Search

Funding Acknowledgements Type of funding sources: None. Background Both, the prevalence of obesity and incidence of cardiac implantable electronic device (CIED)-related complications are increasing worldwide. Transvenous laser lead extraction is a way to meet the rising complexity of cases, but knowledge about the impact of body-mass-index (BMI) on this procedure is limited. Methods and Results All patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database were stratified by BMI in accordance to the World Health Organization (WHO) definition. Patient characteristics, as well as procedural outcomes were analyzed. Within the group of obese patients (BMI ≥30kg/m2), predictors for adverse outcomes (procedural failure, complications, all-cause mortality) were assessed. A total of 2524 patients were divided into 5 groups (Underweight: BMI 35.0 kg/m2). Most patients (46.6%) were overweight (BMI 25.0-29.9kg/m2). The prevalence of metabolic comorbidities, such as arterial hypertension (84.2%; p Conclusion Laser lead extraction (LLE) in obese patients did not show higher rates of complications. Procedural time as well as duration of hospitalization was not prolonged. With considerate planning and in experienced centers, LLE is a safe and efficacious option for this patient collective. Systemic infection is the main driver of mortality in obese patients with BMI ≥ 30 kg/m2.

Funding Acknowledgements Type of funding sources: None. Background In an aging population with cardiac implantable electronic devices (CIED), an increasing number of octogenarians and even nonagenarians present for lead extraction procedures. Those patients are considered as having an increased risk for surgical procedures including lead extraction. Purpose We here investigated in a large patient cohort safety and efficacy of transvenous lead extraction with powered extraction sheaths in octo- and nonagenerians. Methods A subgroup analysis of the German Laser Lead Extraction Registry (GALLERY) registry was performed. 499 patients were aged ≥80 years and included in this analysis. Primary extraction method was Laser lead extraction, with additional use of mechanical rotational sheaths or femoral snares, if necessary. Predictors for complications and mortality were evaluated in multivariate analysis. Results Mean patients age was 84.3±3.7 years, 27.1% were female. 1196 leads were treated. The median lead dwell time was 118.0 (78;167) months. Clinical procedural success rate was achieved in 97.6% of the cases. Procedural failure was observed in 2.1%. Overall complication rate was 4.4%, including 1.8% major- and 2.6% minor complications. BMI Conclusion Laser lead extraction in octo- and nonagenarians, is safe and effective. BMI BMI≤20 kg/m2 was the only statistically significant predictor for procedural complications. According to our data, advanced age should not be considered as contraindication for laser lead extraction.

An efficient, scalable source of shaped single photons that can be directly integrated with optical fiber networks and quantum memories is at the heart of many protocols in quantum information science. We demonstrate a deterministic source of arbitrarily temporally shaped single-photon pulses with high efficiency (detection efficiency = 14.9%) and purity ($g^{(2)}(0) = 0.0168$) and streams of up to 11 consecutively detected single photons using a silicon-vacancy center in a highly directional fiber-integrated diamond nanophotonic cavity. Combined with previously demonstrated spin-photon entangling gates, this system enables on-demand generation of streams of correlated photons such as cluster states and could be used as a resource for robust transmission and processing of quantum information.

Funding Acknowledgements Type of funding sources: None. Background Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD). Objectives Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE. Methods We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed. Results A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p Conclusions Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.

We generate streams of high purity single photons from a single atom-like defect in a diamond nanophotonic cavity demonstrating an integrable system for quantum information processing.

Long-distance quantum communication and networking require quantum memory nodes with efficient optical interfaces and long memory times. We report the realization of an integrated two-qubit network node based on silicon-vacancy centers (SiVs) in diamond nanophotonic cavities. Our qubit register consists of the SiV electron spin acting as a communication qubit and the strongly coupled 29Si nuclear spin acting as a memory qubit with a quantum memory time exceeding two seconds. By using a highly strained SiV with suppressed electron spin-phonon interactions, we realize electron-photon entangling gates at elevated temperatures up to 1.5 K and nucleus-photon entangling gates up to 4.3 K. Finally, we demonstrate efficient error detection in nuclear spin-photon gates by using the electron spin as a flag qubit, making this platform a promising candidate for scalable quantum repeaters., Comment: 24 pages, 19 figures

