Search

The proposed donor heart selection guidelines provide evidence-based and expert-consensus recommendations for the selection of donor hearts following brain death. These recommendations were compiled by an international panel of experts based on an extensive literature review. © 2022 International Society for Heart and Lung Transplantation

OBJECTIVES HTK-Solution (Custodiol) is a well-established cardioplegic and organ preservation solution. We currently developed a novel HTK-based solution, Custodiol-N, which includes iron chelators to reduce oxidative injury, as well as l-arginine, to improve endothelial function. In this first-in-human study, Custodiol-N was compared to Custodiol in patients undergoing elective coronary artery bypass surgery. The aim of this comparison was to evaluate the safety and ability of Custodiol-N to protect cardiac tissue. METHODS The study was designed as a prospective randomized double-blind non-inferiority trial. Primary end point was area under the curve (AUC) of creatine kinase muscle-brain (CK-MB) within the first 24 h after surgery. Secondary end points included peak CK-MB and troponin-T and AUC of troponin-T release, cardiac index, cumulative catecholamine dose, intensive care unit stay and mortality. All values in the abstract are given as mean ± SD, P RESULTS Early termination of the trial was performed per protocol as the primary non-inferiority end-point was reached after inclusion of 101 patients. CK-MB AUC (878±549 vs 779±439 h U/l, non-inferiority P CONCLUSIONS This study shows that Custodiol-N is safe and provides similar cardiac protection as the established HTK-Custodiol solution. Significantly reduced peak CK-MB levels in the Custodiol-N group in the full analysis set may implicate a beneficial effect on ischaemia/reperfusion injury in the setting of coronary bypass surgery.

The aim of the present study was to evaluate the acceptance of a webinar series for continuing medical education hosted by the Austrian Society for Oral and Maxillofacial Surgery (OGMKG). A series of twelve webinars was streamed via the Internet and the participants’ satisfaction was evaluated by an online questionnaire. 51 out of 140 participants (36.4%) completed the questionnaire completely and were included into the study for further analysis. The mean age of the participants was 37.9 ± 8.9 and did not vary significantly between gender (p = 0.53). The results of the questionnaire revealed a positive attitude of the participants towards this kind of webinar. The participants found that the webinars allowed for an adequate transfer of knowledge. Continuing medical education by webinars in oral and maxillofacial surgery is well accepted by the participants. Although both male and female participants had a positive attitude towards the webinars, females gave even better ratings than their male counterparts did.

Orthognathic surgery treatment (OGS) after orthodontic treatment of dentofacial deformities is a widely performed procedure, often accompanied by a bilateral sagittal split osteotomy (BSSO). Positioning of the condyle during this procedure is a crucial step for achieving optimal functional and anatomical results. Intraoperatively poorly positioned condyles can have a negative effect on the postoperative result and the patient’s well-being. Changes of the condylar position during OGS Procedures and its effects on the temporomandibular joint in orthognathic surgical interventions (OGS) are subject of scientific discussions. However, up to date, no study has investigated the role of condyle position in the surgery first treatment concept. The aim of this study was to investigate the influence of OGS on the three-dimensional position of the condyle in the joint in a surgery first treatment concept without positioning device and to record the change in position quantitatively and qualitatively. Analysis of our data indicated that OGS in surgery first treatment concept has no significant effect on the position of the condyle and the anatomy of the temporomandibular joint.

Made available in DSpace on 2022-04-29T08:32:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-03-01 Objective: The aim of this study was to compare bone formation between 2 distraction osteogenesis protocols by analyzing cone beam computed tomography (CBCT) scan data. Study Design: In this retrospective study, the efficacy of 2 different surgically assisted rapid maxillary expansion protocols (group 1 [G1], 3 × 0.25 mm/d; group 2 [G2], 1 mm start followed by 2 × 0.25 mm/d) was analyzed using CBCT scans obtained at 3 time points: preoperatively (T0), immediately after surgery (T1), and 6 months after surgery (T2). Bone formation at T0, T1, and T2 was analyzed using the Dolphin Imaging 11 program. Results: At T1, both groups had significantly higher bone volume than at T0 (G1, 135.6 vs 124.65 mm3, respectively; G2, 153.49 vs 118.9 mm3, respectively), with no significant difference between groups (P = .6). Moreover, bone density measured in the region of interest was similar between groups at all 3 time points; however, in both groups, bone density was significantly lower at T1 and T2 than at T0 (P < .01), with no difference between T1 and T2. Conclusions: Bone density between the incisors decreased with progressive distraction (i.e., increasing volume), regardless of the distraction protocol used; thus, both protocols can be used safely in clinical practice. Nevertheless, our results indicate that stress should not be applied to the incisors within 6 months of surgery, regardless of the protocol used. Surgeons and orthodontists should therefore consider immature bone formation and avoid using excessive force to close a diastema. Department of Oral and Maxillofacial Surgery Medical University of Vienna. Department of Diagnosis and Surgery Dental School of Araraquara São Paulo State University. Department of Diagnosis and Surgery Dental School of Araraquara São Paulo State University.

