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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2008.12.054 Byline: Katarzyna Januszewska, Edward Malec, Gerd Juchem, Ingo Kaczmarek, Ralf Sodian, Peter Uberfuhr, Bruno Reichart Abbreviations: CMV, cytomegalovirus; CPB, cardiopulmonary bypass; HLTX, heart-lung transplantation; MAPCA, major aortopulmonary collateral artery; PA+VSD, pulmonary atresia with ventricular septal defect Abstract: Heart-lung transplantation for patients with pulmonary atresia and ventricular septal defect is challenging. The aim of the study was to present a single-center experience with heart-lung transplantation in this difficult group of patients. Author Affiliation: Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany Article History: Received 12 September 2008; Revised 18 November 2008; Accepted 25 December 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2008.05.041 Byline: Calin Vicol, Diana Kellerer, Paraskevi Petrakopoulou, Ingo Kaczmarek, Peter Lamm, Bruno Reichart Abbreviations: AF, atrial fibrillation; ECG, electrocardiogram; NYHA, New York Heart Association Abstract: Microwave ablation has been reported as efficient for the surgical treatment of long-standing atrial fibrillation. However, the influence of ablation lesions on long-term results is not known. Author Affiliation: Department of Cardiac Surgery, GroAhadern Medical Center, Ludwig Maximilian University Munich, Munich, Germany Article History: Received 25 October 2007; Revised 22 February 2008; Accepted 9 May 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2005.11.017 Byline: Bettina Jungwirth (a), G. Burkhard Mackensen (a)(b), Manfred Blobner (a), Frauke Neff (d), Bruno Reichart (c), Eberhard F. Kochs (a), Georg Nollert (c) Abbreviations: CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest; MAP, mean arterial blood pressure; mHBT, modified hole board test Abstract: Neurodevelopmental impairments after repair of congenital heart disease with cardiopulmonary bypass and deep hypothermic circulatory arrest continue to affect the lives of children. To date, the preclinical investigation of cerebral injury mechanisms related to deep hypothermic circulatory arrest has been restricted to expensive, personnel-demanding, and cumbersome large-animal models without validated neuropsychologic assessment. We aimed to establish a rodent recovery model of deep hypothermic circulatory arrest to overcome these disadvantages. Author Affiliation: (a) Klinik fur Anaesthesiologie, Technische Universitat Munchen, Klinikum rechts der Isar, Munich, Germany (d) Institut fur Allgemeine Pathologie und Pathologische Anatomie, Technische Universitat Munchen, Klinikum rechts der Isar, Munich, Germany (b) Department of Anesthesiology, Duke University Medical Center, Durham, NC (c) Herzchirurgische Klinik im Klinikum GroAhadern, Ludwigs-Maximilian Universitat Munchen, Munich, Germany. Article History: Received 29 July 2005; Revised 27 October 2005; Accepted 8 November 2005 Article Note: (footnote) This work was supported in part by the Deutsche Forschungsgemeinschaft (NO 344/3-1).

Byline: Hermann Reichenspurner (a), Jose A. Navia (b), Gerald Berry (c), Robert C. Robbins (c), Denise Barbut (d), Jeffrey P. Gold (d), Bruno Reichart (a) Abstract: Objective: Particulate embolization is associated with neurologic morbidity after cardiac surgery. Crossclamp manipulation has been identified as the single most significant cause of particulate emboli release during cardiac surgery. A new intra-aortic filtration method has been assessed with regard to its safety and its ability to capture particulate emboli before they enter the central circulation. Methods: Patients undergoing cardiac surgery with cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intra-aortic filtration. A novel intra-aortic filter device was inserted through a modified 24F arterial cannula immediately before releasing the crossclamp in 77 patients. Filters remained in the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effect on routine cardiopulmonary bypass operation and function. Results: The insertion and removal of the intra-aortic filter were safe, easy, and uneventful in most patients. Patient hemodynamics and bypass flow rates remained normal throughout the filter dwell period. No strokes or gross neurologic defects were noted. Electron microscopic analysis of 12 filters revealed an insignificant degree of platelet adhesion on filter surfaces. Histology samples (n = 44) were examined, and 66% (n = 29) showed evidence of atheromatous material, 36% (n = 16) with platelet-fibrin, 25% (n = 11) with true thrombus and/or blood clot, 7% (n = 3) with normal vessel wall, and 2% (n = 1) with aggregates of cholesterol or grumous portion of atheromatous plaque. Conclusion: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined. (J Thorac Cardiovasc Surg 2000;119:233-41) Author Affiliation: (a) University Hospital Munich-Grosshadern, Munich, Germany (b) Italian Hospital of Buenos Aires, Buenos Aires, Argentina (c) Stanford University Medical Center, Stanford, Calif (d) Cornell University Medical College, New York, NY. Article History: Received 22 April 1999; Revised 7 July 1999; Revised 14 October 1999; Accepted 14 October 1999 Article Note: (footnote) [star] Drs Reichenspurner, Navia, Robbins, Gold, and Barbut serve as clinical consultants to Embol-X, Inc., [star][star] Read at the Seventy-ninth Annual Meeting of The American Association for Thoracic Surgery, New Orleans, La, April 18-21, 1999., a Address for reprints: Hermann Reichenspurner, MD, PhD, Department of Cardiac Surgery, University Hospital Grosshadern, Marchioninistrasse 15, Munich, Germany D-81377 (E-mail: hcr@hch.med.uni-muenchen.de) ., aa 0022-5223/2000 $12.00 + 0 12/6/103733

