97 results on '"Reichart, Bruno"'
Search Results
2. Heart-lung transplantation in patients with pulmonary atresia and ventricular septal defect
- Author
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Januszewska, Katarzyna, Malec, Edward, Juchem, Gerd, Kaczmarek, Ingo, Sodian, Ralf, Uberfuhr, Peter, and Reichart, Bruno
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Cardiac patients -- Care and treatment ,Pulmonary artery -- Atresia ,Pulmonary artery -- Care and treatment ,Health - Abstract
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
- Published
- 2009
3. Long-term results after ablation for long-standing atrial fibrillation concomitant to surgery for organic heart disease: Is microwave energy reliable?
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Vicol, Calin, Kellerer, Diana, Petrakopoulou, Paraskevi, Kaczmarek, Ingo, Lamm, Peter, and Reichart, Bruno
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Atrial fibrillation ,Health - Abstract
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
- Published
- 2008
4. Neurologic outcome after cardiopulmonary bypass with deep hypothermic circulatory arrest in rats: Description of a new model
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Jungwirth, Bettina, Mackensen, G. Burkhard, Blobner, Manfred, Neff, Frauke, Reichart, Bruno, Kochs, Eberhard F., and Nollert, Georg
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Coronary artery bypass ,Congenital heart disease ,Heart diseases ,Genetic disorders ,Health - Abstract
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).
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- 2006
5. Particulate emboli capture by an intra-aortic filter device during cardiac surgery
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Reichenspurner, Hermann, Navia, Jose A., Berry, Gerald, Robbins, Robert C., Barbut, Denise, Gold, Jeffrey P., and Reichart, Bruno
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Medical colleges -- Analysis ,Coronary artery bypass -- Analysis ,Air pollution -- Analysis ,Cardiac patients -- Analysis ,Surgery -- Analysis ,Health - Abstract
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
- Published
- 2000
6. Reproducibility of double indicator dilution measurements of intrathoracic blood volume compartments, extravascular lung water, and liver function
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Godje, Oliver, Peyerl, Marcus, Seebauer, Tobias, Dewald, Oliver, and Reichart, Bruno
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Cardiac output -- Measurement -- Physiological aspects ,Intensive care units -- Services -- Measurement -- Physiological aspects ,Hemodynamics -- Physiological aspects -- Measurement ,Health ,Physiological aspects ,Measurement ,Services - Abstract
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 [...]
- Published
- 1998
7. Total replacement of the mitral apparatus with a stentless, chordally supported mitral valve allograft: An experimental study
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Vetter, Herbert, Nerlich, Andreas, Welsch, Ulrich, Liao, Kangxiong, Dagge, Andreas, Strenkert, Christine, and Reichart, Bruno
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Heart valve diseases ,Transplantation of organs, tissues, etc. ,Health - Abstract
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
- Published
- 1996
8. Giant left atrial thrombus with mechanical compromise of the mitral valve
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Beiras-Fernandez, Andres, Moehnle, Patrick, Kaczmarek, Ingo, Weis, Florian, Reichart, Bruno, and Vicol, Calin
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Heart valve diseases ,Blood clot ,Thrombosis ,Health - Abstract
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
- Published
- 2008
9. In situ cannulation, microgrid follow-up and low-density plating provide first passage endothelial cell masscultures for in vitro lining
- Author
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Zilla, Peter, Fasol, Roland, Dudeck, Uta, Siedler, Susanne, Preiss, Petra, Fischlein, Teddy, Muller-Glauser, Werner, Baitella, Gaby, Sanan, David, Odell, John, and Reichart, Bruno
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Transplantation of organs, tissues, etc. -- Innovations ,Endothelium -- Health aspects ,Blood vessel prosthesis -- Complications ,Autografts -- Methods ,Health - Abstract
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.)
- Published
- 1990
10. Pig-to-non-human primate heart transplantation: The final step toward clinical xenotransplantation?
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Reichart, Bruno, Längin, Matthias, Radan, Julia, Mokelke, Maren, Buttgereit, Ines, Ying, Jiawei, Fresch, Ann Kathrin, Mayr, Tanja, Issl, Lara, Buchholz, Stefan, Michel, Sebastian, Ellgass, Reinhard, Mihalj, Maks, Egerer, Stefanie, Baehr, Andrea, Kessler, Barbara, Kemter, Elisabeth, Kurome, Mayuko, Zakhartchenko, Valeri, and Steen, Stig
- Subjects
- *
HEART transplantation , *XENOTRANSPLANTATION , *LUNG transplantation , *THROMBOTIC thrombocytopenic purpura , *PRIMATES - Abstract
The demand for donated human hearts far exceeds the number available. Xenotransplantation of genetically modified porcine organs provides an alternative. In 2000, an Advisory Board of the International Society for Heart and Lung Transplantation set the benchmark for commencing clinical cardiac xenotransplantation as consistent 60% survival of non-human primates after life-supporting porcine heart transplantations. Recently, we reported the stepwise optimization of pig-to-baboon orthotopic cardiac xenotransplantation finally resulting in consistent success, with 4 recipients surviving 90 (n = 2), 182, and 195 days. Here, we report on 4 additional recipients, supporting the efficacy of our procedure. The first 2 additional recipients succumbed to porcine cytomegalovirus (PCMV) infections on Days 15 and 27, respectively. In 2 further experiments, PCMV infections were successfully avoided, and 3-months survival was achieved. Throughout all the long-term experiments, heart, liver, and renal functions remained within normal ranges. Post-mortem cardiac diameters were slightly increased when compared with that at the time of transplantation but with no detrimental effect. There were no signs of thrombotic microangiopathy. The current regimen enabled the prolonged survival and function of orthotopic cardiac xenografts in altogether 6 of 8 baboons, of which 4 were now added. These results exceed the threshold set by the Advisory Board of the International Society for Heart and Lung Transplantation. The results of our current and previous experimental cardiac xenotransplantations together fulfill for the first time the pre-clinical efficacy suggestions. PCMV-positive donor animals must be avoided. [ABSTRACT FROM AUTHOR]
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- 2020
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11. New alternative coronary bypass graft: First clinical experience with an autologous endothelialized cryopreserved allograft
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Lamm, Peter, Juchem, Gerd, C, Peter Weyrich, Nees, Stephan, and Reichart, Bruno
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Transplantation of organs, tissues, etc. ,Health - Abstract
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
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- 1999
12. Acquired Factor VIII Inhibitor and Cardiopulmonary Bypass.
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Längin, Matthias, Konrad, Mark, Reichart, Bruno, Bauer, Andreas, and Lison, Susanne
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- 2018
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13. Hemodynamic Monitoring by Double-Indicator Dilution Technique in Patients After Orthotopic Heart Transplantation(*)
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Goedje, Oliver, Seebauer, Tobias, Peyerl, Markus, Pfeiffer, Ulrich J., and Reichart, Bruno
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Hemodynamic monitoring -- Methods ,Heart -- Transplantation ,Health ,Methods - Abstract
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 [...]