BACKGROUND: The therapeutic success in patients with congenital heart disease (CHD) leads to a growing number of adults with CHD (adult CHD [ACHD]) who develop end-stage heart failure. We aimed to determine patient characteristics and outcomes of ACHD listed for heart transplantation. METHODS: Using data from all the patients with ACHD in 20 transplant centers in the Eurotransplant region from 1999 to 2015, we analyzed patient characteristics, waiting list, and post-transplantation outcomes. RESULTS: A total of 204 patients with ACHD were listed during the study period. The median age was 38 years, and 62.3% of the patients were listed in high urgency (HU), and 37.7% of the patients were in transplantable (T)-listing status. A total of 23.5% of the patients died or were delisted owing to clinical worsening, and 75% of the patients underwent transplantation. Median waiting time for patients with HU-listing status was 4.18 months and with T-listing status 9.07 months. There was no difference in crude mortality or delisting between patients who were HU status listed and T status listed (p = 0.65). In multivariable regression analysis, markers for respiratory failure (mechanical ventilation, hazard ratio [HR]: 1.41, 95% CI: 1.11-1.81, p = 0.006) and arrhythmias (anti-arrhythmic medication, HR: 1.42, 95% CI: 1.01-2.01, p = 0.044) were associated with a higher risk of death or delisting. In the overall cohort, post-transplantation mortality was 26.8% after 1 year and 33.4% after 5 years. CONCLUSIONS: Listed patients are at high risk of death without differences in the urgency of listing. Respiratory failure requiring invasive ventilation and possibly arrhythmias requiring anti-arrhythmic medication indicate worse outcomes on waiting list. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.

BACKGROUND: Heart transplantation is limited by the scarcity of suitable donors. Patients with advanced biventricular failure may require biventricular support to provide optimal cardiac output and end-organ perfusion. We highlight the outcomes of using the HeartWare HVAD System (HVAD) in a biventricular configuration. METHODS: This retrospective study included patients implanted with HVAD as a biventricular assist device (BiVAD) between 2009 and 2017 at 12 participating centers. When used as a right ventricular assist device (VAD) (RVAD), the HVAD can be attached to the right ventricle (RV) or the right atrium (RA). Kaplan–Meier survival estimates were calculated comparing the 2 RVAD implant locations. Comparisons were also made between the timing of RVAD implantation (primary vs staged) on adverse event (AE) profiles and survival. RESULTS: Among the 93 patients who were implanted with a HVAD BiVAD, Kaplan–Meier survivals at 1-year and 2-year were 56% and 47%, respectively. Survival was independent of the location of the HVAD RVAD implant or whether there was an interval between left VAD and RVAD implantation. The most common AEs were bleeding (35.5%), infection (25.8%), and respiratory failure (20.4%). CONCLUSIONS: This study illustrated similar survival in patients receiving a primary or staged HVAD BiVAD implant at 1 year and 2 years. This study also established that the locations of the RVAD implant (RV or RA) result in similar AE profiles. © 2020 International Society for Heart and Lung Transplantation, Medtronic Abbott Laboratories Medtronic, A.R.S. is a consultant for Medtronic and Transmedics Inc. J.G. and M.O. are consultants for Medtronic and Abbott. C.S.H. is a consultant for Medtronic and has received honoraria from Abbott and Medtronic. D.Z. and J.D.S. are consultants for Medtronic and receive research grant support from Abbott. The remaining authors have no conflicts of interest to disclose., The authors gratefully acknowledge the assistance of Vince Cannon, Alexandra Dedrick, and Kristie Wallace from Medtronic for support in the analysis and preparation of this manuscript. This retrospective study was supported by Medtronic (formerly HeartWare Inc).

Purpose The aim of this study was to evaluate soft tissue changes after intraoral quadrangular Le Fort II osteotomy (IOQLFII) and correlate those changes to underlying osseous changes. Materials and Methods Twenty-six non-growing patients with midfacial deficiency and Class III malocclusion were analyzed. A study group of 13 patients who underwent IOQLFII was compared with 13 patients who underwent conventional Le Fort I osteotomy (LFI). After fusion of pre- and postoperative computed tomograms, each patient's hard and corresponding soft tissue changes were measured. Measurement points were defined at 3 levels in the IOQLFII group (infraorbital rim [IR], sinus floor [SF], and lateral incisor tip [LI]) and at 2 levels in the LFI group (SF and LI). Linear models were created to test for correlations between hard and soft tissues. Results The slope (a1 coefficient) between anteroposterior hard and soft tissue changes was found to be highly significant at each measurement point for all groups. In the IOQLFII group, soft tissue advancement was 69% (confidence interval [CI], 62 to 77%) of the hard tissue advancement at the IR, 90% (CI, 84 to 96%) at the SF, and 73% (CI, 64 to 82%) at the LI. In the LFI group, the corresponding percentages were 90% (83 to 97%) at SF and 84% (77 to 90%) at LI. Conclusion IOQLFII results in predictable correction of midfacial deficiency. At the IR, bony advancement always resulted in markedly less soft tissue advancement than at the SF level. These results indicate that the planned infraorbital advancement should not be too conservative because soft tissue changes are smaller in this region.

Despite the increasing use of ventricular assist devices (VADs), gender differences in indications, hemodynamics, and outcome are not well understood. We examined gender differences and gender-specific predictors for perioperative outcome in patients on ventricular support.Multicenter data of 966 patients (median age 55 years, 151 women) from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) were analyzed. Median follow-up was 1.26 years.At the time of VAD implantation, women were more often in an unstable condition (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1 and 2) (51.7% vs 41.6% in men), experiencing significantly more often major bleeding (p = 0.0012), arrhythmias (p = 0.022), and right ventricular (RV) failure (p0.001) with need for additional RV support. The survival of women on isolated LVAD support was significantly worse (1-year survival 75.5% vs 83.2% in men). Age-adjusted Cox regression analyses showed significant associations with mortality for preoperative inotropic therapy, percutaneous mechanical support, INTERMACS profile 1 and 2, RV dysfunction, major bleeding, cerebral bleeding, ischemic stroke, and RV failure. In women, pump thrombosis was more strongly related with mortality compared to men, while the direction of the association of renal dysfunction with mortality was different for women and men (p-value interaction 0.028 and 0.023, respectively).Women and men differ in perioperative hemodynamics, adverse events, and mortality after VAD implantation. A gender-dependent association of pump thrombosis with mortality was seen. The impact on treatment practice needs to be shown.

