Publications by authors named "Ernst Wolner"

133 Publications

One year follow-up of the multi-centre European PARTNER transcatheter heart valve study.

Eur Heart J 2011 Jan 12;32(2):148-57. Epub 2010 Nov 12.

Institut Hospitalier Jacques Cartier, 6 avenue du Noyer Lambert, Massy, France.

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option in high-risk patients with severe aortic stenosis.

Aims: PARTNER EU is the first study to evaluate prospectively the procedural and mid-term outcomes of transfemoral (TF) or transapical (TA) implantation of the Edwards SAPIEN® valve involving a multi-disciplinary approach.

Methods And Results: Primary safety endpoints were 30 days and 6 months mortality. Primary efficacy endpoints were haemodynamic and functional improvement at 12 months. One hundred and thirty patients (61 TF, 69 TA), aged 82.1 ± 5.5 years were included. TA patients had higher logistic EuroSCORE (33.8 vs. 25.7%, P = 0.0005) and more peripheral disease (49.3 vs. 16.4%, P< 0.0001). Procedures were aborted in four TA (5.8%) and six TF cases (9.8%). Valve implantation was successful in the remaining patients in 95.4 and 96.4%, respectively. Thirty days and 6 months survival were 81.2 and 58.0% (TA) and 91.8 and 90.2% (TF). In both groups, mean aortic gradient decreased from 46.9 ± 18.1 to 10.9 ± 5.4 mmHg 6 months post-TAVI. In total, 78.1 and 84.8% of patients experienced significant improvement in New York Heart Association (NYHA) class, whereas 73.9 and 72.7% had improved Kansas City Cardiomyopathy Questionnaire (KCCQ) scores in TA and TF cohorts, respectively.

Conclusion: This first team-based multi-centre European TAVI registry shows promising results in high-risk patients treated by TF or TA delivery. Survival rates differ significantly between TF and TA groups and probably reflect the higher risk profile of the TA cohort. Optimal patient screening, approach selection, and device refinement may improve outcomes.
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http://dx.doi.org/10.1093/eurheartj/ehq427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021390PMC
January 2011

[Obituary for Prof. Helmut Jenny].

Wien Klin Wochenschr 2010 May;122(9-10):259

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http://dx.doi.org/10.1007/s00508-010-1382-5DOI Listing
May 2010

Extended videoscopic robotic thymectomy with the da Vinci telemanipulator for the treatment of myasthenia gravis: the Vienna experience.

Interact Cardiovasc Thorac Surg 2009 Nov 28;9(5):784-7. Epub 2009 Apr 28.

Department of Cardiothoracic Surgery, Medical University of Vienna, AKH Vienna, Vienna, Austria.

Surgical treatment of myasthenia gravis should include the complete resection of the thymus with the whole fatty tissue adherent to the pericardium for immunologic as well as oncologic reasons. The aim of the current study was to investigate the efficacy and safety of robotic approach. A total of 18 patients with myasthenia gravis (mean age 44 years) have been operated robotically via a left-sided approach. Preoperative MGFA (Myasthenia Gravis Foundation of America) classification was: Class I n=4, Class IIa n=4, Class IIb n=5, and Class IIIa n=3, IIIb n=2. Total endoscopic resection was feasible in 17/18 patients. One patient had to be converted due to bleeding. In the remaining patients, operative time was 175 min, intensive care unit (ICU) one day, hospital stay four days. In all patients it was possible to perform an extended thymic resection. MGFA post-intervention status after a mean of 18 months follow-up showed complete stable remission n=5, pharmacologic remission n=4, minimal manifestations n=5, unchanged n=1. Complete endoscopic thymus surgery with the da Vinci surgical system enables a complete and extended resection of all thymic tissue in the mediastinum. Due to the minimal trauma, patients can return to full activity within a short time.
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http://dx.doi.org/10.1510/icvts.2009.202531DOI Listing
November 2009

Improved myocardial protection in the failing heart by selective endothelin-A receptor blockade.

J Thorac Cardiovasc Surg 2009 Apr 12;137(4):1005-11, 1011e1. Epub 2009 Feb 12.

Department of Cardiac Surgery, LK St Poelten, Vienna Medical University, Vienna, Austria.

Objective: Ischemia/reperfusion injury caused by cardioplegic arrest is still a major challenge in patients with reduced left ventricular function. We investigated the effect of chronic versus acute administration of the selective endothelin-A receptor antagonist (ERA) TBC-3214Na during ischemia/reperfusion in failing hearts.

Methods: Male Sprague-Dawley rats underwent coronary ligation. Three days after myocardial infarction (MI), 19 randomly assigned animals (ERA chronic) were administered TBC-3214Na continuously with their drinking water, 29 MI rats received placebo, and 3 rats died during the observation period. Six weeks after infarction, hearts were evaluated in a blood-perfused working heart model during 60 minutes of ischemia and 30 minutes of reperfusion. In 14 MI rats, TBC-3214Na (ERA acute) was added to the cardioplegic solution during ischemia. Thirteen MI rats served as control.

Results: At a similar infarct size, postischemic recovery of cardiac output (ERA chronic: 91% +/- 10%, ERA acute: 86% +/- 11% vs control: 52% +/- 15%; P < .05) and external heart work (ERA chronic: 90% +/- 10%, ERA acute: 85% +/- 13% vs control: 51% +/- 17%; P < .05) was significantly enhanced in both TBC-3214Na-treated groups whereas recovery of coronary flow was only improved in ERA acute rats (ERA acute: 121% +/- 23% vs ERA chronic: 75% +/- 13%; control: 64% +/- 15%; P < .05). Blood gas measurements showed enhanced myocardial oxygen delivery and consumption with acute TBC-3214Na therapy. Additionally, high-energy phosphates (phosphocreatine) were significantly higher and transmission electron microscopy revealed less ultrastructural damage under acute TBC-3214Na administration.

Conclusion: Acute endothelin-A receptor blockade is superior to chronic blockade in attenuating ischemia/reperfusion injury in failing hearts. Therefore, acute endothelin-A receptor blockade might be an interesting option for patients with heart failure undergoing cardiac surgery.
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http://dx.doi.org/10.1016/j.jtcvs.2008.10.037DOI Listing
April 2009

Direct epicardial shock wave therapy improves ventricular function and induces angiogenesis in ischemic heart failure.

