full-text · Article · Nov 2003 · Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Intermittent antegrade warm blood cardioplegia (IAWBC) is a simple and cost-effective method of myocardial preservation. However, there are only few prospective trials comparing this type of cardioplegia to established cardioplegic strategies in elective on-pump coronary surgery with respect to myocardial protection and outcome. In a prospective, randomized trial IAWBC (33 degrees C) (n=100) was compared to intermittent antegrade cold (4 degrees C) blood cardioplegia (n=100), regarding clinical outcome and myocardial protection using cardiac troponin-I (cTNI) and creatine kinase MB isoenzyme (CK-MB) measurements to assess ischemia. Preoperative parameters were comparable in both groups. Results demonstrated no differences in-between the groups regarding mortality (2.0% both), incidence of perioperative myocardial infarction (2 versus 3%), need for intra-aortic balloon pump (3 versus 4%), length of ICU stay (2.0+/-2.5 versus 2.1+/-3.0 days) and incidence of postoperative atrial fibrillation (41 versus 34%). However, the necessity of defibrillation after cardiac arrest (18 versus 43%, P<0.001) was significantly less frequent and of lower intensity (3.4+/-10.8 versus 10.8+/-20.6 J, P<0.001) in the IAWBC-group. Postoperatively the ischemia markers were significantly lower in the IAWBC-group, cTNI within the first 72 h (from P<0.001 to P=0.013) and even CK-MB within the first 24 h (from P=0.004 to P<0.011). IAWBC is a safe and simple method in elective on-pump coronary artery bypass surgery. Significantly lower ischemic markers suggest an improved myocardial protection compared to cold blood cardioplegia in these patients.
    Full-text · Article · Mar 2003 · European Journal of Cardio-Thoracic Surgery
  • M. Kaluza · J.M. Albes · T. Wahlers
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    ABSTRACT: Newly developed oxygenators require a limited clinical evaluation prior to clinical use routinely. From September to October 2000 we evaluated 40 Capiox RX 25 oxygenators (Terumo CVSE GmbH, Borken) coated with X-coating® in a clinical setting measuring different parameters and evaluating the over-all handling. The oxygenator Capiox RX 25 achieved in view of the large membrane surface area (2.5 m2) a very good gas exchange rate. We did not detect a "high pressure drop phenomenon" during use which we related to the bio-passive, inert polymer coating: X-coating®. The measured pressure drop of 71.5 ± 1.3 mmHg (at 5 1/min flow, 34 °C blood temperature, Hb 7-8 g/dl) is low when compared to other available oxygenators. The heat exchanger showed a sufficient efficiency of Q = 69 ± 3.1 %. We also found no differences in the measured standard laboratory parameters when compared to our clinical data. A slight drop in the thrombocyte count (statistically not significant) was noted during our first evaluations. However the non-disconnectable bypass and priming lines and the not sufficient fixation of the oxygenator in the holder were disadvantages. Both of these issues were addressed and altered in the oxygenators produced from July 2001. With these changes incorporated, the Capiox RX 25 is a user-friendly oxygenator, which has had reliable performance in the clinical routine.
    No preview · Article · Jan 2002 · Kardiotechnik