Solid-state quantum emitters are promising candidates for the realization of quantum networks, owing to their long-lived spin memories, high-fidelity local operations, and optical connectivity for long-range entanglement. However, due to differences in local environment, solid-state emitters typically feature a range of distinct transition frequencies, which makes it challenging to create optically mediated entanglement between arbitrary emitter pairs. We propose and demonstrate an efficient method for entangling emitters with optical transitions separated by many linewidths. In our approach, electro-optic modulators enable a single photon to herald a parity measurement on a pair of spin qubits. We experimentally demonstrate the protocol using two silicon-vacancy center sin a diamond nanophotonic cavity, with optical transitions separated by 7.4 GHz. Working with distinguishable emitters allows for individual qubit addressing and readout, enabling parallel control and entanglement of both co-located and spatially separated emitters, a key step towards scaling up quantum information processing systems, Comment: 6 pages and 3 figures. Supplementary material, 13 pages and 13 figures, is available at the end of the manuscript

OnBehalf GALLERY investigators Background The number of cardiac implantable electronic device (CIED)-associated complications such as infection, lead dysfunction or thrombotic events is continuously rising and thus making transvenous lead extraction (TLE) an ever more needed procedure in clinical practice today. Patients with abandoned leads represent a special cohort with a potentially higher susceptibility to CIED-related infections and vascular complications. Moreover, according to literature abandoned leads seem to be associated with more procedural complications and mortality during TLE. Aim The aim of this study was to provide an insight on safety, procedural outcome and risk prediction on pacemaker patients with abandoned leads undergoing TLE from the largest national laser-sheath registry to date. Methods + Results: We conducted a retrospective analysis of the GALLERY database, which collected 2533 patients undergoing TLE in Germany between 2013 and 2017. Out of 903 pacemaker patients, who underwent TLE, 226 patients (25.0%) with abandoned leads were identified. Those patients had a higher number of leads per patient (3.2 ± 0.8 vs. 1.9 ± 0.3; ns) and longer lead dwell-times (168.0 ± 89.7 vs. 123.0 ± 69.2 months; p < 0.0001) compared to pacemaker patients without abandoned leads. There were no differences in age (71.5 vs. 72.3 years; ns), body mass index (26.5 ± 4.5 vs. 26.78 ± 4.8 kg/m2; ns) or gender distribution (69.0 vs. 66.5% male; ns). Leading indication for TLE was device infection with no difference between groups (79.7 vs 77.8 %; ns). There were no differences in terms of pacemaker dependency, length of hospitalization or comorbidities. Patients with abandoned leads had longer procedure times (112.0 ± 69.0 vs. 86.4 ± 53.0 minutes; p < 0.0001) and a higher incidence of procedural complications (6.6 vs. 3.1%; p = 0.03), but there were no differences in neither procedural and clinical success rates (96.5 vs. 97.3%; ns), nor all-cause mortality (1.33 vs. 2.66%; ns). Multivariate logistic regression revealed abandoned leads (OR 2.1, CI 1.0-4.4, p = 0.04) and female gender (OR 2.4, CI 1.2-4.9, p = 0.02) as independent predictors for procedural complications. Systemic infection (OR 5.4, CI 2.0-14.8, p = 0.001) and chronic kidney disease (OR 4.0, CI 1.5-10.7, p = 0.007) were strong predictors for all-cause mortality in patients with indwelling pacemaker. Patient age > 75 years (OR 3.9, CI 2.7-5.6, p < 0.0001) and a lead dwell-time > 10 years (OR 1.6, CI 1.1-2.2, p = 0.01) were identified as risk factors for an infectious cause for TLE. Conclusion Abandoned leads are frequently encountered in pacemaker patients undergoing TLE and pose an important risk factor for procedural complications. Systemic CIED-related infections are the strongest driver of mortality in this patient cohort and urgently call for further improvements in early diagnosis and prevention.