J Thorac Cardiovasc Surg 2009 Apr;137(4):963-70

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Objectives: Direct application of low-energy unfocused shock waves induces angiogenesis in ischemic soft tissue. The potential effects of epicardial shock wave therapy applied in direct contact to ischemic myocardium are uncertain.

Methods: For induction of ischemic heart failure in a rodent model, a left anterior descending artery ligation was performed in adult Sprague-Dawley rats. After 4 weeks, reoperation with (treatment group, n = 60) or without (control group, n = 60) epicardial shock wave therapy was performed. Low-energy shock waves were applied in direct contact with the infarcted myocardium (300 impulses at 0.38 mJ/m(2)). Additionally, healthy animals (n = 30) with normal myocardium were studied. Angiogenesis, ventricular function upregulation of growth factors, and brain natriuretic peptide levels were analyzed.

Results: Histologic analysis revealed significant angiogenesis 6 weeks (treatment group: 8.2 +/- 3.7 vs control group: 2.9 +/- 1.9 vessels per field, P = .016) and 14 weeks (treatment group: 7.1 +/- 3.1 vs control group: 3.2 +/- 1.8 vessels per field, P = .011) after shock wave treatment. In the treatment group ventricular function improved throughout the follow-up period (6 weeks: 37.4% +/- 9% [P < .001] and 14 weeks: 39.5% +/- 9% [P < .001]). No improvement of ventricular function was observed in the control group (6 weeks: 28.6% +/- 5% and 14 weeks: 21.4% +/- 5%). Rat brain natriuretic peptide 45 levels were lower in the treatment group compared with those in the control group 6 and 14 weeks after treatment. Vascular endothelial growth factor, Fms-related tyrosine kinase 1, and placental growth factor levels were upregulated after 24 and 48 hours and 7 days in the treatment group. No effects on healthy myocardium were observed.

Conclusion: Direct epicardial low-energy shock wave therapy induces angiogenesis and improves ventricular function in a rodent model of ischemic heart failure.
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http://dx.doi.org/10.1016/j.jtcvs.2008.11.006DOI Listing
April 2009

Renal function and outcome after continuous flow left ventricular assist device implantation.

Ann Thorac Surg 2009 Apr;87(4):1072-8

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: Renal dysfunction as a risk factor with the use of left ventricular assist devices (LVAD) is controversial. We determined the effect of renal function on outcomes after continuous flow LVAD implantation.

Methods: Eighty-six patients with advanced heart failure undergoing continuous flow LVAD implantation as bridge to transplantation from November 1998 to July 2007 were retrospectively analyzed. Renal function was assessed using the Modification of Diet in Renal Disease study-derived glomerular filtration rates (GFR [mL x min(-1) x 1.73 m(-2)]). Patients were categorized into two groups based on pre-LVAD GFR: those with normal renal function (GFR > 60, n = 46), and those with renal dysfunction (GFR < 60, n = 40).

Results: Post-LVAD survival at 1, 3, and 6 months for GFR greater than 60 was 91.3%, 79.9%, 72.6%, respectively, and for GFR less than 60, it was 92.5%, 66.5%, 47.9%, respectively (p = 0.038). Bridge-to-transplant rate was lower for GFR less than 60 than for GFR greater than 60 (40.0% versus 63.0%, p = 0.033). For GFR less than 60, GFR improved on LVAD support: implant to month 6, 41.7 +/- 11.5 to 62.7 +/- 25.0 (p = 0.021). Post-LVAD survival was improved in GFR less than 60 patients who after LVAD implantation recovered renal function to GFR greater than 60 (p < 0.001). Patients with post-LVAD renal failure had significantly lower post-LVAD survival regardless of pre-LVAD renal function (p < 0.001).

Conclusions: Patients with renal dysfunction have poorer outcomes after continuous flow LVAD implantation. However, renal function improves after LVAD implantation and is associated with improved survival. Our data underscore the importance of end-organ function in patient selection for LVAD therapy.
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http://dx.doi.org/10.1016/j.athoracsur.2009.01.022DOI Listing
April 2009

Safety and efficacy of statin therapy in patients switched from cyclosporine a to sirolimus after cardiac transplantation.

Transplantation 2008 Dec;86(12):1771-6

Department of Cardiothoracic Surgery, Medical University of Vienna, Währinger Gürtel, Vienna, Austria.

Introduction: Statins are an established therapy after cardiac transplantation. Sirolimus (Srl) has been used successfully in cardiac transplant patients. However, potential side effects are hyperlipidemia and interactions with statins. The aim of the study was to evaluate the safety and efficacy of statin therapy after switch to a Srl-based immunosuppression.

Patients And Methods: Ninety-eight long-term patients were switched from Cyclosporine A to Srl. Also all patients received mycophenolate mofetil alone or mycophenolate mofetil plus steroid therapy. Reasons for switch were renal dysfunction, graftvasculopathy, or skin cancer. Patients were switched 7.8+/-4.7 years after transplant. Total observation period was 12 months before and after switch, respectively. Safety evaluation consisted of regular measurements of CPK and liver enzymes to evaluate the incidence myopathy and hepatoxicity. Efficacy analysis was performed by serial blood lipid assessments (low-density lipoprotein, high-density lipoprotein, total cholesterol, and triglycerides).

Results: Forty-three percentage of patients received atorvastatin, 38% pravastatin, and 18% other drugs or therapy changes. Most lipid blood levels increased significantly after switch (cholesterol: 192.9+/-38.6 mg/dL vs. 221.8+/-49.2 mg/dL, P<0.0001; low-density lipoprotein: 108.0+/-35.6 mg/dL vs. 123.8+/-37.9 mg/dL, P<0.0001; and triglycerides: 178.3+/-88.2 mg/dL vs. 225.5+/-139.1 mg/dL, P<0.0001). Blood lipid levels after switch were not associated with statin type. Overall safety was acceptable, although incidence of myopathy doubled after switch (n=20 vs. 40; P<0.01). However, most cases were asymptomatic CPK elevations in the pravastatin group. Hepatotoxicity rate was 4% and only temporary.

Conclusion: Statin therapy after switch from cyclosporine A to Srl in long-term cardiac transplant patients is safe. However, regular testing of blood lipids and CPK should be mandatory.
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http://dx.doi.org/10.1097/TP.0b013e3181910eb2DOI Listing
December 2008

Platelet dysfunction in outpatients with left ventricular assist devices.