Study objective: Arterial thermal dye dilution (TDDart) with the COLD system (Munich, Germany) allows measurement of cardiac index (CI), partial blood volumes, lung water, and liver function. The aim of [...]

Byline: Herbert Vetter, Andreas Nerlich, Ulrich Welsch, Kangxiong Liao, Andreas Dagge, Christine Strenkert, Bruno Reichart Abstract: Mitral valves, including the papillary muscles, were harvested from freshly slaughtered sheep and implanted in 10 recipient growing sheep. A strip of ovine pericardium was used to reinforce the anulus and a patch of expanded polytetrafluoroethylene was used to cover the donor papillary muscle. In four valves the natural chordae tendineae at the anterior cusp were supported by two pairs of 5-0 expanded polytetrafluoroethylene sutures. At the beginning of the experiment two animals died early of valve incompetence. Another animal had to be put to death because of paraplegia after extracorporeal circulation and one died on postoperative day 41 of endocarditis. Six sheep were electively put to death, five after 153 [+ or -] 8 days and one after 43 days. At the time of follow-up, a complete hemodynamic study including echocardiography and stress testing was performed. Heart rate at rest was 91 [+ or -] 14 beats/min, left ventricular systolic pressure 96 [+ or -] 20 mm Hg, left ventricular end-diastolic pressure 11 [+ or -] 5 mm Hg, cardiac output 2.04 [+ or -] 0.40 L/min, and the mean transvalvular pressure gradient was 4.9 [+ or -] 2.8 mm Hg as measured by cardiac catheterization. Echocardiography showed excellent movement of all valve components. However, minor regurgitation was evident in one case. Gross morphologic characteristics showed good healing at the anulus and host papillary muscle; in one case there was a rupture of one small first-order chorda. On radiography no signs of calcification were evident. Light microscopy revealed minor to moderate collagen degeneration in all valve components. However, on electron microscopy the presence of numerous fibroblasts within the long-term implants indicated the biosynthesis of new collagen. In summary, allograft mitral valve replacement seems to be a promising procedure if the chordae tendineae are reinforced by expanded polytetrafluoroethylene sutures. (J THORAC CARDIOVASC SURG 1996;111:595-604) Article History: Received 28 December 1994; Accepted 31 May 1995 Article Note: (footnote) [star] From the Departments of Cardiac Surgery,a Pathology,b and Anatomy,c Ludwig-Maximilians University, Munich, Germany, and the Cardiothoracic Research Laboratory,d The Albert Einstein College of Medicine of Yeshiva University, Bronx, N.Y., [star][star] Supported by a grant from the Deutsche Stiftung fur Herzforschung, Frankfurt, Germany., a Address for reprints: Herbert Vetter, MD, Department of Cardiac Surgery, University of Munich, Herzklinik Augustinum, Wolkerweg 16, 81375 Munich, Germany., aa 0022-5223/96 $5.00 + 0, acents 12/1/66607