Objective The aim of this study was to test the bone thickness and potential screw length for osteosynthesis of condylar base fractures (according to the Loukota classification) with an experimental titanium plate, placed in an ideal position against 2 types of conventional plates. Study Design After exclusion of completely edentulous mandibles, 28 dentate macerated mandibles available at the time of the study were included. Linear regression models 1 and 2 compared the sums of the 2 cranial bone thicknesses and the 3 caudal thicknesses among the 3 different plate designs, and linear models 3 and 4 tested the bone thickness in the 2 most cranial screw axes. Results Linear models 1 and 2 revealed significantly higher potential screw lengths for the experimental oblique plate. Equally, linear models 3 and 4 indicated significantly higher bone thickness for the novel oblique plate. Conclusion The novel proposed oblique plate allows for favorable plate positioning in a biomechanically ideal location with sufficient amounts of local bone for stable plate fixation. When plates with 15-degree angulated screw holes are used, stable bicortical plate fixation can be achieved.

Objective The phase III clinical trial PERFECT was designed to assess clinical safety and efficacy of intramyocardial CD133 + bone marrow stem cell treatment combined with CABG for induction of cardiac repair. Design Multicentre, double-blinded, randomised placebo controlled trial. Setting The study was conducted across six centres in Germany October 2009 through March 2016 and stopped due slow recruitment after positive interim analysis in March 2015. Participants Post-infarction patients with chronic ischemia and reduced LVEF (25–50%). Interventions: Eighty-two patients were randomised to two groups receiving intramyocardial application of 5ml placebo or a suspension of 0.5–5×10 6 CD133 + . Outcome Primary endpoint was delta (∆) LVEF at 180days (d) compared to baseline measured in MRI. Findings (prespecified) Safety ( n =77): 180d survival was 100%, MACE n =2, SAE n =49, without difference between placebo and CD133 + . Efficacy ( n =58): The LVEF improved from baseline LVEF 33.5% by +9.6% at 180d, p =0.001 ( n =58). Treatment groups were not different in ∆LVEF (ANCOVA: Placebo +8.8% vs. CD133 + +10.4%, ∆CD133 + vs placebo +2.6%, p =0.4). Findings (post hoc) Responders (R) classified by ∆LVEF≥5% after 180d were 60% of the patients (35/58) in both treatment groups. ∆LVEF in ANCOVA was +17.1% in (R) vs. non-responders (NR) (∆LVEF 0%, n =23). NR were characterized by a preoperative response signature in peripheral blood with reduced CD133 + EPC (RvsNR: p =0.005) and thrombocytes ( p =0.004) in contrast to increased Erythropoeitin ( p =0.02), and SH2B3 mRNA expression ( p =0.073). Actuarial computed mean survival time was 76.9±3.32months (R) vs. +72.3±5.0months (NR), HR 0.3 [Cl 0.07–1.2]; p =0.067.Using a machine learning 20 biomarker response parameters were identified allowing preoperative discrimination with an accuracy of 80% (R) and 84% (NR) after 10-fold cross-validation. Interpretation The PERFECT trial analysis demonstrates that the regulation of induced cardiac repair is linked to the circulating pool of CD133+ EPC and thrombocytes, associated with SH2B3 gene expression. Based on these findings, responders to cardiac functional improvement may be identified by a peripheral blood biomarker signature. TRIAL REGISTRATION: ClinicalTrials.gov NCT00950274.

BACKGROUND Infections are major complications in patients with ventricular assist devices (VAD). Positron emission tomography with deoxyglucose marked by fluorine-18 ( 18 F-FDG PET/CT) is a diagnostic tool to scan for tissue with high metabolism as present in infections. The specificity of 18 F-FDG PET/CT to discriminate between infection and an aseptic reaction of the implanted device is not defined and its evaluation is the aim of this retrospective analysis. METHODS Until September 2015 a total of 100 patients underwent VAD implantations in our institution. Twenty-one patients (mean age 53.7 ± 14.3 years) had 29 PET-CT examinations for a suspected infection. All radiology reports were compared to clinical and intraoperative parameters. Infections were reported according to the guidelines of the International Society of Heart and Lung Transplantation. Follow-up was 222 days (range 107-484 days) after PET-CT scans and was complete in all patients. RESULTS In 7 patients PET-CT scan ruled out any VAD associated infection. Sixteen patients had a VAD specific infection. Two patients had false negative PET-CT scan results. The sensitivity of VAD-specific infections was 87.5%, the specificity 100%, the positive predictive value was 100% and the negative predictive value 86.7%. Seven patients had more than one PET-CT scans at different time points. CONCLUSIONS PET-CT scan findings showed a high specificity and positive predictive value for VAD-specific infections. Therefore, it may have the potential to guide the clinician in handling patients with infectious complications after VAD implantation.

Objective Three-dimensional (3D) printing has become widely available, and a few cases of its use in clinical practice have been described. The aim of this study was to explore facilities for the semi-automated delineation of breast cancer tumors and to assess the feasibility of 3D printing of breast cancer tumors. Methods In a case series of five patients, different 3D imaging methods—magnetic resonance imaging (MRI), digital breast tomosynthesis (DBT), and 3D ultrasound—were used to capture 3D data for breast cancer tumors. The volumes of the breast tumors were calculated to assess the comparability of the breast tumor models, and the MRI information was used to render models on a commercially available 3D printer to materialize the tumors. Results The tumor volumes calculated from the different 3D methods appeared to be comparable. Tumor models with volumes between 325 mm3 and 7,770 mm3 were printed and compared with the models rendered from MRI. The materialization of the tumors reflected the computer models of them. Conclusion 3D printing (rapid prototyping) appears to be feasible. Scenarios for the clinical use of the technology might include presenting the model to the surgeon to provide a better understanding of the tumor's spatial characteristics in the breast, in order to improve decision-making in relation to neoadjuvant chemotherapy or surgical approaches. J. Surg. Oncol. 2017;115:238–242. © 2016 Wiley Periodicals, Inc.