Ann Thorac Surg 2009 Jan;87(1):131-7

Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria.

Background: Thromboembolic and bleeding complications in outpatients with a left ventricular assist device are common and can be detrimental. A meticulous balance between anticoagulant and procoagulant factors is therefore crucial. However, in contrast to routinely performed plasmatic coagulation tests, platelet function is hardly ever monitored although recent reports indicated platelet dysfunction. We therefore differentially evaluated platelet function with four commonly used point-of-care devices.

Methods: In a cross-sectional design platelet function was assessed in 12 outpatients and 12 healthy matched volunteers using thrombelastography platelet mapping, thromboelastometry, platelet function analyzer, and a new whole blood aggregometer (Multiplate).

Results: Phenprocoumon produced an international normalized ratio of 3.5. It was associated with a twofold prolongation in the thromboelastometry clotting time (p < 0.001). Platelet function under high shear was severely compromised: collagen adenosine diphosphate closure times were 2.5-fold longer in patients than in volunteers (p < 0.001), and 50% of patients had maximal collagen adenosine diphosphate closure time values. Although antigen levels of von Willebrand factor were 80% higher in patients (p < 0.001), von Willebrand factor-ristocetin was subnormal in 5 of 12 patients. Ristocetin-induced aggregation was also threefold higher in volunteers (p < 0.001), indicating an additional functional defect of platelets affecting the glycoprotein Ib-von Willebrand factor axis. The von Willebrand factor multimer pattern in patients also appeared abnormal.

Conclusions: Multimodal antiplatelet monitoring showed markedly impaired platelet function in patients with a left ventricular assist device. Platelet dysfunction under high shear rates and abnormal ristocetin-induced aggregation is only partly attributable to low von Willebrand factor activity. These findings resemble the acquired von Willebrand syndrome that is associated with microaggregate formation and enhanced bleeding.
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http://dx.doi.org/10.1016/j.athoracsur.2008.10.027DOI Listing
January 2009

Prophylactic low-energy shock wave therapy improves wound healing after vein harvesting for coronary artery bypass graft surgery: a prospective, randomized trial.

Ann Thorac Surg 2008 Dec;86(6):1909-13

Department of Cardiothoracic Surgery, Medical University of Vienna, Austria.

Background: Wound healing disorders after vein harvesting for coronary artery bypass graft surgery increase morbidity and lower patient satisfaction. Low-energy shock wave therapy (SWT) reportedly improves healing of diabetic and vascular ulcers by overexpression of vascular endothelial growth fractor and downregulation of necrosis factor kappaB. In this study, we investigate whether prophylactic low-energy SWT improves wound healing after vein harvesting for coronary artery bypass graft surgery.

Methods: One hundred consecutive patients undergoing coronary artery bypass graft surgery were randomly assigned to either prophylactic low-energy SWT (n = 50) or control (n = 50). Low-energy SWT was applied to the site of vein harvesting after wound closure under sterile conditions using a commercially available SWT system (Dermagold; Tissue Regeneration Technologies, Woodstock, GA). A total of 25 impulses (0.1 mJ/mm(2); 5 Hz) were applied per centimeter wound length. Wound healing was evaluated and quantified using the ASEPSIS score. (ASEPSIS stands for Additional treatment, presence of Serous discharge, Erythema, Purulent exudate, Separation of the deep tissue, Isolation of bacteria, and duration of inpatient Stay). Patient demographics, operative data, and postoperative adverse events were monitored.

Results: Patient characteristics and operative data including wound length (SWT 39 +/- 13 cm versus control 37 +/- 11 cm, p = 0.342) were comparable between the two groups. We observed lower ASEPSIS scores indicating improved wound healing in the SWT group (4.4 +/- 5.3) compared with the control group (11.6 +/- 8.3, p = 0.0001). Interestingly, we observed a higher incidence of wound healing disorders necessitating antibiotic treatment in the control group (22%) as compared with the SWT group (4%, p = 0.015). No SWT-associated adverse events were observed in the treatment group.

Conclusions: As shown in this prospective randomized study, prophylactic application of low-energy SWT improves wound healing after vein harvesting for coronary artery bypass graft surgery.
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http://dx.doi.org/10.1016/j.athoracsur.2008.07.117DOI Listing
December 2008

Low molecular weight heparin as an alternative to unfractionated heparin in the immediate postoperative period after left ventricular assist device implantation.

Artif Organs 2008 Oct;32(10):819-22

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

We present a regimen for anticoagulation in the immediate postoperative period after left ventricular assist device (LVAD) implantation using low molecular weight heparin (LMWH) as an alternative to unfractionated heparin. Between May and September 2007, eight consecutive patients undergoing LVAD implantation for advanced heart failure received the LMWH nadroparin. Nadroparin was given twice daily to achieve anti-Factor Xa activity target peak levels of 0.4 +/- 0.1 U/mL. The antiplatelet therapy consisted of aspirin (100 mg/day) and dipyridamole (3 x 75 mg/day). One patient underwent heart transplantation, three patients died, and four patients continued to receive device support. The median duration of support was 78 days (range, 46 to 174). No major bleeding was observed; minor bleeding occurred in three patients. In two patients, pump thrombosis was suspected. There were two ischemic and no hemorrhagic strokes. The use of LMWH may provide a new anticoagulation treatment option in the immediate postoperative period after LVAD implantation.
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http://dx.doi.org/10.1111/j.1525-1594.2008.00634.xDOI Listing
October 2008

Recent trends in heart transplantation: the University of Vienna experience.

Clin Transpl 2007 :81-97

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Since the beginning of the University of Vienna Cardiac Transplant Program in 1984, 1086 heart transplant procedures have been performed through the end of 2007. One- and five-year survival has increased steadily over time (82% and 76%). Ten-year survival is 65%. Over the past 10 years our program has seen dramatic changes in patient selection, accepting now patients with more risk factors (Age, diabetes, elevated pulmonary resistance,..). Developments in immunosuppression have decreased incidence of infection, rejection and graft arteriosclerosis continuously. Our program continues to pursue novel strategies to improve the survival and quality of life of our heart transplant patients.
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August 2008

Programmed cell death in idiopathic dilated cardiomyopathy is mediated by suppression of the apoptosis inhibitor Apollon.