- Published
- 2000
14. Lung Function and Cardiopulmonary Exercise Performance After Heart Transplantation(*)
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Schwaiblmair, Martin, von Scheidt, Wolfgang, Uberfuhr, Peter, Reichart, Bruno, and Vogelmeier, Claus
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Transplantation of organs, tissues, etc. -- Analysis ,Exercise tests -- Analysis ,Heart -- Transplantation ,Pulmonary gas exchange -- Analysis ,Health ,Analysis ,Complications and side effects - Abstract
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 [...]
- Published
- 1999
15. First successful transapical aortic valve implantation after aortic allograft replacement
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Schmoeckel, Michael, Boekstegers, Peter, Nikolaou, Konstantin, and Reichart, Bruno
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Heart valve diseases ,Transplantation of organs, tissues, etc. ,Health - Abstract
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
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- 2009
16. Surgicel Nu-Knit hemostat for bleeding control of fragile sternum
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Mair, Helmut, Kaczmarek, Ingo, Oberhoffer, Martin, Groetzner, Jan, Daebritz, Sabine, and Reichart, Bruno
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Health - Abstract
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
- Published
- 2005
17. Robotically assisted endoscopic coronary artery bypass procedures without cardiopulmonary bypass
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Reichenspurner, Hermann, Boehm, Dieter H., Gulbins, Helmut, Detter, Christian, Damiano, Ralph, Mack, Michael, and Reichart, Bruno
- Subjects
Health - Abstract
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
- Published
- 1999
18. Use of Human Umbilical Cord Blood-Derived Progenitor Cells for Tissue-Engineered Heart Valves.
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Sodian, Ralf, Schaefermeier, Philipp, Abegg-Zips, Sybille, Kuebler, Wolfgang M., Shakibaei, Mehdi, Daebritz, Sabine, Ziegelmueller, Johannes, Schmitz, Christoph, and Reichart, Bruno
- Subjects
CORD blood ,TISSUE engineering ,HEART valves ,MYOFIBROBLASTS ,IMMUNOHISTOCHEMISTRY ,CONNECTIVE tissues ,CONGENITAL heart disease ,ENDOTHELIUM ,THERAPEUTICS - Abstract
Background: Tissue engineering of autologous heart valves with the potential to grow and to remodel represents a promising concept. Here we describe the use of cryopreserved umbilical cord blood-derived CD133
+ cells as a single cell source for the tissue engineering of heart valves. Methods: After expansion and differentiation of CD133+ cells, phenotypes were analyzed by immunohistochemistry and cryopreserved. Heart valve scaffolds fabricated from a biodegradable polymer (n = 8) were seeded with blood-derived myofibroblasts and subsequently coated with blood-derived endothelial cells. Afterward, the heart valve constructs were grown in a pulse duplicator system. Analysis of all heart valves, including histology, immunohistochemistry, electron microscopy, fluorescence imaging, and biochemical and biomechanical examination, was performed. Results: The tissue-engineered heart valves showed endothelialized layered tissue formation including connective tissue between the inside and the outside of the scaffold. The notion of an intact endothelial phenotype was substantiated by fluorescence imaging studies of cellular nitric oxide production and Ca2+ signaling. Electron microscopy showed that the cells had grown into the pores and formed a confluent tissue layer. Biochemical examination showed extracellular matrix formation (77% ± 9% collagen of human pulmonary leaflet tissue [HPLT], 85% ± 61% glycosaminoglycans of HPLT and 67% ± 17% elastin of HPLT). Conclusions: Importantly, this study demonstrates in vitro generation of viable human heart valves based on CD133+ cells derived from umbilical cord blood. These findings constitute a significant step forward in the development of new clinical strategies for the treatment of congenital defects. [Copyright &y& Elsevier]- Published
- 2010
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19. 3-Dimensional Printing of Models to Create Custom-Made Devices for Coil Embolization of an Anastomotic Leak After Aortic Arch Replacement.
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Sodian, Ralf, Schmauss, Daniel, Schmitz, Christoph, Bigdeli, Amir, Haeberle, Sandra, Schmoeckel, Michael, Markert, Matthias, Lueth, Tim, Freudenthal, Franz, Reichart, Bruno, and Kozlik-Feldmann, Rainer
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AORTA surgery ,THERAPEUTIC embolization ,HIV-positive persons ,FALSE aneurysms ,TOMOGRAPHY ,ARTERIAL occlusions - Abstract
Purpose: The objective of this study was to show the use of 3-dimensional printing models to fabricate a custom-made occluder for device embolization of an anastomotic leak after replacement of the ascending aorta and the aortic arch in a human immunodeficiency virus (HIV)-infected patient. Description: We present a 50-year-old HIV-infected patient who underwent ascending aorta and aortic arch replacement for a type A dissection, and who had an aortic arch pseudoaneurysm (sized 5 × 5 × 4 cm) with a slit-shaped entrance hole located anteriorly to the implanted supra-aortic vessels. The patient''s 128-slice computed tomography data were visualized and reconstructed. Afterward we fabricated a life-like replica of the complex pathology of the ascending aorta and the aortic arch using a rapid prototyping machine. After careful examination of the model, we fabricated a custom-made occluder device for interventional closure of the leakage. Evaluation: Using data derived from 128-slid computed tomography linked to proprietary software, we were able to create models of the ascending aorta, the aortic arch end, especially the pseudoaneurysm with its slit-shaped opening between the aortic lumen and the aneurysm. This was very helpful to build a perfectly fitting custom-made occluder device to plan and simulate the interventional closure. Moreover, the models were helpful for intra-interventional orientation. Conclusions: The stereolithographic replicas were extremely useful for choosing the treatment option and for planning and simulating the occlusion of the pseudoaneurysm. Furthermore, the models were necessary for our engineers who were building the custom-made occluder device. [Copyright &y& Elsevier]
- Published
- 2009
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20. Three-Dimensional Printing Creates Models for Surgical Planning of Aortic Valve Replacement After Previous Coronary Bypass Grafting.
- Author
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Sodian, Ralf, Schmauss, Daniel, Markert, Mathias, Weber, Stefan, Nikolaou, Konstantin, Haeberle, Sandra, Vogt, Ferdinand, Vicol, Calin, Lueth, Tim, Reichart, Bruno, and Schmitz, Christoph
- Subjects
PLANT propagation ,TOMOGRAPHY ,CORONARY artery bypass ,NEW product development - Abstract
Purpose: Resternotomy for aortic valve replacement in patients with previous coronary artery bypass grafting and an internal mammary artery graft may be a surgical problem. Thus, we are exploring the effect of using rapid prototyping techniques for surgical planning and intraoperative orientation during aortic valve replacement after previous coronary artery bypass grafting (CABG). Description: As a proof of concept, we studied a patient who had undergone CABG 5 years earlier. At that time the patient received a left internal mammary artery graft to the left anterior descending artery and a venous graft to the right coronary artery. Now the patient required aortic valve replacement due to symptomatic aortic valve stenosis. The left internal mammary artery bypass and the right coronary artery bypass were patent and showed good flow in the angiography. The patient was examined by 128-slice computed tomography. The image data were visualized and reconstructed. Afterwards, a replica showing the anatomic structures was fabricated using a rapid prototyping machine. Evaluation: Using data derived from 128-slice computed tomography angiography linked to proprietary software, we were able to create three-dimensional reconstructions of the vascular anatomy after the previous CABG. The models were sterilized and taken to the operating theatre for orientation during the surgical procedure. Conclusions: Stereolithographic replicas are helpful for choosing treatment strategies in surgical planning and for intraoperative orientation during reoperations of patients with previous CABG. [Copyright &y& Elsevier]
- Published
- 2008
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21. Stereolithographic Models for Surgical Planning in Congenital Heart Surgery.