The incidence of atrial fibrillation increases with age, and therefore many elderly patients presenting for cardiac surgery have atrial fibrillation. In recent publications, increasing age has been recognized as a predictor for ablation failure. Furthermore, many surgeons are reluctant to perform a surgical ablation in elderly patients. We investigated the safety and efficacy of concomitant surgical atrial fibrillation ablation in elderly patients.Between 2003 and 2013, 556 patients underwent concomitant surgical atrial fibrillation ablation at the University Heart Center Hamburg and served as our primary study cohort. During follow-up, rhythm monitoring was established by 24-hour Holter electrocardiogram (70.5%) or an implantable loop recorder (29.5%) at 3, 6, and 12 months postoperatively. The primary end point of the study was freedom from atrial fibrillation at 12 months follow-up and the detection of deviations from a linear association between age and risk of atrial fibrillation recurrence. A multiple logistic regression model including age as a linear term was used to identify predictors for rhythm outcome.Mean patients' age was 68.4 ± 9.07 years, and 67.3% of the patients were male. Mean duration of atrial fibrillation was 3.5 ± 3.3 years, and mean left atrium diameters were enlarged with 50.5 ± 8.8 mm. There were no major ablation-related complications. The 30-day and 1-year survivals were 97.7% and 95.8%, respectively. The overall rate of freedom from atrial fibrillation ranged from 62% to 72% and was independent of age. The age-dependent risk of atrial fibrillation at 12 months was significantly increased in elderly patients undergoing a concomitant coronary artery bypass grafting surgery. Multiple logistic regression model revealed double valve procedures (odds ratio, 3.48; P = .020), preoperative persistent atrial fibrillation (odds ratio, 2.43; P = .001), and coronary artery bypass grafting surgery in elderly patients (odds ratio, 2.03; P = .009) as risk factors for recurrence of atrial fibrillation. Sinus rhythm at discharge (odds ratio, 0.39; P .001) and bipolar ablation (odds ratio, 0.32; P .001) were significant predictors for successful ablation.Surgical atrial fibrillation ablation was safe and effective independently of age. Sinus rhythm at discharge and bipolar ablation were significant predictors for successful ablation, whereas double valve procedures, preoperative persistent atrial fibrillation, and coronary artery bypass grafting surgery in elderly patients were risk factors for recurrence of atrial fibrillation.

Over the last decade, the number of heart transplantations declined, and the number of implanted left ventricular assist devices (LVADs) markedly increased. Accordingly, common intensive care interventions rise and present their own challenges, especially because of the necessary anticoagulation regimen. One of these procedures is percutaneous dilatation tracheostomy (PDT). We herein report our experience with 34 patients with LVAD and established phenprocoumon therapy (International normalized ratio 2.1 ± 0.9, partial thromboplastin time 68.9 ± 19.0 seconds) who underwent PDT between 2006 and 2015 at our specialized cardiac surgery intensive care unit. Intraprocedural success was achieved in all cases (34/34 patients) with sufficient placement of the tracheal tube and adequate mechanical ventilation. No retained secretions or tracheostomy tube obstructions were observed during follow-up. In no case, conversion to surgical tracheostomy was necessary. No serious bleeding complications that required urgent or emergent reoperation occurred during or after the PDT procedure. A total of 16 patients (47.1%) died within the first 30 days after LVAD implantation. This is the first report describing outcomes of patients with LVAD under established phenprocoumon therapy and postoperative implemented PDT. PDT is a safe procedure for those patients. It is not connected with bleeding complications and shows a good procedural outcome.

Background Minimally invasive left ventricular assist device (LVAD) implantation may reduce peri-/postoperative complications and risks associated with resternotomies. In this study, we describe our first results using a minimally invasive LVAD implantation technique (lateral thoracotomy [LT] group). These results were compared with LVAD implantations done via full median sternotomy (STX group). Methods HVAD (HeartWare, Framingham, Massachusetts, United States) implantations in 70 patients (LT group n = 22, 52 ± 15 years old; STX group n = 48, 59 ± 11 years old) were retrospectively analyzed. Minimally invasive access via left thoracotomy was feasible in 22 patients. Peri- and postoperative analyses of survival and adverse events were performed. Results No survival differences were observed between the LT and STX group (p = 0.43). LT patients without temporary right ventricular assist device (tRVAD) showed a significantly better survival rate compared to LT patients with concomitant tRVAD implantation (p = 0.02), which could not be demonstrated in the STX group (p = 0.11). Two LT and four STX patients were successfully bridged to heart transplantation and three STX patients were successfully weaned with subsequent LVAD explantations. LVAD-related infections (n = 4 LT group vs n = 20 STX group, p = 0.04) were less likely in the LT group. No wound dehiscence occurred in the LT group, whereas five were observed in the STX group (p = 0.17). The amount of perioperative blood transfusions (within the first 7 postoperative days) did not differ in both study groups (p = 0.48). Conclusion The minimally invasive approach is a viable alternative with the possibility to reduce complications and should be particularly considered for bridge-to-transplant patients.