Der implantierbare Kardioverter-Defibrillator (ICD) stellt seit Jahrzehnten den Goldstandard in der Primar- und Sekundarprophylaxe des plotzlichen Herztodes (PHT) fur Patienten mit definiertem Hochrisikoprofil dar. Allerdings mahnen die aktuellen Leitlinien zur Zuruckhaltung bei der fruhzeitigen primarpraventiven ICD-Implantation im Rahmen erstmalig erhobener Risikokonstellationen. Auf diese Weise soll die Implantation eines, im weiteren Krankheitsverlauf nicht mehr indizierten ICDs vermieden werden. Anstelle dessen ist diesen Patienten eine angemessene Zeit zur Restitution der kardialen Grunderkrankung unter leitliniengerechter Therapie zu gewahren. Indikationsbereiche, bei denen Zuruckhaltung empfohlen wird, stellen u. a. herzchirurgische Eingriffe wie koronare Revaskularisations- oder Herzklappeneingriffe dar, insbesondere bei Patienten mit einer perioperativen linksventrikularen Ejektionsfraktion (LV-EF) von 35 % oder geringer. Oftmals kommt es hierbei namlich nach einer Remodeling-Phase zur deutlichen Erholung der kardialen Pumpfunktion mit Wiederanstieg der LV-EF. Folglich entfallt zu diesem Zeitpunkt die leitliniengerechte ICD-Indikation. Andererseits besteht gerade fur diese Patienten wahrend der Restitutionsphase ein hohes Risiko zum Auftreten von lebensbedrohlichen Herzrhythmusstorungen und somit fur den PHT. Vor diesem Hintergrund kommt dem tragbaren Kardioverter-Defibrillator (WCD) eine besondere Bedeutung zu. Dieser kann als passageres Defibrillatorsystem Patienten zuverlassig und effektiv vor dem PHT schutzen. Aus diesem Grund ist der Einsatz eines WCD nach aktuellen Leitlinien indiziert, wenn zum einen eine passagere, moglicherweise reversible Phase von erhohtem PHT-Risiko vorliegt oder zum anderen die Extraktion eines infizierten ICD-Systems mit der temporaren Kontraindikation zur zeitgleichen Neuimplantation eines ICD-Systems besteht. Nachfolgend werden daher neben der WCD-Funktionsweise die Anwendungsgebiete in der Kardiochirurgie, die aktuellen Studien- und Leitlinienempfehlungen sowie die Implementierung eines WCD-Programms in den klinischen Alltag aufgezeigt, um Arzten eine praxisgerechte Hilfestellung fur den klinischen Einsatz zu geben.

Vorhofflimmern ist eine haufige und potenziell lebensbedrohliche Erkrankung, die relevante Teile der Allgemeinbevolkerung betrifft. Der Verlust der atrialen Transportfunktion und die Reduktion des Herzzeitvolumens fuhren zu einer Erhohung der Inzidenz thrombembolischer Ereignisse und zu Einschrankungen der Lebensqualitat. Die Konversion in einen stabilen Sinusrhythmus hingegen ist mit einer Verbesserung von Lebensqualitat und Uberleben assoziiert. Auch wenn die medikamentose Therapie den Hauptteil des Behandlungsregimes darstellt, bietet die chirurgische Therapie hervorragende klinische Ergebnisse. Die ursprungliche, technisch anspruchsvolle „Cut-and-sew“-Technik wurde im Laufe der vergangenen 25 Jahre kontinuierlich weiterverbessert. Neue und innovative Linienkonzepte sowie neue Applikationsgerate haben die gegenwartige Cox-Maze-IV-Technik einer breiten Schicht von Herzchirurgen zuganglich gemacht. Eine Ubersicht uber aktuelle Linienkonzepte, Energiequellen und klinische Ergebnisse wird gegeben. Die chirurgische Therapie von begleitendem Vorhofflimmern ist mit vernachlassigbaren prozeduralen Risiken verbunden, bietet aber exzellente Konversionsraten in einen stabilen Sinusrhythmus.

Coronary artery bypass grafting (CABG) in dialysis-dependent patients with end-stage renal failure (ESRF) has become the standard treatment for CAD in this patient group, but is still considered as a risk procedure due to the increased mortality and morbidity. The avoidance of extracorporeal circulation in dialysis-dependent patients seems to be an attractive alternative. This retrospective study analyzed and compared our experience with CABG surgery with and without extracorporeal circulation in dialysis-dependent patients with ESRF. We analyzed the clinical results of isolated CABG in 73 dialysis-dependent patients with ESRF with and without the use of extracorporeal circulation. The on-pump group consisted of 43 patients (7 female and 36 male, 65 +/- 7.3 years) and the off-pump group included 30 patients (4 female and 26 male, 67 +/- 7.2 years). Demographic and preoperative data were comparable in both groups. Overall hospital mortality rate was 4.2 % (n = 3), two patients (4.6 %) in the on-pump group and one patient (3.3 %) in the off-pump group died due to noncardiac reasons. Morbidity was comparable in both groups. The mean number of grafts was 3.1 +/- 0.9 in the on-pump group and 2.9 +/- 0.8 in the off-pump group. During follow-up, 13 patients (30.2 %) in the on-pump group died, nine of these patients (69.2 %) due to cardiac reasons; eight patients (26.7 %) in the off-pump group died, mostly due to cardiac reasons (n = 5, 62.5 %). CABG can be performed in patients with dialysis-dependent ESRF with good clinical results and low morbidity with two different surgical approaches. Midterm results are still affected by cardiac events.

