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Background To minimize the surgical damage, minimally invasive mitral valve surgery (MIMVS) has become the therapy of choice. However, this approach is technically more challenging, especially in endocarditis. The data on MIMVS in endocarditis are scarce, we therefore retrospectively analyzed the result at our institute. Methods From January 2011 and July 2017, 420 MIMVS were performed, out of which 44 (10%) were for endocarditis. Mean age was 55 ± 17 years and 41% (n = 18) were male. Results Euroscore II was 7.3 (range: 2–38). Operation times, cardiopulmonary bypass times, and clamp times were 230 (±77), 158 (±56), and 84 (±39) minutes, respectively. Seven cases (16%) were cardiac redo operations. Mitral valve repair and replacement was performed in 46 (n = 20) and 54% (n = 24) of patients, respectively. Overall in-hospital mortality, apoplexy, and reoperation rates (all for bleeding) were 7 (n = 3), 0 (n = 0), and 11% (n = 5), respectively. New onset of dialysis was required in three patients (7%). No patient developed superficial wound infection. Overall intensive care unit and hospital stay was 3 (±3) and 24 (±32) days, respectively. Conclusion MIMVS can be performed with acceptable outcome and low perioperative morbidity in patients with mitral valve endocarditis. Especially absence of any postoperative wound infections and low rate of endocarditis recurrence; use of MIMVS must be encouraged as an eligible approach in most cases.

Background Right ventricular failure is a life-threatening postoperative complication after pericardiectomy. We conducted a retrospective study with a special emphasis on right ventricular failure. Methods Between June 1997 and September 2011, 69 patients underwent surgical pericardiectomy at our center. Mean age was 59 ( ± 15.5) years, and 49 (71%) patients were male. Causes of constrictive pericarditis included idiopathic (52%, n = 36), tuberculosis (9%, n = 6), postcardiotomy (12%, n = 8), radiation (4%, n = 3), renal insufficiency (12%, n = 8), and autoimmune disease (12%, n = 8). Concomitant cardiac surgery was performed in 33 (48%) patients. Results In-hospital mortality rate was 14% (10/69 patients). Extracorporeal membrane oxygenation (ECMO) was necessary in 8 (12%) cases because of right (n = 7) or biventricular (n = 1) failure. Statistical analysis showed a significant correlation between early mortality and the following preoperative variables: postcardiotomy (p = 0.049), radiation (p = 0.009), pleural effusion (p = 0.012), ascites (p = 0.039), hepatic congestion (p = 0.023), absence of calcification on X-ray (p = 0.041), tricuspid valve insufficiency (TI, p Conclusion We recommend nondelayed ECMO support in case of significant postoperative right-sided heart failure. High-risk patients might benefit from elective pre- or intraoperative ECMO implantation.

s S17 O2 and transported to an operating room. A detailed medical/social donor history was obtained by our OPO. Lungs were flushed antegrade with cold PerfadexTM (containing Alprostadil and heparin) and retrograde. Lungs were evaluated for transplant suitability with EVLP (XVIVOTM) for 4 hours. PostEVLP spiral CT scans were obtained. Consented recipients receive whichever lung becomes available first based on blood type, LAS, and size. Lung availability is a random event. Primary outcome measures are 72 hour PGD score and survival at 30 days & 1 year. Results: EMS identified __ potential NHBDs for lung retrieval. ___ donor lungs were evaluated by EVLP. As of March 10, 2014 ___ have been transplanted with conv donors, and ___ with uDCDDs. Data and outcomes will be updated March 10, 2014. Conclusion: LTX from Cat 1 & 2 uDCDDs may provide large numbers of lungs for transplant.

Introduction: Lymphangioleiomyomatosis (LAM) is a rare disease in women leading to progressive deterioration of lung function and respiratory failure. Here, we describe the outcome of patients with end stage LAM who underwent lung transplantation at our centre. Patients and methods: We conducted a retrospective study of 20 patients who underwent lung transplantation for end-stage LAM between 11/96 and 10/12. Analyses included demographic parameters (e.g. age, survival) as well as surgical approach, use of ECC, operation and ICU time etc. Results: Out of as total of more than 1237 double/single lung transplantations during the period of analysis, one single and 19 bilateral lung transplants were performed in 20 patients with LAM. All patients were women with a mean age of 50 years. The mean cold ischemia time was 376.5 ± 136.5 minutes. 30 day survival was 100%. Four late deaths occurred due to chronic graft dysfunction (1), sepsis (1), airway stenosis (1) and CMV pneumonitis (1). The actuarial survival in the LAM group was 92% at 1 year, 69% at 3 years and 69% at 5 years compared to an overall survival of 77%, 69% and 61% after LTx for other indications. Conclusions: LTx in patients with end-stage pulmonary LAM yields equivalent results to patients with lung transplantation for other indications. While there are no prospective data on survival in LAM patients, lung transplantation improves quality of life and very likely increases survival in patients with end-stage LAM.