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Sodian, Ralf, Weber, Stefan, Markert, Mathias, Rassoulian, Darius, Kaczmarek, Ingo, Lueth, Tim C., Reichart, Bruno, and Daebritz, Sabine
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CARDIAC surgery ,CONGENITAL heart disease ,RAPID prototyping ,MAGNETIC resonance imaging - Abstract
Purpose: Currently we are exploring the impact of using rapid prototyping techniques for surgical planning and intraoperative orientation during the correction of complex congenital malformation. Description: We studied a patient with a left abnormal subclavian artery and right descending aorta as a rare cause of dyspnea and dysphagia. The patient was examined by magnetic resonance imaging angiography. The image data were visualized and reconstructed. Afterward a replica of the malformation was fabricated using a rapid prototyping machine. In addition, a stereolithographic model of an intracardiac lesion (ventricular septal defect) was fabricated with data obtained from a computed tomographic scan. Evaluation: Using data derived from a magnetic resonance imaging angiography or computed tomographic scan linked to proprietary software, we were able to create three-dimensional reconstructions of complex vascular pathology and intracardiac lesions. In addition, we fabricated replicas of congenital malformations using a rapid prototyping machine. The models could be sterilized and taken to the operating room for orientation during the corrective surgical procedure. Conclusions: Stereolithographic replicas are helpful for choosing treatment strategies, surgical planning of corrections, and intraoperative orientation, and as demonstrations on life-like models for the patient. [Copyright &y& Elsevier]
- Published
- 2007
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22. Mid-Term Patency After Magnetic Coupling for Distal Bypass Anastomosis in Coronary Surgery.
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Vicol, Calin, Eifert, Sandra, Oberhoffer, Martin, Boekstegers, Peter, and Reichart, Bruno
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BLOOD vessels ,ARTERIES ,CORONARY arteries ,INTERNAL thoracic artery - Abstract
Background: The magnetic vascular positioner (MVP), a device for distal bypass anastomosis in coronary surgery, was developed to allow a simple and rapid procedure and to improve graft patency. We analyze our mid-term results with this device. Methods: Eighteen distal anastomoses were performed by using the MVP, and 18 with a hand-sewn technique were completed in 11 patients. The target arteries for the MVP anastomosis were the left anterior descending in 9 patients, a marginal branch in 4, a diagonal branch in 3, and right coronary artery in 2. The left internal thoracic artery was used as graft in 9 patients, saphenous vein in 6, right internal thoracic artery in 2, and radial artery in 1. Results: Coronary angiography was performed at discharge and after a complete follow-up of 19 ± 3.5 months. Patency at follow-up was 83.3% (15/18) for MVP anastomoses and 100% (18/18) for hand-sewn anastomoses. All occluded MVP anastomoses were performed with small-size devices. In one patient, a high-grade left main stenosis was overestimated. Competitive flow may be suspected in this case as a cause of graft occlusion. No deaths occurred during hospital stay or during follow-up. Freedom from reintervention was 100%. Conclusions: The MVP is the only mechanical connector for distal anastomoses applicable for all kind of grafts, for all coronary artery locations, and with both end-to-side and side-to-side technique. Mid-term patency of MVP anastomoses is acceptable but inferior to the patency of hand-sewn anastomoses. Occlusion of MVP supplied grafts may be produced by small device size. [Copyright &y& Elsevier]
- Published
- 2006
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23. Tissue Engineering of Autologous Human Heart Valves Using Cryopreserved Vascular Umbilical Cord Cells.
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Sodian, Ralf, Lueders, Cora, Kraemer, Liv, Kuebler, Wolfgang, Shakibaei, Mehdi, Reichart, Bruno, Daebritz, Sabine, and Hetzer, Roland
- Subjects
CARDIAC surgery patients ,COLLAGEN ,TISSUES ,IMMUNOHISTOCHEMISTRY - Abstract
Background: Tissue engineering of autologous heart valves with the potential to grow and to remodel represents a promising concept in pediatric cardiovascular surgery. Currently we are exploring the impact of cryopreserved human umbilical cord cells (CHUCCs) for the fabrication of tissue-engineered heart valves for patients diagnosed prenatally with congenital heart lesions, potentially enabling heart valve replacement in the early years of life. Methods: Human umbilical cord cells were isolated from vascular segments of umbilical cords and cryopreserved in a cell bank. After 12 weeks the cryopreserved cells were again expanded in culture and characterized by histology, immunohistochemistry, and proliferation assays. Trileaflet heart valve scaffolds were fabricated from a porous polymer (P4HB, Tepha Inc, Cambridge, MA) and sequentially seeded with CHUCCs (n = 10). Five of the heart valve constructs were grown for 7 days in a pulse duplicator and, as a control, five constructs were grown under static cell culture conditions for 7 days. Analysis of all tissue-engineered heart valves included histology, immunohistochemistry, electron microscopy, functional analysis, and biomechanical and biochemical examination. Results: We found that CHUCCs remained viable after 12 weeks of cryopreservation and showed a myofibroblast-like morphology that stained positive for α-actin and fibroblast specific marker. Histology of the tissue-engineered heart valves showed layered tissue formation, including connective tissue between the inside and the outside of the porous scaffold. Immunohistochemistry was positive for collagen (types I, III, and IV), desmin, laminin, and α-actin. Electron microscopy showed that the cells had grown into the pores and formed a confluent tissue layer during maturation in the pulsatile flow system. Biochemical examination showed an increase of extracellular matrix formation in constructs after pulsatile flow exposure compared with the static control group. Functional analysis demonstrated a physiological increase of the intracellular Ca
2+ concentration of the recultivated cells and the conditioned constructs after stimulation with histamine. Conclusions: This study demonstrates in vitro generation of viable and functional human heart valves based on CHUCCs and biomimetic flow culture systems. The CHUCCs demonstrated excellent growth potential and abilities of in vitro tissue formation. These findings suggest the potential benefit of establishing autologous human cell banks for pediatric patients diagnosed intrauterinely with congenital defects that will potentially require heart valve replacement in the early years of life. [Copyright &y& Elsevier]- Published
- 2006
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24. Successful Endothelialization of Porcine Glutaraldehyde-Fixed Aortic Valves in a Heterotopic Sheep Model.