ICU patients are exposed to adverse events, which are defined as unintended complications but are preventable.

There is a big divergence regarding the indexes that show whether an extubation process is successful or not. Regardless of this, the spontaneous breathing trial is the most recommended for that aim.

Koronarchirurgische Interventionen betreffen mit zunehmender Haufigkeit Patienten in der achten Lebensdekade. Gleichwohl stellen diese, bei relativ hoher Morbiditat und Mortalitat, eine Hochrisikogruppe dar. In den vergangenen Jahren konnte sich die Off-pump-Chirurgie innerhalb der Koronarchirurgie etablieren. Insbesondere fur Hochrisikopatienten scheint der Verzicht der extrakorporalen Zirkulation (EKZ) eine sinnvolle Alternative. Im Rahmen einer retrospektiven Untersuchung untersuchten wir den klinischen Verlauf nach isolierter koronarchirurgischer Versorgung von Patienten in der achten Lebensdekade mit und ohne Einsatz der EKZ. Gegenstand der Untersuchung waren 344 isoliert koronarchirurgisch therapierte Patienten (219 Manner, 125 Frauen; Alter 82±2,4 Jahre) mit einem Alter von mindestens 80 Jahren. Die Patienten wurden zwei Gruppen in Abhangigkeit des Einsatzes der EKZ zugeteilt. Die On-pump-Gruppe bestand aus 237 Patienten (151 Manner, 86 Frauen; Alter 82±2,4 Jahre), die Off-pump-Gruppe beinhaltete 107 Patienten (68 Manner, 39 Frauen; Alter 82±1,9 Jahre). Der EUROSCORE sowie das daraus abgeschatzte Mortalitatsrisiko waren fur beide Gruppen vergleichbar. Die Hospitalmortalitat beider Gruppen betrug 5,5% (n=17), davon verstarben 14 Patienten (5,9%) der On-pump-(n=237=100%) und funf Patienten (4,6%) der Off-pump-Gruppe (n=107=100%). Die durchschnittliche Anzahl der Grafts betrug in der On-pump-Gruppe 2,8±0,4 und 2,4±0,6 in der Off-pump-Gruppe (p=0,05). Vergleichbar in beiden Gruppen war die Morbiditat. Signifikante Risikoerhohung ergab sich in der Multivarianzanalyse fur praoperativ bestehende Arrhythmia absoluta (p=0,03, RR=2,7), COPD (p=0,0001, RR=6,5) und postoperativ verlangerte Intubationsdauer (p=0,005, RR=4,1). Der isoliert koronarchirurgische Eingriff kann bei Patienten in der achten Lebensdekade mit guten klinischen Ergebnissen durchgefuhrt werden, auch wenn eine substantiell erhohte Mortalitat verbleibt. Die Ergebnisse hinsichtlich der Anwendung der EKZ sind mit und ohne derselben innerhalb dieser Patientengruppe bezuglich Mortalitat und Morbiditat vergleichbar.