Ann Thorac Surg 2008 Jul;86(1):109-14; discussion 114

Department of Cardiothoracic Surgery, Center of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.

Background: Idiopathic dilated cardiomyopathy (DCM) is characterized by ventricular wall remodeling and an increased frequency of cardiac cell apoptosis. Apollon is a 528kD cell membrane-anchored protein that inhibits apoptosis by ubiquitinylation facilitating the degradation of Smac/Diablo and caspase-9. The present study tested the hypothesis that the Apollon/Smac system may mediate programmed cell death in DCM.

Methods: Apollon and caspase-9 protein expression was assessed in left ventricular biopsies of explanted failing hearts using Western blotting in 36 DCM patients undergoing cardiac transplantation and in 10 controls. Human cardiac cells were transfected with a plasmid containing the human Apollon complementary DNA or control vector and were subsequently stressed by hypoxia. Apollon, Smac/Diablo, and caspase-9 expression were then examined in cell lysates by real-time polymerase chain reaction and a transferase-mediated dUTP nick-end labeling assay was used to determine the apoptotic index.

Results: In DCM myocardial tissue, Apollon messenger (m)RNA and protein expression was down-regulated compared with control hearts (p < 0.001 and p < 0.005, respectively) concomitant with an increase in activated caspase-9 protein levels (p < 0.001). Cell stress resulted in increased apoptosis in cardiac cells in vitro and down-regulation of Apollon mRNA expression compared with control cells (p < 0.001). Transfection increased Apollon mRNA expression in cell lysates (p < 0.001) and completely prevented hypoxia-induced apoptosis associated with reduced expression of Smac/Diablo and activated caspase-9.

Conclusions: These results suggest that Apollon down-regulation plays a role in programmed cell death associated with DCM. Up-regulation of Apollon might therefore represent a novel therapeutic strategy in the treatment of DCM.
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http://dx.doi.org/10.1016/j.athoracsur.2008.03.057DOI Listing
July 2008

Mechanical aortic valve prostheses in the small aortic root: Top Hat versus standard CarboMedics aortic valve.

Ann Thorac Surg 2008 Jul;86(1):64-70

Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.

Background: The purpose of this study was to evaluate outcome in patients with a small aortic root receiving either a standard CarboMedics mechanical aortic valve or a Top Hat CarboMedics valve (CarboMedics, Austin, TX), specifically designed for the small aortic root.

Methods: Between 1986 and 2006, 316 consecutive patients underwent 19- or 21-mm mechanical aortic valve replacement, receiving either a CarboMedics Top Hat bileaflet valve (n = 56; mean age, 66 +/- 14 years) or a standard CarboMedics aortic valve replacement (n = 260; mean age, 60 +/- 13 years) at our institution based on institutional indications for the choice of type of valve prostheses. Median follow-up time was 83.5 months. We studied survival, valve-related and non-valve-related events, and hemodynamic performance by serial echocardiographic follow-up studies.

Results: In-hospital mortality was 8.9% in the Top Hat group and 10.0% in the standard group (p = 0.354). Five- and ten-year survival in patients in the Top Hat group was 83% and 67%, respectively. Five- and ten-year survival in the standard group was 73% and 59%, respectively (log-rank = 0.331). There were no differences in regard to valve-related and non-valve-related events. Cox regression analysis revealed age (hazard ratio, 1.045; 95% confidence interval, 1.026 to 1.066), previous cardiac surgery (hazard ratio, 1.812; 95% confidence interval, 1.101 to 2.982), additional procedures at the time of valve replacement (hazard ratio, 2.604; 95% confidence interval, 1.651 to 4.108), New York Heart Association class IV (hazard ratio, 3.645; 95% confidence interval, 1.214 to 10.945), and severely impaired left ventricular ejection fraction (hazard ratio, 2.253; 95% confidence interval, 1.289 to 3.941) to be independent predictors of survival.

Conclusions: Mechanical aortic valve replacement in the small aortic root is associated with substantial perioperative mortality, in particular in the subset of patients requiring additional cardiac surgical procedures. Nevertheless, long-term outcome is satisfying. Because the type of prosthesis does not predict outcome in the multivariate Cox model, we conclude that use of the smaller Top Hat prosthesis can be recommended for the challenging cohort of patients with a small aortic root.
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http://dx.doi.org/10.1016/j.athoracsur.2008.01.085DOI Listing
July 2008

Management of open chest and delayed sternal closure with the vacuum assisted closure system: preliminary experience.

Interact Cardiovasc Thorac Surg 2008 Oct 9;7(5):801-4. Epub 2008 Jun 9.

Department of Cardiothoracic Surgery, Medical University of Vienna, AKH Vienna, Währinger Gürtel, Vienna, Austria.

The management of open chest with the vacuum assisted closure (VAC) system was evaluated in terms of impact on cardiac hemodynamics, respiratory parameters, complications, incidence of wound infection, overall handling and outcome in 22 patients during 2005 and 2008 after cardiac surgery. The decision to leave the sternum open was made electively in all patients at the time of primary operation or reexploration. In four patients the VAC was implanted during the primary operation. In the remainder the VAC was implanted after a mean of five days after the primary operation. The overall mortality rate was 45% (10/22). None of the patients developed a sternal wound infection, nor were there any VAC related complications. Management of open chest with the VAC system can be considered as an alternative to sterile draping. The VAC has no negative impact on cardiac hemodynamics as well as respiratory mechanics. The feared complication of right ventricular rupture and massive bleeding can be effectively prevented. Through the stabilizing of the thoracic cage, the patient can be easily moved and mobilized for nursing reasons and pneumonia prevention. Furthermore, the VAC effectively prevents the contamination of the wound and the mediastinum with potential subsequent infection.
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http://dx.doi.org/10.1510/icvts.2008.177527DOI Listing
October 2008

Renal function after implantation of continuous versus pulsatile flow left ventricular assist devices.

J Heart Lung Transplant 2008 May;27(5):469-73

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: This study was designed to determine the effect of continuous vs pulsatile flow devices on renal function after left ventricular assist device (LVAD) implantation.