- Author
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Gulbins, Helmut, Pritisanac, Anita, Pieper, Korbinian, Goldemund, Angelika, Meiser, Bruno M., Reichart, Bruno, and Daebritz, Sabine
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MYOFIBROBLASTS ,FIBROBLASTS ,AORTIC aneurysms ,AORTIC diseases ,HEART disease research ,CARDIAC research - Abstract
Purpose: The purpose of our study was to evalute the stability of an artificially seeded endothelial cell layer on porcine aortic prostheses under in vivo conditions in the arterial system. Description: Ten female sheep were divided into two groups. Animals of the study group (n = 7) had dissection of their right external jugular vein for cell harvesting. Myofibroblasts and endothelial cells were labelled with PKH-26, seeded onto pretreated (10% citric acid) porcine glutaraldehyde-fixed aortic valves (Freestyle, Medtronic Inc, Duesseldorf, Germany), and the valves were implanted into the descending aorta. Controls (n = 3) received pretreated but unseeded valves. A shunt between the aortic arch and the left atrial appendage ensured systolic or diastolic leaflet motions, or both, that were documented by sonography. After 3 months the valves were explanted. Specimens for scanning electron microscopy and immunohistochemical staining were taken prior to implantation and after explantation. Evaluation: A neointimal proliferation was detected in the control group. No endothelial cells were found on the leaflets and the sinuses, but erythrocytes and thrombocytes were seen entrapped within the collagen fibers. Thrombus formation was documented macroscopically and histologically on the leaflets and the sinuses. In the study group a confluent endothelial cell layer was documented on the walls and leaflets. Neither neointimal proliferation nor any clots were seen. Some cells were still labelled positively indicating their origin from the initial cell seeding. No dilatation of any prosthesis was observed, but all valves showed slight thickening of the leaflets. Conclusions: The artificially seeded endothelial cell layers remained stable under in vivo conditions in the arterial system. Biocompatibility of the prostheses seemed to be improved by reduction of thrombogenicity. [Copyright &y& Elsevier]
- Published
- 2006
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25. Miniaturized Cardiopulmonary Bypass in Coronary Artery Bypass Surgery: Marginal Impact on Inflammation and Coagulation but Loss of Safety Margins.
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Nollert, Georg, Schwabenland, Ina, Maktav, Deniz, Kur, Felix, Christ, Frank, Fraunberger, Peter, Reichart, Bruno, and Vicol, Calin
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CORONARY artery bypass ,CARDIAC surgery ,BLOOD coagulation factors ,CARDIOPULMONARY bypass - Abstract
Purpose: Inflammation and coagulation disturbances are common consequences of cardiopulmonary bypass (CPB). Recently, miniaturized closed CPB circuits without cardiotomy suction and venous reservoir have been proposed to reduce complication rates. We compared outcomes with conventional (CCPB) and miniaturized cardiopulmonary bypass (MCPB) after coronary artery bypass operations (CABG) with respect to inflammation and coagulation. Description: Thirty patients (23% female; aged 67.9 ± 9.0 years) were prospectively randomly assigned to undergo isolated CABG with CCPB or MCPB. Conventional CPB had a pump prime of 1, 600 mL. Miniaturized CPB consisted of a centrifugal pump, arterial filter, heparinized tubing, and oxygenator with a priming volume of 800 mL. Shed blood was removed by a cell-saving device and reinfused. Measurements included interleukin (IL)-2 receptor, IL-6, IL-10, tumor necrosis factor receptor 55 and 75, C reactive protein, leukocyte differentiation, d-dimers, fibrinogen, and thrombocytes at six time points. Evaluation: In both groups no major complication occurred. However, two dangerous air leaks occurred in the closed MCPB circuit, demonstrating the narrow safety margins. Operative handling was also more difficult owing to limitations in venting and fluid management. International normalized ratio (p = 0.03) and antithrombin III (p = 0.04) levels were elevated during CPB in the CCPB group, most likely owing to differences of the intraoperative anticoagulation management. Repeated measures analysis revealed that not a single parameter of inflammation or clinical outcome showed significant differences among groups. Conclusions: Use of a MCPB affected inflammation and coagulation variables only marginally and did not lead to clinical relevant changes as assessed by blood loss, need for blood products, and intensive care unit and clinical stays. However, safety margins for volume loss, air emboli, and weaning from CPB decrease, because of the closed MCPB circuit. [Copyright &y& Elsevier]
- Published
- 2005
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26. Seeding of Human Endothelial Cells on Valve Containing Aortic Mini-Roots: Development of a Seeding Device and Procedure.
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Gulbins, Helmut, Pritisanac, Anita, Uhlig, Antje, Goldemund, Angelika, Meiser, Bruno M., Reichart, Bruno, and Daebritz, Sabine
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ENDOTHELIAL seeding ,IMMUNOGLOBULINS ,COLLAGEN ,THROMBOEMBOLISM - Abstract
Purpose: Complete covering of an artificial valvular scaffold with endothelial cells may prevent thromboembolic complications and lead to an excellent biocompatibility. For this purpose, we developed a seeding device for reproducible cell seeding on valve containing aortic roots. Description: Human endothelial cells and fibroblasts were obtained from saphenous vein pieces. Cryopreserved aortic roots (n = 25) were put into an especially developed tube, set on a rotator, and incubated with the cell suspension. The device rotated in two axes (sagittal and axial), ensuring slight movements of the leaflets. The rotation alternated with resting periods, allowing cell attachment to the surface. Different resting periods were tested (groups 1, 2, and 3 were 30, 45, and 60 min, respectively; n = 5 each). Total incubation time was 24 hours followed by further culturing for 6 days. In two further groups (groups 4 and 5; n = 5 each), a modified inlay was used to allow the cell suspension to flow around the entire graft. In group 4 the grafts were again incubated with human endothelial cells; however, in group 5 pre-seeding with autologous fibroblasts was done in addition. Immunohistochemical staining with antibodies against factor VIII, CD31, laminin, collagen IV, and CD90 were done, and scanning electron microscopy was done after initial seeding and after 6 days in culture. Evaluation: Seeding resulted in homogenous cell layers on the luminal surface of the free walls in all groups. With resting periods of 45 minutes, these results were also obtained on the leaflets, whereas the other resting times resulted in defects of the endothelial cell layer on the cusps. After 6 days under culture conditions, the endothelial cell layers were confluent and viable, with the exception of the leaflets in group 1. With the modified inlay (groups 4 and 5), confluent cell layers were also achieved on the outer surface. In group 5 pre-seeding with autologous fibroblasts resulted in enhanced synthesis of extracellular matrix proteins, as was demonstrated with immunohistochemical staining for collagen IV and laminin. Conclusions: With this newly developed seeding device, confluent cell layers on valve containing aortic roots were reproducibly achieved. The technique enables further experimental research and even clinical application. [Copyright &y& Elsevier]
- Published
- 2005
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27. Early Clinical Results With a Magnetic Connector for Distal Coronary Artery Anastomoses.