Patients who undergo heart surgery may require extracorporeal circulation, a method of oxygenating the blood in which venous blood is diverted outside the body to a heart-lung machine for oxygenation and then returned to the body. Patients who undergo this surgery receive a massive insult to their immune system as a result of the combination of tissue injury, blood transfusions, and inflammation-like state affecting the entire body from the contact between blood and foreign material. These patients have an increased susceptibility to infection. A prospective study was undertaken of 60 patients who were undergoing open heart surgery. Combination therapy with thymopentin and indomethacin was aimed at restoring the patient's immune potential. Immunologic studies were performed prior to surgery. Twenty patients received indomethacin only; 20 received both indomethacin and thymopentin; and 20 patients represented a control group, receiving no immunologic treatment. Significant restoration of immune suppression was achieved in the group that received both indomethacin and thymopentin. Patients receiving combination therapy showed restoration of impaired expression of T-cell receptors, proliferation of lymphocytes, and synthesis of interleukin-2 (a cytokine that stimulates the growth of T-cells). It is concluded that combination therapy with indomethacin and thymopentin is more effective than indomethacin alone in preserving and/or restoring immune potential as defined as intact monocyte T-cell interaction. This approach may be useful in maintaining normal immune system defenses in injured or traumatized patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.12.072 Byline: Andres Beiras-Fernandez (a), Patrick Moehnle (b), Ingo Kaczmarek (a), Florian Weis (b), Bruno Reichart (a), Calin Vicol (a) Author Affiliation: (a) Department of Cardiac Surgery, Grosshadern University Hospital, Munich, Germany (b) Department of Anesthesiology, Grosshadern University Hospital, Munich, Germany Article History: Received 4 November 2007; Revised 20 December 2007; Accepted 22 December 2007

Synthetic vascular graft material does not perform as well as naturally endothelialized grafts. The innermost coat (tunica intima) of a blood vessel consists of a surface layer of endothelium, surrounded by a layer of connective tissue, and then an elastic layer. A method has been needed to create an endothelial lining for vascular prostheses. Recently, a quick and reliable culture technique was developed and shown to provide enough endothelial cells to line cardiovascular (heart vessel) grafts. This procedure involves detaching the endothelial layer of a small segment of a blood vessel using a collagenase solution. It was found that the best vessel from which to harvest endothelial cells was the external jugular vein in the neck, a nonessential vessel which can be easily accessed. Use of a microgrid technique allowed daily assessment of the amount of endothelium available to be sure there would be a sufficient quantity to line the chosen prosthesis. This technique was applied to 124 cultures from baboons and 13 cultures from humans; there was no difference in endothelial cell growth behavior between the two groups. It was found that, by applying this technique, sufficient endothelial cells were obtained after 26.2 days to line long vascular prostheses, such as might be used for aortocoronary bypass grafting. (Consumer Summary produced by Reliance Medical Information, Inc.)

Byline: Peter Lamm, Gerd Juchem, Peter Weyrich c, Stephan Nees, Bruno Reichart Abstract: J Thorac Cardiovasc Surg 1999;117:1217-9 Author Affiliation: Munich, Germany From the Departments of Cardiac Surgery.sup.a and Anesthesiology,.sup.b Klinikum GroAhadern, and the Department of Physiology,.sup.c Ludwig-Maximilians-Universitat Munchen, Munich, Germany Article History: Received 4 December 1998; Accepted 20 January 1999 Article Note: (footnote) [star] Address for reprints: Peter Lamm, MD, Herzklinik der Universitat Munchen am Augustinum, Wolkerweg 16, 81375 Munich, Germany., [star][star] 12/54/97380

Study objectives: A transpulmonary thermal-dye dilution (TDD) technique using cold indocyanine green dye was utilized to monitor cardiac index (CI) and preload in patients after heart transplantation. Preload, determined by [...]

Influence of Cardiac Allograft Vasculopathy Study objective: The reduced exercise capacity observed in most patients after heart transplantation may be due to treatment with immunosuppressive drugs, deconditioning, cardiac denervation, and [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2009.05.019 Byline: Michael Schmoeckel (a), Peter Boekstegers (b), Konstantin Nikolaou (c), Bruno Reichart (a) Author Affiliation: (a) Department of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany (b) Department of Internal Medicine I, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany (c) Department of Radiology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany Article History: Received 4 May 2009; Accepted 17 May 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2005.04.013 Byline: Helmut Mair, Ingo Kaczmarek, Martin Oberhoffer, Jan Groetzner, Sabine Daebritz, Bruno Reichart Author Affiliation: Department of Cardiac Surgery, University of Munich, Munich, Germany Article History: Received 24 March 2005; Accepted 11 April 2005

Byline: Hermann Reichenspurner, Dieter H. Boehm, Helmut Gulbins, Christian Detter, Ralph Damiano, Michael Mack, Bruno Reichart Author Affiliation: Department of Cardiac Surgery, University Hospital Grosshadern, Munich, Germany Article History: Received 23 June 1999; Accepted 27 July 1999 Article Note: (footnote) [star] Address for reprints: Hermann Reichenspurner, MD, PhD, Department of Cardiac Surgery, University Hospital Grosshadern, Marchioninistr 15, D-81377 Munich, Germany (E-mail: hcr@hch.med.uni-muenchen.de )., [star][star] J Thorac Cardiovasc Surg 1999;118:960-1, a 0022-5223/99 $8.00 + 0 12/54/101738