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Der aus Heilbronn stammende Apotheker Gustav Mayer war zweifellos die schillerndste politische Figur im Amtsbezirk Sinsheim während der Revolution von 1848/49. Er kam aus gut situierten bürgerlichen Verhältnissen. Die Familie Mayer war seit Generationen in Heilbronn ansässig gewesen und gehörte zu den Honoratioren der Stadt. Wie sein älterer Bruder Friedrich (Fritz) ergriff der am 22. August 1810 geborene Gustav Mayer den väterlichen Beruf des Apothekers. Nach seiner Heirat mit Amalie Eberbach (1836 in Großgartach), die ihm später in schweren politischen Zeiten aufopferungsvoll zur Seite stand, erwarb Mayer um 1840 die Apotheke in Meßkirch. Der Württemberger Mayer nahm damals die badische Staatsbürgerschaft an und verdiente sich als Mitglied des Meßkircher Gemeinderates seine ersten politischen Sporen.

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.

The study was approved by the institutional review board (IRB) at the University Medical Center Campus Kiel, Kiel, Germany (reference number: AZ D 559/18) and registered at the German Clinical Trials Register (reference number: DRKS00022222). Objective. Unilateral pulmonary edema (UPE) is a complication after minimally invasive mitral valve surgery (MIMVS). We analyzed the impact of this complication on the short- and long-term outcome over a 10-year period. Methods. We retrospectively observed 393 MIMVS patients between 01/2009 and 12/2019. The primary endpoint was a radiographically and clinically defined UPE within the first postoperative 24 h, secondary endpoints were 30-day and long-term mortality and the percentage of patients requiring ECLS. Risk factors for UPE incidence were evaluated by logistic regression, and risk factors for mortality in the follow-up period were assessed by Cox regression. Results. Median EuroSCORE II reached 0.98% in the complete MIMVS group. Combined 30-day and in-hospital mortality after MIMVS was 2.0% with a 95, 93 and 77% survival rate after 1, 3 and 10 years. Seventy-two (18.3%) of 393 patients developed a UPE 24 h after surgery. Six patients (8.3%) with UPE required an extracorporeal life-support system. Logistic regression analysis identified a higher creatinine level, a worse LV function, pulmonary hypertension, intraoperative transfusion and a longer aortic clamp time as predictors for UPE. Combined in hospital mortality and 30-day mortality was slightly but not significantly higher in the UPE group (4.2 vs. 1.6%, p = 0.17). Predictors for mortality during follow-up were age ≥ 70 years, impaired RVF, COPD, drainage loss ≥ 800 mL and length of ventilation ≥ 48 h. During a median follow-up of 4.6 years, comparable survival between UPE and non-UPE patients was seen in our analysis after 5 years (89 vs. 88%, p = 0.98). Conclusions. In-hospital outcome with UPE after MIMVS was not significantly worse compared to non-UPE patients, and no differences were observed in the long-term follow-up. However, prolonged aortic clamp time, worse renal and left ventricular function, pulmonary hypertension and transfusion are associated with UPE.

Background: Acute type A aortic dissection (AAAD) is considered a fatal disease which requires an emergent surgical intervention. This study focuses onthe neurological outcome after surgical repair in cases of AAAD in comparison between elderly and young patients. Methods: a retrospective analysis of 368 consecutive patients who underwent emergency surgery of ascending aorta in moderate hypothermic circulatory arrest (MHCA) (20–24 °C) and antegrade cerebral perfusion after AAAD between 2001 and 2016. Patients were divided into two groups: those aged 75 years and older (68 (18.5%)) and those younger than 75 years (300 (81.5%)). Results: Comparing both groups, average age was 79.0 ± 3.2 vs. 59.2 ± 10.7 years (p &lt, 0.001), female gender represents 58.8% of elderly patients vs. 28.7% in younger patients (p &lt, 0.001). Intraoperatively, cardiopulmonary bypass time (155 min (131, 187) vs. 171 min (137, 220), p = 0.012), cross-clamping time (79 min (60, 105) vs. 93 min (71, 134), p = 0.001] and circulatory arrest time (29 min (22, 40) vs. 33 min (26, 49), p = 0.011) were significantly shorter in elderly than younger group. Postoperatively, there was no significant difference in delirium (11.8% vs. 20.5%, p = 0.0968) or stroke (11.8% vs. 16.1%, p = 0.369). The 30-day mortality was satisfactory for both groups but significantly higher in the elderly group (27.9% vs. 14.3%, p = 0.007). Conclusion: The current study concluded that surgical treatment of AAAD in elderly patients can be applied safely without increasing risk of neurological complication. However, minimizing operation time may help limit the occurrence of postoperative neurological complication.

Background: Active infective endocarditis (IE) is a serious disease associated with high mortality. The current study represents our experience over 18 years with surgical treatment for active infective native and prosthetic valve endocarditis (INVE, IPVE). Method: Analysis of 413 patients (171 with IPVE vs. 242 with INVE) who underwent cardiac surgery due to IE between 2002 and 2020. Results: Patients with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years, p &lt, 0.001) with higher EuroSCORE II (21.2 (12.7, 41.8) vs. 6.9 (3.0, 17.0), 0.001)) and coronary heart disease (50.6% vs. 38.0%, 0.011). Preoperative embolization was significantly higher within INVE (35.5% vs. 16.4%, 0.001) with high incidence of cerebral embolization (18.6% vs. 7.6%, p = 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%, 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs.15.7%, 0.001). Intraoperatively, the duration of surgery was expectedly significantly higher in the IPVE group (356 min vs. 244 min., p = 0.001) as well as transfusion of blood (4 units (0–27) vs. 2 units (0–14), 0.001). Post-operatively, the incidence of bleeding was markedly higher within the IPVE group (700 mL (438, 1163) vs. 500 mL (250, 1075), p = 0.005). IPVE required significantly more permanent pacemakers (17.6% vs. 7.5%: p = 0.002). The 30-day mortality was higher in the IPVE group (24.6% vs. 13.2%, 0.003). Conclusion: Patients with INVE suffered from a higher incidence of cerebral embolization and neurological deficits than patients with IPVE. Surgical treatment in INVE is performed mostly as an emergency indication. However, patients with IPVE were represented commonly with intracardiac abscess, and had a higher indication of pacemaker implantation. The short- and long-term mortality rate among those patients was still high.

Additional file 1: Supplementary Table 1. Pre- and intraoperative variables with univariate association to 30-d-mortality (p-values ≤0.10), Supplement to Table 4 in original article.

Extended material and methods section. (DOCX 25 kb)