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Vicol, Calin, Eifert, Sandra, Oberhoffer, Martin, Boekstegers, Peter, Knez, Andreas, Christ, Frank, and Reichart, Bruno
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ARTERIOVENOUS anastomosis ,CORONARY arteries ,MEDICAL equipment ,MAGNETIC devices - Abstract
Purpose: The main goals in the development of an anastomotic device are to reduce the invasiveness of the procedure and to improve graft patency. We analyze our preliminary clinical experience with the Ventrica magnetic vascular positioner (MVP) series 6000 system. Description: Eighteen distal anastomoses were performed in 11 patients using the MVP. Evaluation: The target artery for MVP was left anterior descending in 9 patients, a marginal branch in 4, the first diagonal branch in 3, and the right coronary artery in 2. Graft material was the left internal thoracic artery in 9 patients, saphenous vein in 6, the right internal thoracic artery in 2, and the radial artery in 1 case. Fifteen anastomoses were performed in an end-to-side and 3 in a side-to-side fashion. Predischarge angiography was performed in 10 of 11 patients. There was a patent MVP anastomosis in all patients. Conclusions: Distal anastomoses using the MVP were performed successfully in all patients. The procedure is simple. Short-term patency is excellent. Further randomized trials are necessary to determine long-term safety and patency. [Copyright &y& Elsevier]
- Published
- 2005
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28. First Clinical Experience With the HEARTSTRING, a Device for Proximal Anastomoses in Coronary Surgery.
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Vicol, Calin, Oberhoffer, Martin, Nollert, Georg, Eifert, Sandra, Boekstegers, Peter, Wintersperger, Bernd, and Reichart, Bruno
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ARTERIOVENOUS anastomosis ,CARDIAC surgery ,MYOCARDIAL revascularization ,MEDICAL equipment - Abstract
Purpose: The HEARTSTRING is a device designed to enable the creation of a clampless hand-sewn proximal anastomosis. Description: Seventy-six patients who underwent myocardial revascularization had 113 proximal anastomoses created by the HEARTSTRING. Fifty-five procedures were performed on cardiopulmonary bypass and 21, off pump. Evaluation: Of 114 intended proximal anastomoses, 113 (99.1%) were successfully performed using the HEARTSTRING. The conduits anastomosed proximal with support of the HEARTSTRING were in 92 cases saphenous veins and in 21 cases radial arteries. Mean time to perform a HEARTSTRING-supported anastomosis was 6.6 ± 1.2 minutes. One patient (1.3%) died postoperatively; the death was not device related. In 1 additional patient (1.3%), a stroke most likely due to air embolism occurred. Forty-nine patients (64.5%) underwent a predischarge coronary angiography (n = 20) or a contrast multislice computed tomography (n = 29). Of 76 grafts with a HEARTSTRING-supported proximal anastomosis, 74 (97.4%) were patent in these 49 patients. Conclusions: Our initial clinical experience with the HEARTSTRING demonstrates safety, reliability, and ease of use. Side clamping of the ascending aorta can be avoided, potentially decreasing the incidence of neurologic complications. [Copyright &y& Elsevier]
- Published
- 2005
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29. First Clinical Experience With the VSTENT: A Device for Direct Left Ventricle-to-Coronary Artery Bypass.
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Vicol, Calin, Reichart, Bruno, Eifert, Sandra, Raake, Philip, Hinkel, Rabea, Steinbeck, Gerhard, and Boekstegers, Peter
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CORONARY artery bypass ,MYOCARDIAL revascularization ,CARDIAC surgery patients ,HEART ventricles - Abstract
Background: Stent-based left ventricle-to-coronary artery stent (VSTENT) is a newly developed, alternative surgical revascularization procedure (VCAB). We present here our initial experience using this technique. Methods: Twelve patients (10 male and 2 female, mean age 61 ± 13 years) underwent a VCAB concomitant to coronary artery bypass surgery. Myocardial revascularization was performed on-pump with arrested heart in 4 patients, on-pump with beating heart in 6 patients, and off-pump in 2 patients. Average number of coronary anastomoses per patient was 2.4 ± 0.8. In all cases left internal thoracic artery-to-left anterior descending was used. In each patient only one VSTENT was implanted. Target artery for the VCAB was a diagonal branch in 5 patients, an intermediate branch in one patient and a marginal branch in 6 patients. Mean time for the VCAB was 23 ± 5 minutes (17 to 30 minutes). Results: An immediate procedural success was observed in 11 of 12 cases. In one case VCAB was not successful and conventional aortocoronary bypass was performed. One patient died on the second postoperative day due to a systemic inflammatory response syndrome. Autopsy demonstrated a patent VSTENT. Angiography was performed in 10 patients 2 to16 days (9 ± 5 days) postoperatively showing a patent VSTENT in 8 patients. Conclusions: The VCAB was feasible and potentially safe in the short-term postoperative follow-up, particularly with increasing experience after the first patients. Though the VSTENT is a promising tool for myocardial revascularization, long-term safety, patency, and performance of the device needs to be determined. [Copyright &y& Elsevier]
- Published
- 2005
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30. Video and Robotic-Assisted Minimally Invasive Mitral Valve Surgery: A Comparison of the Port-access and Transthoracic Clamp Techniques.
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Reichenspurner, Hermann, Detter, Christian, Deuse, Tobias, Boehm, Dieter H., Treede, Hendrik, and Reichart, Bruno
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CARDIAC surgery patients ,CARDIOPULMONARY bypass ,ARTIFICIAL blood circulation ,MECHANICAL hearts - Abstract
Background: In order to assess different surgical techniques for video-assisted minimally invasive mitral valve surgery, a retrospective study was undertaken comparing the Port-Access system (Cardiovations, Ethicon Inc, Somerville, NJ) and the transthoracic clamp technique. Methods: In 120 patients mitral valve surgery was performed through a small right minithoracotomy using either the Port-Access endovascular cardiopulmonary bypass system (Port-Access, n = 60) or the transthoracic clamp technique (MICRO, n = 60). Mean patient age was 61.5 ± 10.5 years (81 patients with isolated mitral valve insufficiency, 39 patients with combined mitral valve disease). Results: Eighty-one (67.5%) patients underwent mitral valve repair and 39 (32.5%) patients had valve replacement. Mean time of surgery was 4.5 ± 3.5 and 4.1 ± 3.2 hours (p = 0.07), aortic cross-clamp time 89 ± 69 and 78 ± 65 minutes (p = 0.08), mean intensive care unit stay 1.5 ± 2.1 and 1.6 ± 2.5 days (p = ns), and hospital stay 9.0 ± 10.5 and 9.2 ± 9.7 days (p = ns) in the Port-Access and MICRO groups, respectively. In the Port-Access group, there were 6 reexplorations for bleeding, one perforation of the right ventricle with the endopulmonary vent, and 2 reconstructions of the femoral artery necessary after femoral cannulation, compared to one reexploration for bleeding in the MICRO group. There was only one minor paravalvular leak after replacement and 2 cases of residual greater than or equal to grade II mitral valve regurgitation after mitral valve repair in the Port-Access group, necessitating reoperation. In both groups, there was no mortality, no cerebrovascular accident, no aortic dissection, and no conversion to sternotomy. Conclusions: Minimally invasive mitral valve surgery has become a standard approach for isolated mitral valve operations at our institution. The MICRO technique tends to shorten the time of surgery and aortic cross-clamping and reduces perioperative costs by simplifying the operative procedure. [Copyright &y& Elsevier]
- Published
- 2005
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31. Cardiac Transplantation in Pediatric Patients: Fifteen-Year Experience of a Single Center.