Die chirurgische Behandlung des Vorhofflimmerns durch das klassische MAZE-Verfahren oder andere Ablationsmethoden resultiert in Konversionsraten in den Sinusrhythmus von 50–90%. Bis heute liegen keine Ergebnisse zum Einfluss der Ablationsbehandlung auf die Mortalitat vor. In einer prospektiven Registerstudie wurden 210 konsekutive Patienten mit permanentem Vorhofflimmern hinsichtlich peri- und postoperativer Mortalitat nach herzchirurgischen Eingriffen uber 2 Jahre nachverfolgt. Bei 111 Patienten wurde eine endokardiale Mikrowellenablation durchgefuhrt, 99 Patienten wurden ohne Ablation operiert. In der Ablationsgruppe starb ein Patient (0,9%) perioperativ, weitere sieben starben wahrend des ersten Jahres (6,3%) und neun wahrend des zweiten Jahres des follow-ups (8,1%). In der Kontrollgruppe verstarben funf Patienten perioperativ (5,1%), 12 Patienten starben innerhalb des ersten Jahres (12,1%) und 22 innerhalb des zweiten Jahres des follow-ups (22,2%). Daraus ergab sich eine signifikant hohere Mortalitat in der Kontrollgruppe gegenuber der Ablationsgruppe (Log-Rank-Test: p=0,0051). Die Ergebnisse dieser Registerstudie zeigen, dass unter Patienten mit permanentem Vorhofflimmern die Mortalitat nach herzchirurgischen Eingriffen mit Mikrowellenablation signifikant geringer ist als bei vergleichbaren Eingriffen ohne Ablationsbehandlung. Der deutliche Mortalitatsunterschied basierte vor allem auf den typischen Folgen des Vorhofflimmerns (thrombembolische Komplikationen, kardiale Arrhythmien und Blutungen unter Antikoagulanzientherapie), welche in der Ablationsgruppe seltener auftraten.

Postinfarct patients with malignant ventricular tachyarrhythmias (VTs) are prone to an increased risk for sudden cardiac death and implantation of an internal cardioverter-defibrillator (ICD) often is recommended. In cases where the VTs are incessant or refractory to medical treatment, disruption of the macro-reentry circuit, which represents the arrhythmogenic substrate for postinfarct VTs, is a major therapeutical goal for electro-physiologists. The precise identification of this underlying macro-reentrant circuit depends on conventional mapping techniques (i.e. diastolic potentials, entrainment) and more recently by a three-dimensional non-fluoroscopic electro-anatomical mapping system (CARTO), which integrates anatomical and electrophysiological information to reconstruct a three-dimensional activation and propagation map of the relevant VT. This reports describes on a patient with recurrent, drug-refractory, hemodynamically stable monomorphic VTs on the basis of a 2-vessel coronary artery disease, reduced left ventricular ejection fraction, who was scheduled for coronary artery bypass graft operation combined with mitral valve replacement and reconstruction of the tricuspid valve. Preoperatively, the underlying mechanism of the VT was identified by CARTO mapping with a slow conduction zone and a wide exit site at the inferoapico-basal portion of the left ventricle. In close cooperation between the cardiologists and the surgeons the decision for a simultaneous ablation approach during the subsequent operation was made. Successful ablation of the VT using microwave energy was confirmed by non-inducibility of the VT in the perioperative electrophysiologic study. This case report highlights the use of CARTO mapping to identify postinfarct VTs as well as the application of microwave energy as a useful tool to cure postinfarct ventricular arrhythmias.

Der Anteil von Patienten mit dialysepflichtigem terminalem Nierenversagen und koronarer Herzerkrankung (KHK) hat in den letzten Jahren zugenommen. Die koronare Bypassoperation hat sich als Standardtherapie in dieser Patientengruppe etabliert, gilt jedoch als Risikoeingriff aufgrund erhohter Mortalitat und Morbiditat. In einer retrospektiven Analyse wurden die klinischen Daten und Ergebnisse der isolierten koronaren Bypassoperation bei 40 dialysepflichtigen Patienten mit terminaler Niereninsuffizienz (5 Frauen, 35 Manner, Alter 65±7 Jahre) untersucht und der perioperative Verlauf mit einer Kontrollgruppe von 51 Patienten (10 Frauen, 41 Manner, Alter 67±7,3 Jahre) mit normaler Nierenfunktion und isoliertem koronarchirurgischem Eingriff verglichen. Zusatzlich erfolgte ein Follow-up der Dialysegruppe (mittlerer Beobachtungszeitraum 34±24 Monate). Demographische und klinische Daten der beiden Gruppen waren vergleichbar. Die Hospitalmortalitat war bei vergleichbarer Morbiditat 2,5% (n=1) in der Dialysegruppe und 0% in der Kontrollgruppe. Die Anzahl der Bypasse lag bei 3,1±0,9 in der Dialysegruppe und 2,9±0,8 in der Kontrollgruppe. Im gesamten Beobachtungszeitraum verstarben 8 Patienten, dabei fand sich bei 4 Patienten eine kardiale Genese. Die isolierte Koronarchirurgie kann bei Patienten mit dialysepflichtigem Nierenversagen mit guten klinischen Ergebnissen und geringer Morbiditat durchgefuhrt werden.