Methods: Ninety-two patients undergoing LVAD implantation as bridge-to-transplant therapy were retrospectively analyzed. Patients receiving continuous flow devices (n = 63, 68.5%) were compared with patients receiving pulsatile flow devices (n = 29, 31.5%). Renal function was assessed by 2 calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease (MDRD)-derived GFR (ml/min/1.73 m(2)) and the Cockcroft-Gault-derived creatinine clearance (CrCl, ml/min).

Results: Mean GFR/CrCl was comparable between the groups at LVAD implantation, in the post-implantation period, and at transplantation. Both groups had a significant increase in mean GFR at Week 1 post-implantation (continuous, 59.4 +/- 22.8 to 76.4 +/- 38.6, p = 0.001; pulsatile, 52.5 +/- 21.1 to 69.2 +/- 34.7; p = 0.007), Week 4 (continuous, 59.9 +/- 23.0 to 84.3 +/- 32.9; p < 0.001; pulsatile, 50.3 +/- 21.1 to 79.9 +/- 38.7, p = 0.007), and Week 12 (continuous, 60.3 +/- 23.1 to 75.3 +/- 30.2, p = 0.004; pulsatile, 55.5 +/- 23.1 to 74.2 +/- 27.2, p = 0.037) that was also seen with the Cockcroft-Gault-calculated CrCl. No significant increase occurred in mean GFR/CrCl to transplantation. Incidence of post-implantation renal failure was comparable between the groups (continuous, 38.1%; pulsatile, 31.0%; p = 0.512).

Conclusions: After LVAD implantation, patients with continuous flow devices and patients with pulsatile flow devices have comparable renal function.
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http://dx.doi.org/10.1016/j.healun.2007.12.012DOI Listing
May 2008

Treatment of symptomatic coral reef aorta by endovascular stent-graft placement.

Ann Thorac Surg 2008 May;85(5):1817-9

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

We report 2 patients who were referred for treatment of hemodynamically significant symptomatic stenosis of the aorta at the thoracoabdominal transition (coral reef aorta) that was causing abdominal angina and intermittent claudication. Both patients underwent successful transfemoral endovascular stent-graft placement and are free of symptoms, with regular findings at 6-month follow-up completion computed tomography scan.
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http://dx.doi.org/10.1016/j.athoracsur.2007.11.053DOI Listing
May 2008

Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta.

Eur J Cardiothorac Surg 2008 Jun 6;33(6):1019-24. Epub 2008 Mar 6.

Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.

Background: To determine mid-term durability of endovascular stent-graft placement in patients with penetrating atherosclerotic ulcers (PAU) involving the thoracic aorta and to identify risk factors for death as well as early and late cardiovascular events.

Methods: From 1997 to 2006, 27 patients (mean age 66 yrs) presented with PAU (rupture n=7). Mean numeric EuroScore was 11 and mean logistic EuroScore was 35. Median follow-up was 42 (10-86) months, being complete in all patients. Outcome variables included death and occurrence of early and late cardiovascular events.

Results: In-hospital mortality was 11%. Primary success rate was 100%. Actuarial survival rates at 1, 3 and 5 years were 93%, 78% and 70%, respectively. Hemodynamic instability (HR 2.5, 2.1-3.9; p=0.034) as well as logistic EuroScore (HR 2.8, 2.4-4.3; p=0.019) was identified as independent predictor of early and late cardiovascular events.

Conclusions: Endovascular stent-graft placement in patients with PAU is an effective palliation for a life-threatening sign of a severe systemic process. Hemodynamic instability at referral and a high preoperative risk score predict adverse outcome. During mid-term follow-up, patients are mainly limited by sequelae of their underlying disease.
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http://dx.doi.org/10.1016/j.ejcts.2007.12.054DOI Listing
June 2008

Experimental stent-graft treatment of ascending aortic dissection.

Ann Thorac Surg 2008 Feb;85(2):470-3

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: This study assessed the feasibility of stent graft treatment of ascending aortic dissections in a porcine in vitro model.

Methods: The entire thoracic aortic aorta including the supraaortic branches was harvested from 12 adult pigs and an intimal tear was artificially created. The aortic annulus was then sewn into a silicon ring of a driving chamber. The distal aorta was connected to tubing with adjustable resistance elements. The circulation was driven by a hydraulic motor piston pump to mimic aortic flow and pressure. After creating a dissection by elevating the systolic aortic pressure to 180 mm Hg, a 2- x 2.6-cm covered stent graft was inserted through the brachiocephalic trunk using a specially designed delivery system. Stent graft placement was performed under continuous ultrasound control.

Results: The longitudinal length of the created ascending aortic dissection was 1.8 +/- 0.39 cm. Ultrasound studies revealed successful deployment of the stent graft and closure of the false lumen in all 12 cases. Diameter and area of the true lumen increased from 0.52 +/- 0.15 cm to 2.54 +/- 0.36 cm (p < 0.05) and from 0.78 +/- 0.27 cm2 to 5.13 +/- 1.35 cm2 (p < 0.05), respectively. The circumference of the true lumen increased from 4.50 +/- 0.52 cm to 7.96 +/- 1.2 cm (p < 0.05). Ultrasound studies also revealed uncompromised function of the aortic valve in all cases. No dislodging of stent grafts was observed.

Conclusions: Given ideal anatomy, experimental stent graft placement for ascending aortic dissection is feasible and achieves complete closure of the false lumen.
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http://dx.doi.org/10.1016/j.athoracsur.2007.09.049DOI Listing
February 2008

Heat shock proteins 27, 60, 70, 90alpha, and 20S proteasome in on-pump versus off-pump coronary artery bypass graft patients.

Ann Thorac Surg 2008 Jan;85(1):80-7

Department of Cardiac Surgery, University of Debrecen, Debrecen, Hungary.

Background: The secretion of heat shock protein (HSP) 27, HSP60, HSP70, HSP90alpha, 20S proteasome, and their correlations to proinflammatory cytokine interleukin-6 is unknown in patients undergoing on-pump versus off-pump coronary artery bypass graft (CABG) operation.

Methods: Forty patients were included in this explorative study (on- versus off-pump CABG, each n = 20). Serum samples were obtained before and 30 minutes, 60 minutes, and 24 hours after CABG operation. Enzyme-linked immunosorbent assay technique was utilized to determine soluble HSP27, 60, 70, and 90alpha, 20S proteasome, and levels of interleukin-6.