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Groetzner, Jan, Reichart, Bruno, Roemer, Ulrich, Reichel, Stefanie, Kozlik-Feldmann, Rainer, Tiete, Andreas, Sachweh, Joerg, Netz, Heinrich, and Daebritz, Sabine
- Subjects
HEART transplant recipients ,HEART transplantation ,MORTALITY ,CARDIAC surgery - Abstract
Background: Pediatric heart transplantation is a surgical therapy for dilated cardiomyopathy and for complex congenital heart defects with low pulmonary artery resistance. However, it is still discussed as controversial because of uncertain long-term results. We report our experience with pediatric heart transplantation in a heterogeneous population.Methods: Since 1988, 50 heart transplants were performed in 47 patients (30 with dilated cardiomyopathy, 17 with congenital heart disease). Mean age was 9.4 ± 6.9 years (range, 4 days to 17.9 years). Twenty-three patients had a total of 36 previous operations. Clinical outcome was evaluated retrospectively.Results: Perioperative mortality was 6% due to primary graft failure. Late mortality (12%) was caused by acute rejection (n = 2), pneumonia (n = 2), intracranial hemorrhage (n = 1), and suicide (n = 1). Mean follow-up was 5.24 ± 3.6 years. Actuarial 1, 5, and 10 year survival was 86%, 86%, and 80% and improved significantly after 1995 (92% [1 year]; 92% [5 years]). There was no significant difference between patients with dilated or congenital heart disease (1 year: 86% vs 82%; 5 years: 83% vs 74%; 10 years 83% vs 74%; p = 0.62). Three patients with therapy resistant acute or chronic rejection and assisted circulation underwent retransplantation and are alive. Freedom from acute rejection after 5 years was 40% with primary cyclosporine immunosuppression regime and 56% with tacrolimus. Since the introduction of mycophenolate mofetil, freedom from acute rejection increased to 62%. All survivors are at home and in good cardiac condition.Conclusions: Pediatric heart transplantation is the treatment of choice for end-stage dilated cardiomyopathy as for congenital heart disease with excellent clinical midterm results. It is a valid alternative to reconstructive surgery in borderline patients. However, further follow-up is necessary to evaluate the long-term side effects of immunosuppressants. [Copyright &y& Elsevier]
- Published
- 2005
- Full Text
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32. Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein conduit: a word of caution.
- Author
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Tiete, Andreas R., Sachweh, Jörg S., Roemer, Ulrich, Kozlik-Feldmann, Rainer, Reichart, Bruno, and Daebritz, Sabine H.
- Subjects
RIGHT heart ventricle ,PULMONARY blood vessels ,JUVENILE diseases ,POSTOPERATIVE care - Abstract
Background: Since introduction in 1999, pulmonary valve replacement in pediatric patients with the Contegra conduit (Medtronic Inc, Minneapolis, MN) has gained widespread application with increasing enthusiasm. However, unexpected graft related adverse effects may occur.Methods: Between April 2001 and December 2002, 29 patients (20 male; mean age, 3.39 ± 3.66 years; range, 0.01 to 13.0 years; mean weight, 11.62 ± 8.73 kg) underwent right ventricular outflow tract reconstruction with the Contegra conduit. Seventeen patients underwent primary repair, 8 had prior homografts, and 4 had other previous operations.Results: There were no deaths. Three early graft related complications were observed. In two infants (age, 1.8 and 3.5 months; weight, 3.6 and 3.8 kg, respectively) thrombus formation at the conduit valve was detected 2 weeks postoperatively. Under anticoagulation with low-molecular-weight heparin, thrombi resolved completely in both patients. One patient (4.5 months, 4.43 kg) developed severe regurgitation due to a fibrous layer covering the inner conduit wall and required conduit exchange 3 weeks postoperatively. After a mean follow-up time of 10.2 ± 6.4 months all patients are in good clinical condition. However, one patient with systemic right ventricular pressure developed pseudoaneurysm at both graft insertion sites and is scheduled for reoperation. Two other patients underwent balloon dilation. Freedom from reoperation and intervention at 1 year is 89.4%. With regard to regurgitation and conduit stenosis all other conduits perform well.Conclusions: Contegra conduits are an alternative to homografts for right ventricular outflow tract reconstruction. However, there is a risk of thrombus formation in small infants so that prophylactic anticoagulation may be necessary. Patients with systemic right ventricular pressure require close observation as pseudoaneurysm formation has been observed. [Copyright &y& Elsevier]
- Published
- 2004
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33. Risk factors for sudden death after repair of tetralogy of Fallot.
- Author
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Nollert, Georg D. A., Däbritz, Sabine H., Schmoeckel, Michael, Vicol, Calin, and Reichart, Bruno
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CARDIAC arrest ,TETRALOGY of Fallot ,HYPERTROPHY ,SUDDEN death - Abstract
: BackgroundSudden cardiac death remains the most common cause of death after repair of tetralogy of Fallot. It has been suggested that sudden cardiac death is related to right ventricular hypertrophy or dilation. However, it is uncertain whether the preoperative patient status or operative techniques predispose for sudden cardiac death.: MethodsFrom 1958 to 1977, 658 patients underwent repair of tetralogy of Fallot at our institution at a median age of 12.2 ± 8.6 years. One third had at least one previous palliative operation 4.6 ± 2.5 years earlier. A total of 490 patients survived the first postoperative year and were analyzed for sudden cardiac death. During a follow-up period of 25.3 ± 5.8 years (range, 1.0 to 35.5 years), 42 patients died, and 15 (36%) of those deaths were as a result of sudden cardiac death.: ResultsActuarial 10-year, 20-year, and 30-year survival rates were 97%, 94%, and 89%. Freedom from sudden cardiac death was 99%, 98%, and 95% after 10, 20, and 30 years. The risk of sudden cardiac death increased after 10 years from 0.06%/y to 0.20%/y. Univariate predictors (p < 0.1) of sudden cardiac death were use of an outflow tract patch (p = 0.068), male sex (p = 0.048), no previous palliation (p = 0.013), and higher preoperative New York Heart Association status (p = 0.014). Multivariate analysis confirmed these risk factors except use of an outflow tract patch.: ConclusionsThe most important risk factors for sudden cardiac death were higher preoperative New York Heart Association class and no previous palliation. Thus, early surgical intervention is recommended. The risk of sudden cardiac death increases with time, suggesting that long-term follow-up by specialized cardiologists or pediatricians should be intensified. However, all patients who died suddenly had at least two risk factors at the time of surgery. [Copyright &y& Elsevier]
- Published
- 2003
- Full Text
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34. Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease.