Die chirurgische Therapie der nativen infektiosen Endokarditis gilt weiterhin als Herausforderung aufgrund gleich bleibend hoher Morbiditat und Mortalitat bis zu 20%. Die Risikoanalyse des klinischen Verlaufes bleibt Voraussetzung fur eine Verbesserung der chirurgischen Ergebnisse. In einer retrospektiven Analyse erfolgte die Betrachtung verschiedener klinischer Faktoren bei chirurgischer Therapie der nativen infektiosen Endokarditis. Retrospektiv analysiert pra-, intra- und postoperative Faktoren bei 165 Patienten (130 Manner, 5 Frauen, Alter 55,5±13,8 Jahre) mit chirurgischer Therapie der nativen Endokarditis im Zeitraum von 02/97–12/2003. Die Hospitalmortalitat war 7,3% (n=8), im Rahmen der Nachbetrachtung (mittlerer Beobachtungszeitraum 3,3±2,5 Jahre) verstarben 38 Patienten (23%). Bei 121 Patienten (73,3%) war der klinische Verlauf unauffallig. Risikofaktoren waren hohes Alter, Notfalloperation, COPD und Diabetes mellitus, lange Perfusionszeit, prolongierte Beatmungsdauer und Blutung. Die chirurgische Therapie der nativen infektiosen Endokarditis ist mit guten klinischen fruh- und mittelfristigen Ergebnissen verbunden, dennoch verbleiben Risikokonstellationen, die vor allen von pra- und postoperativen Faktoren bestimmt wird.

Summary Previous work on various organs and tissues has shown that ischemic preconditioning protects against reperfusion injury in these organs and also against secondary effects in the lung. In contrast, the purpose of this study was to investigate the effects of preconditioning in a remote organ (hind limb ischemia) on an ischemia/reperfusion (I/R) treatment of the lung itself. A porcine model of in situ left lung ischemia (90 min) and reperfusion (5 h) was used. Systemic preconditioning was induced by clamping the left common femoral artery (3 × 5 min). Lung injury was assessed in terms of pulmonary vascular resistance, pulmonary artery pressure, pulmonary venous and arterial pO2, and tissue macrophage counts. The zymosan-stimulated release of reactive oxygen species (ROS) in whole blood was determined by a chemiluminometric procedure. Inflammatory cytokines (interleukin-1β and interleukin-6) were measured in arterial plasma as indicators of a systemic inflammatory reaction. Preconditioning by hind limb ischemia completely prevented the I/R-induced functional impairment of the lung, the pulmonary hypertension and the reduced oxygenation capacity. The plasma levels of interleukin-1β and the macrophage counts in preconditioned animals were reduced to control values, whereas the levels of interleukin-6 and the release of ROS were not affected by preconditioning. In conclusion, systemic preconditioning by repeated hind limb ischemia protects against acute I/R injury of the lung but not against all indices of reperfusion-associated systemic inflammation.

Im Rahmen einer Registerstudie wurden alle Patienten mit permanentem Vorhofflimmern erfasst, bei denen im Rahmen einer elektiven Herzoperation zusatzlich eine Mikrowellen-Ablation durchgefuhrt wurde. Aus dem Register wurden nur Operationen von einem Operateur ausgewertet um eine Intraoperateurvariabilitat zu vermeiden. In die Auswertung gelangten so 136 Patienten mit einer intraoperativen Mikrowellen-Ablation und 51 Patienten als Kontrollgruppe (gleiche OP ohne Ablation). Schwerwiegende Komplikation der Ablationstherapie traten nicht auf. Wahrend in der Ablationsgruppe 64% nach 6 bzw. 62% der Patienten nach 12 Monaten einen stabilen Sinusrhythmus aufwiesen, waren dies in der Kontrollgruppe 8 bzw. 10%. Die intraoperative Ablation mit Mikrowellenenergie fuhrt in Verbindung mit einer antiarrhythmischen Begleittherapie damit signifikant haufiger (p