Results: Serum levels of HSP are increased in patients undergoing on-pump CABG operation as compared with off-pump CABG technique. These differences were highly significant for HSP27, 70, and 90alpha at 60 minutes after initiation of cardiopulmonary bypass (all, p < 0.001). Concentrations of soluble 20S proteasome were increased 24 hours after operation in on- and off-pump CABG patients (p < 0.001) and correlated significantly with the serum content of HSP 27, 70, and 90alpha at 60 minutes after initiation of cardiopulmonary bypass (p < 0.001). No correlation was found when comparing interleukin-6 levels with intravascular leakage of HSP and 20S proteasome after CABG operation.

Conclusions: We conclude from our data that the innate immune system is activated owing to spillage of known immune modulatory and apoptosis-associated proteins after CABG operation.
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http://dx.doi.org/10.1016/j.athoracsur.2007.06.049DOI Listing
January 2008

Midterm follow-up of tricuspid valve reconstruction due to active infective endocarditis.

Ann Thorac Surg 2007 Dec;84(6):1943-8

Department of Cardiothoracic Surgery, Medical University Vienna, Vienna, Austria.

Background: Surgical methods for treatment of tricuspid valve (TV) endocarditis include complete TV excision, TV replacement, and the use of various reconstructive techniques even in cases of severe TV destruction and incompetence. This study summarizes our experience with TV reconstruction and replacement in patients with severe TV endocarditis.

Methods: Between October 1997 and July 2004, TV reconstruction was performed in 18 patients (mean age, 38 +/- 17 years; 7 women, 11 men), and TV replacement in 4 patients (mean age, 48 +/- 22 years; 2 women, 2 men). All patients presented with active endocarditis and severe TV incompetence. Reconstructive techniques included debridement of vegetations, complete resection of infected or destroyed leaflet tissue, leaflet reconstruction with pericardial tissue, sliding plasty of residual valve tissue and bicuspid valve formation with construction of a new commissure, and consecutive ring annuloplasty in all patients.

Results: There were no perioperative deaths. Late mortality was 0% for patients with TV reconstruction and 25% (n = 1) in the TV replacement group. At the latest follow-up (78% complete; mean, 53 +/- 18 months), 11 patients had no recurrent TV incompetence. Three patients presented with TV incompetence grade I or II. Two patients with TV reconstruction had recurrent TV endocarditis between 3 and 18 month postoperatively, including new vegetations in both patients and an additional pleural empyema in one. In all cases, conservative treatment was successful and no reoperation was required.

Conclusions: The results of our study clearly demonstrate that in patients with severe TV endocarditis, complex reconstructive techniques yield excellent midterm results with regard to freedom of recurrence of endocarditis and valvular competence and should be considered as the primary surgical option in these patients. Tricuspid valve replacement should only be performed in cases of severe TV destruction that renders reconstructive techniques impossible.
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http://dx.doi.org/10.1016/j.athoracsur.2007.04.116DOI Listing
December 2007

In vivo microdialysis to measure antibiotic penetration into soft tissue during cardiac surgery.

Ann Thorac Surg 2007 Nov;84(5):1605-10

Department of Cardiothoracic Anesthesia and Intensive Care Medicine, University of Vienna, General Hospital, Vienna, Austria.

Background: Wound infections remain an important problem after cardiac surgery despite antimicrobial prophylaxis, causing increased mortality, morbidity, and costs. Penetration properties of antibiotics are altered by extracorporeal circulation, fluid resuscitation, surgery, and postoperative treatment measures. So far, interstitial antibiotic concentration has not been measured continuously during surgery. It remains uncertain whether the concentration of the prophylactic antibiotic is sufficient in interstitial tissue. Therefore, we measured interstitial concentrations of cefazolin in vivo during cardiac surgery.

Methods: Seven patients undergoing aortic valve replacement were studied in this prospective, observational, pharmacokinetic study. Cefazolin, 4 g, was administered before skin incision and additionally 2 g during skin closure. Microdialysis, an in vivo approach, was used to measure unbound interstitial drug concentrations.

Results: Cefazolin plasma concentration rose to a peak of 443 microg/mL (range, 169 to 802 microg/mL) within 20 minutes (range, 20 to 40 minutes). The maximum of interstitial concentration of cefazolin was observed within 60 minutes after antibiotic administration. Cefazolin tissue levels exceeded minimum inhibitory concentration values for most potential wound pathogens for more than 600 minutes after infusion. The maximum drug concentration of cefazolin in subcutaneous interstitial fluid was 22.6% of maximum plasma levels, comparable with 19.4% in muscular tissue.

Conclusions: Cefazolin, administered in the high dose used at our institution, is effective for prevention against infection with the most prevalent pathogens during and immediately after cardiac surgery. Additionally, our data show that it is important to reevaluate clinical dosing schemas by means of direct in vivo measurements.
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http://dx.doi.org/10.1016/j.athoracsur.2007.06.052DOI Listing
November 2007

Atrial function after ablation procedure in patients with chronic atrial fibrillation using steady-state free precession magnetic resonance imaging.

Ann Thorac Surg 2007 Nov;84(5):1600-4

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: Surgical ablation procedures are an established surgical procedure for restoration of sinus rhythm and reestablishment of atrial function in patients with chronic atrial fibrillation. The purpose of this study was to evaluate the feasibility and reproducibility of steady-state free precession magnetic resonance imaging (SSFP MRI) for examination of atrial dimensions and function after ablation procedures.

Methods: Nineteen patients (mean age, 63.1 +/- 11.7 years) being at least six months after surgical ablation procedure, with stable sinus rhythm, were selected for the study. They underwent cardiac MRI. End-diastolic and end-systolic volumes were measured using Simpson's rule. The presence of visual contraction was visually assessed.

Results: In MRI evaluation mean end-diastolic volume of the right atrium and left atrium after an ablation procedure was 127 +/- 45 mL and 163 +/- 50 mL, respectively. Mean stroke volume was 23 +/- 15 mL and 26 +/- 12 mL for the right and left atrium. Mean ejection fraction of the right atrium was 0.19 +/- 0.14 and 0.17 +/- 0.1 for the left atrium. An atrial kick of both atria was observed in 8 of 19 (47%) patients. An atrial kick of only the right atrium was observed in an additional 13 of 19 (68%) patients.