- Author
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Treede, Hendrik, Becker, Christoph, Reichenspurner, Hermann, Knez, Andreas, Detter, Christian, Reiser, Maximilian, and Reichart, Bruno
- Subjects
ANGIOGRAPHY ,MEDICAL radiography ,CORONARY disease ,DIAGNOSIS ,NERVE grafting ,TOMOGRAPHY - Abstract
: BackgroundSelective coronary angiography (SCA) is the standard invasive procedure for diagnosis in patients eligible for coronary artery bypass grafting (CABG). A recently developed, highly sensitive multidetector computed tomography (MDCT) scan holds promise to be of almost comparable quality and predictiveness. We examined a blinded series of preoperative patients who were admitted to hospital for conventional and minimally invasive CABG procedures. Patients underwent CT scans in addition to SCA; findings were compared regarding location and degree of coronary artery stenosis.: MethodsTwenty patients underwent electrocardiogram-gated helical CT scanning. Images with 250 ms effective exposure time were reconstructed with retrospective electrocardiogram gating. Location and degree of coronary stenoses were described and compared with findings of SCA. The study was limited to patients with a heart rate of less than 70 beats per minute and who had the ability to hold their breath for 20 to 30 seconds.: ResultsCoronary arteries were clearly displayed by MDCT. Compared with SCA, sensitivity was 92%, specificity 84%, and negative predicted value 89% for significant stenosis (more than 50%). Early forms of atherosclerotic changes were even clearer on MDCT. In addition, the CT examination allowed differentiation of calcified and fatty or fibrous stenoses.: ConclusionsMultidetector CT scanning is an effective noninvasive technique for the diagnosis of coronary artery disease. In selected patients, MDCT scanning might be able to replace SCA as a preoperative test for CABG procedures. The intrathoracic situs can be clearly exposed as it is important for the planning of minimally invasive CABG procedures. [Copyright &y& Elsevier]
- Published
- 2002
- Full Text
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35. Comparison of two stabilizer concepts for off-pump coronary artery bypass grafting.
- Author
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Detter, Christian, Deuse, Tobias, Christ, Frank, Boehm, Dieter H., Reichenspurner, Hermann, and Reichart, Bruno
- Subjects
CORONARY artery bypass ,CARDIAC surgery ,ANGIOGRAPHY ,MYOCARDIAL revascularization - Abstract
Background. This study was designed to evaluate the efficacy of two different stabilizer concepts for off-pump coronary artery bypass grafting.Methods. Between 2000 and 2001, 100 consecutive patients who underwent off-pump coronary artery bypass grafting were randomly assigned to two stabilization systems: the Medtronic Octopus 3 (n = 50) and the Genzyme Immobilizer (n = 50). During operation, two-dimensional cardiac surface motion was assessed by intravital microscopy using orthogonal polarization spectral imaging in 20 vessels at the anterior wall. Postoperative angiography of 47 vessels revealed anastomotic quality.Results. Patient demographics were similar in both groups regarding age, sex, ejection fraction, and New York Heart Association functional class. In 7 patients the randomized Immobilizer was rejected by the surgeon for lateral or posterior wall revascularization and subsequently switched to the Octopus device. Patients received 1.8 ± 0.7 grafts in the Octopus and 1.6 ± 0.5 in the Immobilizer group (p = not significant). Two-dimensional cardiac surface motion was significantly less using the Immobilizer (109.7 ± 32.4 μm versus 423.5 ± 129.6 μm; p < 0.001). Time required for anastomosis was significantly shorter in the Immobilizer group (11.3 ± 3.5 versus 14.9 ± 2.4 minutes; p < 0.001). Postoperative angiography showed no vessel occlusions but two anastomotic stenoses in each group.Conclusions. Both stabilizers have been shown useful for off-pump coronary artery bypass grafting. The Immobilizer system showed better epicardial immobilization of the anterior wall resulting in shorter anastomosis times. However, because the Octopus 3 handling is more flexible and allows easier access to all vessels, it is the device of choice for posterior wall revascularization in our institution. [Copyright &y& Elsevier]
- Published
- 2002
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36. Shedding of the endothelial glycocalyx during cardiac surgery: On-pump versus off-pump coronary artery bypass graft surgery.
- Author
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Bruegger, Dirk, Rehm, Markus, Abicht, Jan, Paul, Joern Oliver, Stoeckelhuber, Mechthild, Pfirrmann, Markus, Reichart, Bruno, Becker, Bernhard F., and Christ, Frank
- Published
- 2009
- Full Text
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37. Preventing Blood Loss During Application of the HEARTSTRING Proximal Seal System.
- Author
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Lamm, Peter, Eifert, Sandra, Kilian, Eckehart, Reichart, Bruno, and Juchem, Gerd
- Subjects
AORTA surgery ,SURGEONS ,HEPATITIS ,ARTERIOVENOUS anastomosis ,HIV ,SURGICAL instruments ,HEMORRHAGE prevention ,PATCH-clamp techniques (Electrophysiology) ,DISEASE risk factors - Abstract
The HEARTSTRING Proximal Seal System (Guidant Corp, Santa Clara, CA) is used to avoid aortic clamping while the proximal anastomoses are sewn. To protect surgeons from spurting blood while the device is used, we use a see through plastic sheet to cover the area being operated on. This modified technique is applied whenever the system is used and allows the safe use of the device even in high-risk patients with hepatitis or human immunodeficiency virus. [Copyright &y& Elsevier]
- Published
- 2009
- Full Text
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38. Winged Scapula After Aortic Valve Replacement.
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Schmitz, Christoph, Sodian, Ralf, Witt, Thomas N., Juchem, Gerd, Lang, Nora, Bruegger, Christian, Kowalski, Christian, and Reichart, Bruno
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SCAPULA ,AORTIC valve surgery ,INFECTIVE endocarditis ,MEDICAL care ,CARDIAC surgery ,DISEASES - Abstract
Iatrogenic nerve lesions affecting the long thoracic nerve are very rare after a median sternotomy. Here we report on a patient who developed clinical signs of a so-called “winged scapula” after an uneventful aortic valve replacement for infective endocarditis. [Copyright &y& Elsevier]
- Published
- 2009
- Full Text
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39. Acute Profound Thrombocytopenia After Treatment With Tirofiban and Off-Pump Coronary Artery Bypass Grafting.
- Author
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Beiras-Fernandez, Andres, Kowert, Anke, Jiru, Pascale, Weis, Marion, Spannagl, Michael, Reichart, Bruno, and Schmoeckel, Michael
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THROMBOCYTOPENIA ,CORONARY artery bypass ,ANTICOAGULANTS ,HEALTH outcome assessment ,THERAPEUTIC complications ,PATIENTS - Abstract
The glycoprotein IIb/IIIa (GP IIb/IIIa) receptor antagonists prevent platelet aggregation and thrombus formation, improving outcomes of patients with acute coronary syndrome. Therapy with these agents may lead to bleeding complications and thrombocytopenia, challenging the perioperative management of patients undergoing coronary surgery. We report the successful management of an acute profound thrombocytopenia after urgent off-pump coronary surgery in a patient treated with tirofiban for unstable angina and acute coronary syndrome. [Copyright &y& Elsevier]
- Published
- 2009
- Full Text
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40. Morphological and functional magnetic resonance imaging after heterotopic heart transplantation.