Background Recently, there has been renewed interest in simplifying a surgical cure for atrial fibrillation. Microwave energy ablation provides an easier and faster surgical technique, in lieu of traditional "cut and sew," which can also be applied on the beating heart. Methods Specific absorption rate (SAR) and thermal profiles were determined after microwave energy ablation intended for clinical application. Lesion geometry measures obtained in vitro with tissue equivalent media were compared with values collected from animal myocardium. Results Thermal profile analysis demonstrated lesion penetration depths of 2.5, 3, and 5 mm after 8, 16, and 24 seconds, respectively, with microwave power application of 40 W. Dosimetric studies performed using animal myocardium corresponded to the thermal profile analysis and showed that lesion depth was controlled by the output power and the ablation time. Conclusions Lesion geometry in tissue using microwave energy is similar to that predicted from in vitro analysis. The ablation depths and thermal profile of microwave ablation is favorable for performing atrial ablation, and this is corroborated by favorable early clinical results.

Objectives: Despite evidence-based guideline recommendations for performing concomitant ablation in case of preexisting symptomatic atrial fibrillation, the real-life implementation remains slow-moving. The present monocentric registry gives information of truth and legends of the assumption that extracorporal circulation; functionally equaling a cardioversion, as well as surgical treatment of the underlying cardiac disease could be sufficient for restoring stable sinusrhythm. Patients and methods: The present monocentric, prospective registry included 287 patients with persistent atrial fibrillation undergoing cardiac surgery and being not concomitantly ablated. The enrollment dated back into the early ablation era (2003). Postoperative visits evaluating the heart rhythm by 24-hours ECG were performed 30, 90, 180 and 360 days after the procedure. Study end-point was stable sinusrhythm at the end of the follow-up period. Results: Performed procedures were CABG (51.6%), aortic valve replacement (39.0%), mitral valve repair/replacement (34.8%) and tricuspid valve repair (8.4%), including 57.1% combined procedures. Permanent pacemaker implantation became necessary in 18 patients (6.3%). Standard medical treatment included metoprolol in each patient. Hospital- and 1-year mortality was 6.99% and 14.98%, respectively. At discharge, 29 patients (10.1%) had stable sinusrhythm. During follow-up, 16 of these converted into atrial fibrillation and at the end of follow-up only 13 patients (4.5%) remained in sinusrhythm. Conclusion: Spontaneous conversion rate into stable sinusrhythm after cardiac surgery is negligible low. Since even worst estimations of efficacy of concomitant ablation therapy report 10-times higher conversion rates into stable sinusrhythm than observed in the native course, concomitant ablation therapy should routinely be applied in patients presenting with atrial fibrillation.

Transtibial amputees gait patterns are widely studied. Usually, kinematic and temporal-spatial parameters data are used to investigate their gait pattern. The Gait Profile Score (GPS) and the Movement analysis Profile (MAP) are new tolls that summarize kinematics data in one single number. The aim of this study was to use GPS, Movement analysis Profile (MAP) and temporal-spatial parameters to quantify gait deviations of a homogeneous group of transtibial amputees, using the same prosthetic components and that were rehabilitated in a specific center. Besides, it was observed the correlation between GPS scores and temporal-spatial parameters. Five unilateral traumatic transtibial amputees participated on this study. All the participants used KBM (Kondylen Bettung Munster) prosthetic fitting and solid ankle cushion heel (SACH) foot. Kinematic and temporal-spatial data were assessed through 3D gait analysis. All analyzed variables presented deviations compared with normal expected values. Prosthetic limb GPS score was larger than intact limb GPS score as well as step length with the prosthetic leg was longer than with the intact one. Time of single support with the intact limb was longer than that with the prosthetic limb. The largest gait variable scores (GVS) were in the hip flexion/extension for the prosthetic limb, knee flexion/extension for the intact limb, and hip rotation for both. The strongest correlation occurred between overall GPS and prosthetic step length, overall GPS and time of single support with the prosthetic limb, prosthetic limb GPS and prosthetic step length, and between prosthetic limb GPS and time of single support with the prosthetic limb. The GPS, MAP and temporal-spatial parameters were useful in quantifying gait deviation on transtibial amputees. GPS scores were increased and temporal-spatial parameters values were lower than that found in health subjects.