Purpose There is a growing trend toward the use of less invasive, non-sternotomy approaches in all fields of cardiac surgery, including implantation of left ventricular assist devices (LVADs). The less invasive, thoracotomy procedure has been successfully used worldwide, with an estimated 25% of implants performed internationally using this approach. This approach is also used more frequently in varying patient populations, including those coming into the procedure on ECMO. With the new UNOS transplant listing criteria, ECMO use may change, and understanding the impact on subsequent procedures in this population is of increasingly important. We present here a comparison of outcomes of HVAD implants by a thoracotomy approach in patients either on or off ECMO at baseline. Methods This Retrospectively analysis of clinical data and outcomes of 281 patients implanted with the HVAD Pump via a thoracotomy approach at high volume thoracotomy implanting centers in Europe in a real-world setting. Implants were performed both on and off pump, and with standard and alternative outflow graft locations. Patients were implanted directly from ECMO in 17%. Results Compared to patients implanted with an HVAD without baseline ECMO, those implanted directly from ECMO experienced a higher rate of bleeding events (0.30 vs. 0.11 events per patient year (EPPY), p value = 0.02, respectively), more renal dysfunction (0.19 vs. 0.05 EPPY, p value = 0.03) and a trend toward few cardiac arrythmias (0.19 vs. 0.07 EPPY, p value = 0.08). Overall survival at one year post implant was 81% in the non-ECMO thoracotomy group, compared to 56% in the group implanted directly from ECMO (p value = 0.0003). Conclusion The analysis of real world use of the HVAD implanted using a thoracotomy approach demonstrates that there is significantly worse survival and adverse event profile in patients undergoing implants off ECMO. However, these results do not appear to be worse than previous reports of LVAD implants off ECMO via a sternotomy approach.

The aim of this study was to evaluate the anatomical feasibility of palatal sinus floor augmentation.In 100 men and 100 women, both sinuses were analyzed using computed tomography. The patients were divided into four anatomical groups according to the remaining alveolar bone height: group 1 (0 ≤ ×4), group 2 (4 ≤ ×8), group 3 (8 ≤ ×12), and group 4 (≥12).The 400 maxillary sinuses consisted of 23.5% (n = 94) group 1, 42.75% (n = 171) group 2, 23.5% (n = 98) group 3, and 9.25% (n = 37) group 4 sinuses. Optimal anatomical preconditions for palatal sinus floor augmentations (i.e., ≥5 mm height and5 mm thickness of the window lid) were found in 93.6% of group 1 sinuses, 73.7% of group 2 sinuses, 23.5% of group 3 sinuses, and 5.4% of group 4 sinuses.The palatal approach is feasible in 93.6% of patients with remnant alveolar height of up to 4 mm. Limitations are alveolar heights of ≤5 mm as well as great palatal thickness and thus limited dimensions for a possible palatal window.

Different follow-up methods have been used to report success rates after AF ablation. Recent studies have shown that intermittent rhythm monitoring underestimates the actual AF recurrence rate. We therefore report our experience with continuous rhythm monitoring by implantable loop recorder (ILR) in a large patient cohort. Between 09/2008 and 12/2012, 343 cardiac surgical patients underwent concomitant surgical AF ablation. ILR implantation was performed in 206 patients. ILR interrogation was accomplished at 3, 6 and 12 months postoperatively. Successful ablation was defined as AF Burden

Background To analyze safety and efficacy of surgical totally endoscopic epimyocardial ablation in patients (pts) turned down for interventional catheter therapy due to long-standing persistent atrial fibrillation (pAF) combined with significant atrial dilatation (> 5 cm). Methods Since December 2010, 15 pts were referred for surgical ablation due to persistent AF combined with biatrial dilatation (left atrium [LA] 5.0 ± 0.6 cm). Mean age was 52 ± 6 years, body mass index (BMI) 38 ± 6, duration of AF 2.8 ± 1.2 years, left ventricular end diastolic diameter (LVEDD) 5.8 cm ± 0.6 cm. Ablation was performed via a bilateral endoscopic approach using bipolar RF energy application. Monitoring was achieved by an event recorder (Reveal XT Medtronic, Inc., Minneapolis, MN, USA) or repeated 24-hours Holter electrocardiogram. Results All pts successfully received bilateral pulmonary vein isolation + box lesion + trigonal lesion + left atrial appendage resection. Mean duration of procedure was 235 ± 70 minutes. There was no intraoperative complication; however, one patient had persistent left phrenic nerve palsy. Mean hospital stay was 4 ± 2 days, mean follow-up time was 21 ± 11 months. Incidence of sinus rhythm (SR) was 67, 73, and 80% at discharge, three months, and 12 months follow-up. Mean LA diameter was reduced from 58.1 mm ± 6.0 mm preoperative to 49.7 mm ± 5.4 mm (p = 0.004) at 12 months follow-up. Incidence of SR was 86% at latest follow-up (mean time 21 months). All pts currently in SR (13/15 = 86%) are of class I or III antiarrhythmic drugs. Conclusion Totally endoscopic left atrial ablation including left atrial resection can safely be performed. It achieved excellent rates of SR restoration in patients with long-standing persistent AF combined with significant atrial dilatation. doi: 10.1111/jocs.12523 (J Card Surg 2015;30:469–473)

Purpose The aim of this study was to report on 1-year outcomes of fixed full-arch fiber-reinforced resin bridges on short implants in atrophic maxillary jaws. Materials and Methods A prospective cohort study was designed and patients with severely atrophic maxillas, corresponding to Cawood and Howell Classes V and VI, were included. Mesial and distal peri-implant bone levels were assessed on panoramic radiographs that were taken at the time of implant insertion (baseline) and during follow-up visits. Results Eighteen patients with 72 implants inserted in atrophic maxillary jaws were included in this study. All patients had a follow-up visit 1 year after loading. The cumulative 1-year patient-based implant survival rate was 88.8%, and the cumulative 1-year implant-based survival rate was 97.2%. The marginal bone level (MBL) was −0.5 ± 0.5 mm at the time of loading (n = 72) and −0.8 ± 0.6 mm (n = 72) after 1 year. The MBL depended substantially on the depth at the time of insertion. No prosthetic failure, such as chipping or fracture, occurred within the first year of loading. Conclusion Prosthetic rehabilitation of atrophic maxillas with prostheses supported by 4 4.0- × 5.0-mm or 3.0- × 8.0-mm implants seems to be a viable and cost-effective treatment option in the short-term.