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Nikolaou, Konstantin, Weis, Marion, Schoenberg, Stefan O., Reichart, Bruno, and Reiser, Maximilian F.
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HEART transplantation ,CARDIAC surgery ,VASCULAR resistance ,HEART failure ,CARDIAC magnetic resonance imaging - Abstract
In patients with severe congestive heart failure, a marked elevation in pulmonary vascular resistance limits the success of orthotopic cardiac transplantation, providing the rationale for heterotopic transplantation. In the case reported, cardiac anatomy and function of two hearts in the same chest were imaged using magnetic resonance imaging (MRI). MRI offers a high-resolution, three-dimensional, noninvasive technique to visualize the complex anatomy after heterotopic heart transplantation, providing information of morphologic and functional parameters at the same time. The challenge of sufficient electrocardiogram triggering, hindered by two hearts with electrophysiological activity in the same chest, can be overcome using new real-time techniques. [Copyright &y& Elsevier]
- Published
- 2004
- Full Text
- View/download PDF
41. Optimizing use of the octopus system for off-pump total arterial myocardial revascularization with the TY graft.
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Vicol, Calin, Nollert, Georg D. A., Mair, Helmut, and Reichart, Bruno
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CARDIOLOGY ,CORONARY disease ,CORONARY artery bypass ,MYOCARDIAL revascularization - Abstract
Rapid developments in interventional cardiology for the treatment of coronary artery disease ask for further evolution of surgical revascularization techniques with improved short-term and long-term results. Off-pump bypass grafting, total arterial revascularization, and use of composite arterial grafts are innovative operative procedures that are already established in many centers. We describe our technique to combine all three procedures in a single operation. [Copyright &y& Elsevier]
- Published
- 2004
- Full Text
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42. Hybrid occlusion of a paravalvular leak with an Amplatzer Septal Occluder after mechanical aortic and mitral valve replacement.
- Author
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Lang, Nora, Kozlik-Feldmann, Rainer, Dalla Pozza, Robert, Hinterseer, Martin, Sodian, Ralf, Abicht, Jan, Kowalski, Christian, Netz, Heinrich, Reichart, Bruno, and Schmitz, Christoph
- Published
- 2010
- Full Text
- View/download PDF
43. Reply to the Editor.
- Author
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Kilian, Eckehard Gerd, Beiras-Fernandez, Andres, Bauerfeind, Daniel, Reichart, Bruno, and Lamm, Peter
- Published
- 2009
- Full Text
- View/download PDF
44. Pediatric cardiac transplantation: Three-dimensional printing of anatomic models for surgical planning of heart transplantation in patients with univentricular heart.
- Author
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Sodian, Ralf, Weber, Stefan, Markert, Mathias, Loeff, Markus, Lueth, Tim, Weis, Florian C., Daebritz, Sabine, Malec, Edward, Schmitz, Christoph, and Reichart, Bruno
- Published
- 2008
- Full Text
- View/download PDF
45. Daptomycin for Eradication of a Systemic Infection With a Methicillin-Resistant-Staphylococcus Aureus in a Biventricular Assist Device Recipient.
- Author
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Weis, Florian, Beiras-Fernandez, Andres, Kaczmarek, Ingo, Sodian, Ralf, Vicol, Calin, Reichart, Bruno, and Weis, Marion
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MORTALITY ,DEATH rate ,LIFE tables ,ANIMAL mortality - Abstract
The rate of infection in patients who require ventricular assist devices is estimated at more than 35%. Infections with multi-resistant organisms such as methicillin-resistant Staphylococcus aureus in ventricular assist device recipients are often difficult to treat and present a high mortality rate. Daptomycin is a new cyclic lipopeptide antibiotic, useful in gram-positive organisms resistant to standard treatment. We report a case of a 65-year-old man suffering from a dilatative cardiomyopathy and concomitant MRSA infection who received a biventricular assist device. The patient had MRSA sepsis develop resistant to conventional therapy, which was successfully treated with daptomycin. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
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46. Pericardial Sling Increases OPCAB Safety and Applicability.
- Author
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Mair, Helmut, Daebritz, Sabine, Reichart, Bruno, and Sergeant, Paul
- Published
- 2005
- Full Text
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47. Caution with twisted arterial grafts.
- Author
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Mair, Helmut, Daebritz, Sabine, and Reichart, Bruno
- Published
- 2005
- Full Text
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48. Facial Emphysema After Insertion of Gastric Tube.
- Author
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Bruegger, Dirk, Schwarz, Florian, Reichart, Bruno, and Chappell, Daniel
- Published
- 2013
- Full Text
- View/download PDF
49. Long-term (≤50 years) results of patients after mitral valve commissurotomy—a single-center experience.
- Author
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Reichart, Daniel T., Sodian, Ralf, Zenker, Rudolf, Klinner, Werner, Schmitz, Christoph, and Reichart, Bruno
- Subjects
MITRAL valve surgery ,OPERATIVE surgery ,HEALTH outcome assessment ,CARDIAC catheterization ,MITRAL stenosis ,FOLLOW-up studies (Medicine) ,MEDICAL statistics - Abstract
Objective: Currently, in Middle Europe, closed and open mitral valve commissurotomy (MVC) is rarely done and has been replaced by catheter-based balloon procedures. Especially under these circumstances, data on the long-term outcomes after surgical interventions are important. Methods: From 1955 to 1989, 268 patients (75 male and 193 female patients) with mostly rheumatic or infectious mitral stenoses underwent closed (n = 151) or open (n = 117) surgical procedures. The mean age at surgery was 41.2 ± 11.1 years; 19 patients (7.1%) died within the first 30 days after surgery. Results: The 50-year follow-up was complete for 215 patients (80.2%). The survival rate at 10, 20, and 30 years after surgery was 80.2%, 58.6%, and 41.8%, respectively. The differences after closed and open MVC were nonsignificant. At the latest follow-up, 32 patients were alive and had a mean New York Heart Association functional classification of 2.7. The 10-, 20-, and 30-year freedom from reoperation rate was 93.2%, 82.9%, and 76.0% for the closed intervention group and 88.5%, 80.3%, and 78.7% for the open intervention groups. Again, the differences were nonsignificant. The main cause for reoperation was recurrent fibrosis of the mitral valve. Most patients (n = 51) received mechanical valves, 5 a bioprothesis, and 8 repeat MVC. Four patients required a third intervention. Conclusions: In Middle Europe, closed and open MVCs are now rarely performed, but the ultra-long-term results are excellent and serve as a standard for the now-established balloon valvuloplasty. MVCs remain an option for pregnant women. In third world clinical conditions, closed MVC remains a less expensive alternative. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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50. Intraoperative Assessment of Circumflex Artery Occlusion During Mitral Valve Operation.
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Kilian, Eckehard, Beiras-Fernandez, Anres, Reichart, Bruno, and Lamm, Peter
- Published
- 2011
- Full Text
- View/download PDF
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