Conclusions: The anticipated events after a surgical ablation procedure are the restoration of atrial contractility and the associated atrial kick, thereby enhancing cardiac output and decreasing the risk of thromboembolism. Evaluation of atrial function after an ablation procedure using SSFP MRI is feasible and allows a standardized documentation of postoperative atrial function, thus allowing evaluation of the surgical outcome in a reproducible way. Echocardiographic evaluation seems to underestimate the transport function of the atrium.
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http://dx.doi.org/10.1016/j.athoracsur.2007.05.063DOI Listing
November 2007

Permanent chronic atrial fibrillation: is pulmonary vein isolation alone enough?

Ann Thorac Surg 2007 Oct;84(4):1151-7; discussion 1157

Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.

Background: The efficacy of mere pulmonary vein isolation epicardially for the treatment of permanent chronic atrial fibrillation, in comparison with the left atrial endocardial maze procedure was evaluated.

Methods: Retrospective data collection and analysis toward the outcome of 72 consecutive patients who underwent left atrial maze procedures between January 2003 and December 2005 was performed. Surgical ablation was performed concomitantly with valve and (or) coronary procedures. Group I (n = 29) received an endocardial left atrial ablation using unipolar saline irrigated radiofrequency (Medtronic Cardioblate surgical ablation pen; Medtronic Inc, Minneapolis, MN). Group II (n = 43) received epicardial isolation of the pulmonary veins using bipolar saline irrigated radiofrequency (Medtronic Cardioblate). Follow-up included 24h electrocardiogram and echocardiography 6 and 12 months postoperatively.

Results: Mean follow-up was 19.5 +/- 1.0 months (17.7 +/- 19.5 months group I vs 20.6 +/- 1.1 months group II). Both groups were comparable with regard to duration of preoperative atrial fibrillation, European system for cardiac operative risk evaluation, left ventricular ejection fraction, aortic cross-clamp time, bypass time, intensive care unit and hospital stay (p > 0.05). No maze procedure-related mortality was observed. In group I, three patients required postoperative pacemaker implantation due to atrioventricular (AV) bloc, bradycardia, and sick sinus syndrome, respectively. In group II, five patients required postoperative pacemaker implantation (three AV bloc and two bradycardia). Freedom from atrial fibrillation at last follow-up was 85.7% and 58.5% in groups I and II, respectively (p = 0.016).

Conclusions: Pulmonary vein isolation alone seems to be insufficient in treating permanent chronic atrial fibrillation. In case of chronic permanent atrial fibrillation, left atrial endocardial maze, providing the connection lines to the mitral annulus and (or) between the pulmonary veins, seems to be mandatory.
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http://dx.doi.org/10.1016/j.athoracsur.2007.05.027DOI Listing
October 2007

Transapical minimally invasive aortic valve implantation: multicenter experience.

Circulation 2007 Sep;116(11 Suppl):I240-5

University Leipzig, Heartcenter, Department of Cardiac Surgery, Leipzig, Germany.

Background: To evaluate initial multicenter results with minimally invasive transapical aortic valve implantation (TAP-AVI) for high risk patients with aortic stenosis.

Methods And Results: TAP-AVI was performed via a small anterolateral minithoracotomy with or without femoro-femoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN THV, Edwards Lifesciences) was used. Fifty-nine consecutive patients (81+/-6 years, 44 female) were operated on from 02/06 until 10/06 at 4 centers using fluoroscopic and echocardiographic visualization. Average EuroSCORE predicted risk for mortality was 27+/-14%. TAP valve positioning was performed successfully in 53 patients, 4 required early conversion to sternotomy. Implantation (23-mm valves in 19 and 26-mm valves in 40 patients) was performed on the beating heart during brief periods of rapid ventricular pacing. Thirty-one patients were operated on without cardiopulmonary bypass. Neither coronary artery obstruction nor migration of the prosthesis was observed, and all valves had good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 26 patients (trace in 11, mild in 12, and severe in 3). Eight patients died in-hospital (13.6%) without any valve dysfunction. Actuarial survival was 75.7+/-5.9% at a follow-up interval of 110+/-77 days (range 1 to 255 days).

Conclusions: TAP-AVI can be performed safely with good early results in high risk patients. Long-term valve performance as well as broader based applications of this promising approach will need to be studied.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.106.677237DOI Listing
September 2007

The 3rd hand--a simple but useful tool for beating heart total endoscopic coronary bypass grafting (BH-TECAB).

Interact Cardiovasc Thorac Surg 2006 Oct 10;5(5):519-20. Epub 2006 Jul 10.

Department of Cardiothoracic Surgery, Medical University Vienna, Wäuahringer Gürtel 18-20, A-1090, Vienna, Austria.

The transition to totally endoscopic arterial bypass grafting (TECAB) by computer enhanced instrumentation systems brings the loss of an assisting hand for grasping the pedicle of the internal thoracic artery (ITA) and holding the threads, since only two robotic arms are positioned in the thoracic cavity. That is why exact planning of every step during surgery is mandatory. Especially the positioning of the IMA pedicle during beating heart procedures is imperative for friction-free workflow during the anastomosis. Stay sutures may partially overcome this problem. However, the pedicle hanging on stay sutures still tends to sway around, repositioning is limited. To aid in better workflow, we developed an easy-to-use and cheap holder for the IMA pedicle without the need of any additional port. By inserting a steel wire through the stabilizing system, the pedicle can be easily fixed onto it thus positioned and repositioned wherever it is needed during sewing the anastomosis.
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http://dx.doi.org/10.1510/icvts.2006.129700DOI Listing
October 2006

Vacuum assisted closure therapy for the treatment of sternal wound infections in neonates and small infants.

Interact Cardiovasc Thorac Surg 2006 Jun 1;5(3):285-8. Epub 2006 Mar 1.

Department of Cardiothoracic Surgery, Leitstelle 20A, AKH Vienna, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.