Purpose The aim of this study was to evaluate the midterm outcomes of fixed, full-arch, fiber-reinforced resin bridges on ultrashort implants in terms of marginal bone loss and overall implant survival. Patients and Methods Patients with severely atrophic mandibles, corresponding to Cawood and Howell class V and class VI, were included in this prospective temporal cohort study. Mesial and distal peri-implant bone levels were measured on panoramic radiographs taken at the time of implant insertion (baseline) and at follow-up visits. Results A total of 17 patients with atrophic mandibular jaws with an average follow-up period of 2.9 ± 1.5 years were included. The cumulative 1-, 3-, and 5-year patient-based implant survival rates were 94.1%, and the cumulative implant survival rates were 98.5%. The marginal bone level (MBL) of the mesial implants was 0.0 ± 0.3 mm at the time of loading (n = 33), −0.1 ± 0.3 mm (n = 20) after 1 year, −0.4 ± 0.5 mm (n = 10) after 3 years, and −1.5 ± 1.0 mm (n = 4) after 5 years. The mesial bone level depended significantly on time and insertion depth. The MBL of the distal implants was −0.4 ± 0.4 mm (n = 34) at the time of implantation, −0.4 ± 0.6 mm (n = 20) after 1 year, −0.5 ± 0.5 mm (n = 10) after 3 years, and −2.2 ± 1.7 mm (n = 4) after 5 years. The distal bone level depended significantly on time and insertion depth. Conclusions Fixed, full-arch, fiber-reinforced resin bridges retained by 4 ultrashort implants provide a comparatively cost-effective, safe, stable alternative for prosthetic restoration of the severely atrophic mandible. The overall implant survival rate and the MBL after 5 years are equivalent to those of threaded implants of conventional lengths.

Objectives Left-sided unloading during extracorporeal membrane oxygenation (ECMO) therapy is crucial to prevent pulmonary oedema and facilitate ventricular recovery. We present the case of a 55-year-old man under ECMO therapy with pre-existing left ventricular (LV) thrombus formation and in need of ventricular unloading. Methods We implanted a 21-Fr TandemHeart Protek Solo trans-septal cannula into the left atrium using a trans-septal approach via the femoral vein. The cannula was connected to the venous line of the ECMO circuit. A flow probe and a clamp to reduce flow, if necessary, were attached to the left atrium line. Left atrium flow was adjusted to 900 ml/min under transoesophageal echocardiography control to keep the atrial septum in the mid-line and to prevent suction of the inflow cannula. Results After 9 days, the patient was weaned step-wise from ECMO and the TandemHeart cannula, which was then explanted. The patient is in New York health Association Class II without neurological sequelae (Cerebral Performance Scale 1). After 3 months, the patient has fully recovered and is working daily. The LV function is still moderately impaired, and the size of the LV thrombus remains the same. The atrial septum shows no residual defect. Conclusions Percutaneous trans-septal insertion of a TandemHeart cannula incorporated in an ECMO circuit for the prevention of pulmonary oedema and subsequent weaning from extracorporeal circulation was feasible and safe in a patient with cardiogenic shock and an LV thrombus.

Although primary graft dysfunction (PGD) is fairly common early after cardiac transplant, standardized schemes for diagnosis and treatment remain contentious. Most major cardiac transplant centers use different definitions and parameters of cardiac function. Thus, there is difficulty comparing published reports and no agreed protocol for management. A consensus conference was organized to better define, diagnose, and manage PGD. There were 71 participants (transplant cardiologists, surgeons, immunologists and pathologists), with vast clinical and published experience in PGD, representing 42 heart transplant centers worldwide. State-of-the-art PGD presentations occurred with subsequent breakout sessions planned in an attempt to reach consensus on various issues. Graft dysfunction will be classified into primary graft dysfunction (PGD) or secondary graft dysfunction where there is a discernible cause such as hyperacute rejection, pulmonary hypertension, or surgical complications. PGD must be diagnosed within 24 hours of completion of surgery. PGD is divided into PGD-left ventricle and PGD-right ventricle. PGD-left ventricle is categorized into mild, moderate, or severe grades depending on the level of cardiac function and the extent of inotrope and mechanical support required. Agreed risk factors for PGD include donor, recipient, and surgical procedural factors. Recommended management involves minimization of risk factors, gradual increase of inotropes, and use of mechanical circulatory support as needed. Retransplantation may be indicated if risk factors are minimal. With a standardized definition of PGD, there will be more consistent recognition of this phenomenon and treatment modalities will be more comparable. This should lead to better understanding of PGD and prevention/minimization of its adverse outcomes.

OBJECTIVES Concomitant surgical ablation of atrial fibrillation (AF) is a safe and feasible procedure. However, many surgeons are reluctant to perform it in patients with heart failure. We investigated the safety and efficacy of AF ablation in patients with a severely reduced left ventricular ejection fraction (LVEF

Major problems associated with the use of a bone lid for osteoplastic surgery of the maxillary sinus, as first described by Lindorf, are the possibility of postoperative dislocation of the bony fragment into the sinus (floating bone), as well as inflammatory resorption or fracture of the very thin removed trap door fragment. We describe a technique that prevents dislocation of the bone lid and allows for very good visualization of the entire sinus by a simple extended design and the use of resorbable pins. With the use of this extended bone lid, the removal of severely dislocated teeth, implants, sinus pathologies, or foreign bodies can be performed easily. Furthermore, this is an advantageous approach for large orbital fractures, especially those of the posterior half.