The allocation of donor lungs for transplantation has changed in December 2011. The new lung allocation score (LAS) bestows lung transplantation (LTX) candidates in more critical condition with an advantage, but also weighs the probability of survival after LTX. We follow up on LTX demographics and outcomes in the LAS era and compare them to the pre-LAS era. Methods: We evaluated the first 100 LTX performed in our centre in the LAS era and compare the characteristics to the last 100 LTX performed before LAS was introduced. Characteristics included LAS, underlying disease, 90 d survival, blood group and regular vs. rescue allocation. Results: In the LAS era, mean LAS in the regularly allocated cohort was 57.8 ± 24.4. Analyzed by blood group, patients with blood group 'A' received an organ with a mean LAS of 65.0 ± 23.7, whereas patients with blood group 'O' had a mean LAS of 54.6 ± 18.4. Patients with blood group 'B' had a LAS of 41.7 ± 8.4. Those patients receiving an organ via rescue allocation had significantly lower LAS in the most frequent blood groups: Blood Group 'A' 39.7 ± 17.9 (p < 0.0001), 'O' 40.3 ± 15 (p = 0.02). Patients with blood group 'B' did not have significantly different LAS (41.7 ± 8.4 vs. 34.7 ± 1.3, p = 0.21). Incidence of diseases of the patients receiving LTX has changed in the LAS era: Emphysema used to be a more frequent indication for LTX (31%), but decreased considerably (19%). In contrast, pulmonary fibrosis has become more frequent (Pre-LAS 24%, LAS 32%). Cystic Fibrosis increased (Pre-LAS 22%, LAS 26%), the incidence of pulmonary hypertension (10% vs. 9%) and other diseases remained stable. The 90 d-mortality before the LAS was introduced was 5%, it decreased to 3.7% in the LAS era. Before 12/2011, 43% of the donor lungs transplanted in our centre were offered via rescue allocation. After the LAS was implemented, this increased to 46%. Conclusion: The LAS has changed lung allocation, effectively excluding lung emphysema patients from regular allocation. Our data implies favourable post-transplant outcomes in the LAS era, while the overall impact on waiting list mortality still awaits clarification. The high rate of rescue allocation, however, may indicate an important problem. Attempting allocation of all organs towards the more critical ill patients disregards the common practise in lung LTX to divert extended criteria donor lungs towards more stable patients. Thus, regular offers might be declined and more organs have to undergo rescue allocation.

Objectives: In early 2010, we changed our standard for implementation of cardiopulmonary bypass in lung transplantation (LuTx). Before March 2010, standard cardiopulmonary bypass (CPB) was used after full heparinization (ACT >400s) and central cannulation in selected patients with severe pulmonary artery hypertension (PHT) or other important reasons for the use of CPB. After March 2010 all patients undergoing LuTx and fulfilling the same criteria received extracorporeal membrane oxygenation (ECMO) after single bolus injection of 5000 IE heparine and femoral arterial and venous transcutaneous cannulation. Here, we wished to analyze the impact of this change of strategy on outcome. Methods: Between 08/2008 and 02/2010, 43 consecutive patients underwent LuTx with CPB and thereafter 41 consecutive patients with ECMO. In 2009 (CPB era), 44.4% of all LuTx were performed on cardiocirculatory support. In the ECMO era, this percentage was 38.7%. Preoperatively, more ECMO than CPB patients had primary PHT (44 vs. 12%, p=0.002), were admitted to the intensive care unit (ICU) (34 vs. 12%, p=0.01), or already had ECMO support before surgery (29 vs. 12%, p=0.04). More ECMO than CPB patients underwent minimally invasive surgery (76 vs. 46%, p=0.006) and left the OR with running veno-arterial ECMO support (46 vs. 2%, p

Objective: Extracorporeal membrane oxygenation (ECMO) is a well-established treatment for severe cardiopulmonary failure. Due to the necessity of vascular access, patients undergoing ECMO-support are at risk of vascular complications (VC). Aim of this study was to review such complications in order to increase understanding of ECMO access techniques and outline basic technical principles. Methods: From 01/2005 to 12/2009, 180 patients underwent ECMO-support through cannulation of femoral vessels. Primary outcome were all observed VC. Secondary outcomes were 30-day mortality and one-year survival. A logistic regression analysis identified predictors of VC. Results: Arterial-venous mode was performed in 143 patients (78%) and veno-venous in 37 patients (22%). Arterial access was established percutaneously in 136 patients (95%) and by vessel exposure in 7 patients (5%). In 142 of cases (99%) requiring arterial access, an antegrade perfusion catheter was placed in femoral artery. Of the 17 observed VC (9%), 15 (88%) occurred in patients with arterial-venous access, whereas 2 (12%) occurred after veno-venous access. Two patients developing extremity ischemia, required limb amputation. Thirty-day mortality was 61% and 1-year survival rates were 28%. Peripheral vascular disease was a strong predictor of VC (OR: 7.19, 95%CI: 1.88 to 27.42, P=0.003), whereas implantation technique (open versus percutaneous) and ECMO duration were not. VC did not appear to be risk factors for early- or late mortality. Conclusions: The incidence of VC through femoral cannulation was low but still considerable. Open vascular exposure or alternative vascular access sites should be preferred in patients with pre-existing peripheral arterial occlusive disease.