Sternal wound infections occur with an incidence between 0.4 and 5% in the adult as well as the pediatric population. However, in contrast to the adults, established treatment options do not exist in the pediatric population. We evaluated our preliminary results with 3 neonates, respectively, small infants (mean age 20.3+/-6 days) who underwent vacuum assisted closure (VAC) therapy for the treatment of sternal wound infections with the intention to enable secondary closure and preservation of the sternal bone. The mean VAC duration was 11.3 days, ranging from 10 to 12 days. After three dressing changes (every 48 to 72 h) the infection resolved and a secondary closure was feasible in all three patients. Isolated specimens were Candida albicans, Staphylococcus aureus and MRSA, respectively. These preliminary results show that VAC therapy is a promising alternative to the current treatment options available to neonates. Especially, the preservation of the sternal bone which enables normal thoracic cage stability and growth, is a clear advantage over the currently used muscle flaps.
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http://dx.doi.org/10.1510/icvts.2005.122424DOI Listing
June 2006

Fleece bound sealing prevents pleural adhesions.

Interact Cardiovasc Thorac Surg 2006 Jun 9;5(3):243-6. Epub 2006 Feb 9.

Department of Cardiothoracic Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.

This study assessed the value of haemostatic fleece (HF) in prevention of pleural adhesions in an experimental animal model. Forty rats were randomly assigned to four equal groups and underwent bilateral thoracotomy. In Group 1 standardized defects of 5 mm were generated in the visceral and the opposite parietal pleura without further coverage. In Group 2 a 5-mm piece of HF (TachoSil) was applied onto the intact pleura. In Group 3 a standardized pleural defect was completely covered by HF. The same kind of defect was only partially covered by HF in group 4 animals. Autopsy at 6 weeks (n=5, each group) revealed the fleece widely unchanged and covered by a smooth serous membrane. After 12 weeks (n=5, each group) the fleece had been completely resorbed. Histological studies revealed the area of the defect covered by regular mesothelium. In all animals pleural adhesions were detected only in the area without fleece coverage. In this experimental model HF prevented the development of pleural adhesions. This property may have clinical impact in patients with some probability of re-thoracotomy enabling to reduce the risk of pleural adhesions significantly.
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http://dx.doi.org/10.1510/icvts.2005.121129DOI Listing
June 2006

A conclusion from the first 125 patients treated with the vacuum assisted closure system for postoperative sternal wound infection.

Interact Cardiovasc Thorac Surg 2006 Apr 16;5(2):145-8. Epub 2006 Jan 16.

Department of Cardiothoracic Surgery, Medical University of Vienna, Leitstelle 20A, AKH Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.

Consensus exists that early recognition of sternal wound infection is crucial to prevent involvement and destruction of the sternal bone, which prohibits secondary sternal closure and necessitates the use of muscle flaps for wound closure. Since November 2001 to September 2005, 125 patients received a VAC system after surgical debridement. Thirty-eight patients had a superficial infection (2A) and 87 patients had a deep infection (2B). From those, 59 patients underwent secondary sternal closure after VAC therapy, whereas 28 patients needed muscle flap closure. The time of diagnosis of sternal infection had great impact on the outcome. It was made on POD 10.6+/-8.3 in the 2A group, and on POD 13.2+/-11.1 in the 2B group. In the patients from Group 2A who had a recurrence of infection, the initial diagnosis of infection was made on POD 13.1+/-11.1. In patients where an SC was possible the time of diagnosis was on POD 11.1+/-6.6 whereas POD 17.7+/-16.2 in the MF group. The key to successful management of sternal wound infection is early recognition and aggressive treatment with reopening of the entire wound and sternum, which seems mandatory to achieve a low recurrence rate.
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http://dx.doi.org/10.1510/icvts.2005.122804DOI Listing
April 2006

Intraoperative iatrogenic type A aortic dissection and perioperative outcome.

Interact Cardiovasc Thorac Surg 2006 Feb 28;5(1):11-4. Epub 2005 Oct 28.

Department of Cardiothoracic Surgery, Medical University of Vienna, Leitstelle 20A, Währinger Gürtel 18-20, 1090 Vienna, Austria.

We assessed the risks and causative mechanisms of intraoperative iatrogenic aortic dissection type A. During a 3-year period (2002-2004) with 3000 open heart cases, 7 patients sustained an intraoperative aortic dissection type A, resulting in an incidence of 0.23%. The original procedures were mitral valve replacement in 3 patients, aorto coronary bypass surgery in 2 patients, ascending aortic replacement with aortic valve replacement and single lung transplantation with ECMO support in 1 patient each. Dissection occurred during aortic cannulation or decannulation in 3 patients, during insertion of the antegrade cardioplegia line in 1 patient, during manipulation of the aortic cannula in 1 patient and through direct cannulation of the axillary artery in 1 patient, and during femoral artery cannulation in 1 patient. Replacement of the ascending aorta with resection of the entry side was successfully performed in all 7 patients (median OT time 387 min, ECC 192 min, ACC 101 min, CA 25 min). Patients with iatrogenic aortic dissection have an increased mortality rate and risk factors for bad outcome are as follows: a mean aortic pressure of less than 50 mmHg during the change of arterial cannulation site, advanced age and the time of diagnosis of the dissection.
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http://dx.doi.org/10.1510/icvts.2005.114900DOI Listing
February 2006

Triclosan-coated sutures for the reduction of sternal wound infections: economic considerations.

Ann Thorac Surg 2007 Jul;84(1):232-6

Department of Cardiothoracic Surgery, AKH Vienna, Medical University of Vienna, Vienna, Austria.

Background: Sternal wound infections are a major complication after cardiac surgery in terms of morbidity and cost increase. To decrease the incidence of infection, we evaluated triclosan-coated sutures for the closure of the sternal incision, as it is known that most of the surgical site infections are related to the incision site.

Methods: From May to December 2005, a total of 479 patients underwent a cardiac surgical procedure. From those, 103 patients were closed with triclosan-coated suture material (cost per patient $30 [in United States dollars]), whereas the remaining 376 patients had their incision closed with noncoated sutures (cost per patient $21).

Results: During the study period, 24 patients had superficial (n = 10) or deep (n = 14) sternal wound infections (cost per patient $11,200). All those patients were closed with conventional suture material. In the triclosan group, no wound infection or dehiscence was observed during hospital stay and follow-up visits.

Conclusions: Triclosan-coated sutures might be valuable in the reduction of sternal wound infections and avoid the suture being a risk factor for surgical site infections. The increased cost of the coated suture material has to be weighed against the enormous cost of sternal wound infections caused directly by the cost of care as well as indirectly through the loss of economic productivity.
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http://dx.doi.org/10.1016/j.athoracsur.2007.03.045DOI Listing
July 2007