The palatal sinus lift is a good choice for patients with scarred buccal soft tissue and those with poor wound healing such as smokers or diabetics or when visual side effects such as swelling must be concealed. We provide a surgical protocol for palatal sinus lifting without a vertical release incision. The incision is started in a slightly palatal aspect, at the distal end of the dental arch, and describes a curve laterally on the alveolar crest while running in a mesial direction. As a marginal incision, it can continue to the central incisor. Submucosal exposure will lift the gum and the greater palatine artery. After insertion of a tongue depressor, the sinus is opened on the palatal side, opposite the zygomaticoalveolar crest, using a rose bur or a piezotome. After sinus augmentation, the incision is easy to close, and the wound will heal smoothly.

Objectives: Recurrent tricuspid regurgitation (TR) of more than 20% to 30% even in the early follow-up period after tricuspid valve annuloplasty (TVR) has been the impulse for the development of three-dimensional, anatomically shaped remodeling rings. We analyzed results achieved with a 3D ring and compared them to those after use of standard 2D rings. Patients and Methods: Since February 2013 3D Contour rings were implanted in 100 patients (Gr.1; 49% female, age 67.9 ± 11.1 years) with high grade TR. A cohort of 100 patients after TVR with a Physio Tricuspid ring (Edwards) (Gr.2; 36% female, age 68.4 ± 10.1 years) were matched according to age, gender and preoperative diagnoses and served as control. Analyses included functional and echocardiographic results at discharge and 1-year-follow-up. Preoperative characteristics were similar in both groups with regards to atrial fibrillation (62% versus 68%), mean NYHA score (3.1 ± 0.54 versus 3.1 ± 0.45), and mean TR (3.4 ± 0.48 vs 3.2 ± 0.55) in Gr.1 versus Gr.2 . Preoperative RV function was moderately reduced in 37% in Gr.1 and 34% in Gr.2. TVR was combined with mitral valve surgery in 62% versus 72%, isolated TVR was performed in 32% versus 23% (Gr.1 vs Gr.2, respectively). 3-month follow-up was 98% complete in both groups, 1-year follow-up was 98% complete in 50 patients of the 3D group and 96% in the 2D group. Mean follow-up time was 13.7 ± 8 months in Gr.1with cumulative total 113.3 patient-years (Gr.2: 45.1 ± 8.7 months; cumulative total 376.0 patient-years). Results: Echocardiography at discharge showed satisfactory results in both groups with 100% TR ≤ 1 in Gr.1 and 96% in Gr. 2, mean TR was 0.26 ± 0.61 versus 0.34 ± 0.58 (Gr.1 versus Gr.2). However, only in Gr.2 6% of patients had TR ≥2 (p< 0.001 versus Gr.1) At 1 year follow-up mean TR was 0.43 ± 0.65 versus 0.62 ± 0.92 (Gr.1 vs Gr.2), however, significantly less patients showed recurrent TR ≥ 2 in Gr.1 (4 versus 12% p = 0.008). Mean NYHA score was 1.4 ± 0.5 versus1.7 ± 0.5 after 3 months (p = 0.006), and 1.4 ± 0.6 versus1.9 ± 0.4(p = 0.003) after 1 year in Gr.1 versus Gr. 2 respectively. In Gr.1 RV function had improved significantly after 1year from preop. 37% to 24% moderate dysfunction with no improvement in Gr.2 (34 versus33%). Conclusion: Both tricuspid rings showed excellent repair results at discharge. At 1 year follow-up, however, patients in the 3D Contour ring group showed significantly less recurrence of relevant TR, better RV function and lower NYHA scoring.

Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in cardiac surgery. The aim of this analysis is to determine the effect of a Posthorax support vest (Epple Inc, Vienna, Austria) after median sternotomy. One thousand five hundred and sixty cases were included in a prospective randomized multicenter trial. Patients were randomized as follows: 905 received a flexible dressing postoperatively (group A) and 655 patients were given a Posthorax support vest (group B). Patients in groups A and B were well matched. Their mean age was 68 years (range: 34-87 years). The patient characteristics and operative data were equally distributed in both groups. The mean total hospital stay was significantly shorter in group B than in group A (A: 17.33+/-17.5; B: 14.76+/-7.7; P=0.04). Sternal wound complications necessitating reoperation during the 90 days follow-up period were observed in 4.5%. Reoperation rates were as follows: 3.9% in group A and 0.6% in group B (P

Hepatic hypoperfusion is regarded as an important factor in the pathophysiology of perioperative liver injury. Although epidural anesthesia (EDA) is a widely used technique, no data are available about the effects on hepatic blood flow of thoracic EDA with blockade restricted to thoracic segments in humans.In 20 patients under general anesthesia, we assessed hepatic blood flow index in the right and middle hepatic vein by use of multiplane transesophageal echocardiography before and after induction of EDA. The epidural catheter was inserted at TH7-9, and mepivacaine 1% with a median (range) dose of 10 (8-16) mL was injected. Norepinephrine (NE) was continuously administered to patients who demonstrated a decrease in mean arterial blood pressure below 60 mm Hg after induction of EDA (EDA-NE group). The other patients did not receive any catecholamine during the study period (EDA group). A further 10 patients without EDA served as controls (control group).In five patients, administration of NE was necessary to avoid a decrease in mean arterial blood pressure below 60 mm Hg. Thus, the EDA-NE group consisted of five patients and the EDA group of 15. In the EDA group, EDA was associated with a median decrease in hepatic blood flow index of 24% in both hepatic veins (P0.01). In the EDA-NE group, all five patients showed a decrease in the blood flow index of the right (median decrease 39 [11-45] %) and middle hepatic vein (median decrease 32 [7-49] %). Patients in the control group showed a constant blood flow index in both hepatic veins. Reduction in blood flow index in the EDA group and the EDA-NE group was significant in comparison with the control group (P0.05). In contrast to hepatic blood flow, cardiac output was not affected by EDA.We conclude that, in humans, thoracic EDA is associated with a decrease in hepatic blood flow. Thoracic EDA combined with continuous infusion of NE seems to result in a further decrease in hepatic blood flow.

Background Calcineurin-inhibitor-(CNI)-induced renal failure is one major cause of morbidity in cardiac transplantation (HTx). In this prospective, randomized, multicenter trial, the impact of immunosuppressive conversion toward CNI-free (mycophenolate mofetil [MMF] and sirolimus) or a CNI-reduced immunosuppressive regimen on renal function, efficacy, and safety was evaluated. Methods Since 2004, 63 HTx-patients (0.5-18.4 years after HTx) with CNI-based immunosuppression and reduced creatinine clearance less than 60 mL/min (39+/-15 mL/min) were included in this trial. Patients in the CNI-free-Group (group 1) were converted to sirolimus that was started with 2 mg/day until target trough levels (8-14 ng/mL) were achieved. Subsequently, CNIs were withdrawn. In CNI-reduction-Group (group 2), CNI target trough levels were reduced by 40%. In both groups MMF was continued and trough level adjusted (1.5-4 microg/mL). Results Patients demographics and survival (mean follow-up time: 16.7+/-9 months) was equal (100%). Renal function improved significantly after complete CNI withdrawal while remaining unchanged with CNI-reduction (Creatinine clearance after 12 months: 53+/-24 mg/dL [group 1] vs. 38+/-20 mg/dL [group 2], P=0.01). End-stage renal failure (hemodialysis) was avoided by CNI-withdrawal and occurred only after CNI reduction (n=6; P=0.01). Acute rejection episodes were more common in group 2 (4 vs. 2). Graft function remained stable (echocardiography) within both groups. Adverse events were more common in group 1 (65%) than in group 2 (n=40%) and were responsible for discontinuation in 4 and 0 cases, respectively. Conclusions Conversion toward a CNI-free immunosuppression (Mycophenolate, sirolimus) is superior to CNI-reduced immunosuppression in improving renal failure in late HTx-recipients. However, this benefit is relativized by the increased incidence and severity of sirolimus/MMF-associated side effects.

Purpose To evaluate efficacy and toxicity in elderly patients with glioblastoma multiforme (GBM) treated with postoperative radiochemotherapy with temozolomide (TMZ). Patients and Methods Forty-three patients aged 65 years or older were treated with postoperative with radiochemotherapy using TMZ for primary GBM. Median age at primary diagnosis was 67 years; 14 patients were female, 29 were male. A complete surgical resection was performed in 12 patients, subtotal resection in 17 patients, and biopsy only in 14 patients. Radiotherapy was applied with a median dose of 60 Gy, in a median fractionation of 5 × 2 Gy/wk. Thirty-five patients received concomitant TMZ at 50 mg/m 2 , and in 8 patients 75 mg/m 2 of TMZ was applied. Adjuvant cycles of TMZ were prescribed in 5 patients only. Results Median overall survival was 11 months in all patients; the actuarial overall survival rate was 48% at 1 year and 8% at 2 years. Median overall survival was 18 months after complete resection, 16 months after subtotal resection, and 6 months after biopsy only. Median progression-free survival was 4 months; the actuarial progression-free survival rate was 41% at 6 months and 18% at 12 months. Radiochemotherapy was well tolerated in most patients and could be completed without interruption in 38 of 43 patients. Four patients developed hematologic side effects greater than Common Terminology Criteria Grade 2, which led to early discontinuation of TMZ in 1 patient. Conclusions Radiochemotherapy is safe and effective in a subgroup of elderly patients with GBM and should be considered in patients without major comorbidities.

Fast-track programs have been introduced in many surgical fields to minimize postoperative morbidity and mortality. Morbidity after elective open infrarenal aneurysm repair is as high as 30%; mortality ranges up to 10%. In terms of open infrarenal aneurysm repair, no randomized controlled trials exist to introduce and evaluate such patient care programs.This study involved prospective randomization of 82 patients in a "traditional" and a "fast-track" treatment arm. Main differences consisted in preoperative bowel washout (none vs. 3 l cleaning solution) and analgesia (patient controlled analgesia vs. patient controlled epidural analgesia). Study endpoints were morbidity and mortality, need for postoperative mechanical ventilation, and length of stay (LOS) on intensive care unit (ICU).The need for assisted postoperative ventilation was significantly higher in the traditional group (33.3% vs. 5.4%; p = 0.011). Median LOS on ICU was shorter in the fast-track group, 41 vs. 20 h. The rate of postoperative medical complications was significantly lower in the fast-track group, 16.2% vs. 35.7% (p = 0.045).We introduced and evaluated an optimized patient care program for patients undergoing open infrarenal aortic aneurysm repair which showed a significant advantage for "fast-track" patients in terms of postoperative morbidity.

The aim of this study was to evaluate the functional outcome of patients treated for a fracture of the capitulum humeri and to analyze the grade of osteoarthritic changes. Patients undergoing surgical reconstruction of isolated capitulum humeri fractures were included in a retrospective comparative analysis. Fractures were classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) and Dubberley and were functionally evaluated by the American Shoulder and Elbow Surgeons Score (ASES) and the Mayo Elbow Performance Index (MEPI). Levels of arthritic changes were measured with the Broberg and Morrey Score. Frequency of complications was evaluated whereby all results were compared to the ipsilateral, unaffected side. Thirteen patients, ten females (76.9 %) and three males (23.1 %), with a mean age of 48.7 ± 13.3 years were included in the study. Long-term follow-up range of motion (ROM) in the sagittal plane was significantly influenced by time of surgery (p