Background . Presently no ideal prosthesis for mitral valve replacement exists. The quadrileaflet mitral valve (SJM-Quattro-MV; St. Jude Medical, Inc, St. Paul, MN) is a chordally supported stentless bioprosthesis. Due to its specific geometry it seems to be particularly suited for mitral valve replacement. Methods . From March 1999 to October 2000, 12 patients (ages 71 ± 2 years) received the SJM-Quattro-MV. Six patients suffered from valvular stenosis and 6 patients from incompetence. Preoperatively, all patients were in New York Heart Association functional class III, with left ventricular ejection fraction amounts of 54% ± 17%. Results . Eleven patients received a medium size SJM-Quattro-MV and one patient received a large size SJM-Quattro-MV. Cross-clamp time was 99.8 ± 4.9 minutes. Additional procedures were coronary artery bypass grafting (n = 3) and left atrial microwave ablation (n = 2). Postoperative mortality (n = 1) was procedure related. At follow-up of 11.6 ± 5.4 months, all patients were well, the transvalvular pressure gradient was 5.0 ± 1.4 mm Hg, and the effective orifice area 2.7 ± 0.2 cm 2 . Conclusions . Our preliminary experiences with the SJM-Quattro-MV presented good clinical results and promoted an optimistic way of thinking about the further development of these valve prostheses.

In order to evaluate the benefit provided through less invasive surgical techniques for the treatment of multivessel coronary artery disease, a prospective clinical trial was started.Group 1 included 53 patients (38 males, 15 females, age 51-79 years, mean 62.8 +/- 6.1 years) receiving conventional bypass surgery, group 2 included 69 patients (59 male, 10 female, age 43-82 years, mean 61.9 +/- 8.6 years) receiving less invasive surgical procedure including minithoracotomy in combination with cardiopulmonary bypass.No perioperative death occurred in the whole series of patients. Time of operation was 267 +/- 61 min in group 2 and 162.9 +/- 53.6 min in group 1. Intensive Care Unit stay was 1 day for both groups and Hospitalization 6.9 +/- 6.0 for group 1 and 7.5 +/- 2.6 days for group 2. Perioperative bleeding was less in group 2 (P0.01). Back and chest pain assessment on postoperative day 3 showed less pain in group 2 (P0.05). Three-month follow-up revealed ischemia in stress electrocardiogram in two patients (3.8%) in group 1 and in 2 patients (2.9%) in group 2. Coronary angiograms confirmed the stress ECG findings. There was one (1.4%) redo operation in group 2 and two (3.8%) in group 1.Both techniques are equal efficient. Even though time of operation is longer in patients receiving less invasive procedure, intensive care unit stay and hospitalization is exactly as long. Patients receiving minimally invasive surgery bleed less and have less pain early postoperatively.

OBJECTIVES In order to evaluate the benefit provided through less invasive surgical techniques for the treatment of multivessel coronary artery disease, a prospective clinical trial was started. METHODS Group 1 included 53 patients (38 males, 15 females, age 51-79 years, mean 62.8 +/- 6.1 years) receiving conventional bypass surgery, group 2 included 69 patients (59 male, 10 female, age 43-82 years, mean 61.9 +/- 8.6 years) receiving less invasive surgical procedure including minithoracotomy in combination with cardiopulmonary bypass. RESULTS No perioperative death occurred in the whole series of patients. Time of operation was 267 +/- 61 min in group 2 and 162.9 +/- 53.6 min in group 1. Intensive Care Unit stay was 1 day for both groups and Hospitalization 6.9 +/- 6.0 for group 1 and 7.5 +/- 2.6 days for group 2. Perioperative bleeding was less in group 2 (P > 0.01). Back and chest pain assessment on postoperative day 3 showed less pain in group 2 (P < 0.05). Three-month follow-up revealed ischemia in stress electrocardiogram in two patients (3.8%) in group 1 and in 2 patients (2.9%) in group 2. Coronary angiograms confirmed the stress ECG findings. There was one (1.4%) redo operation in group 2 and two (3.8%) in group 1. CONCLUSIONS Both techniques are equal efficient. Even though time of operation is longer in patients receiving less invasive procedure, intensive care unit stay and hospitalization is exactly as long. Patients receiving minimally invasive surgery bleed less and have less pain early postoperatively.

Background . In a prospective clinical trial, a group of patients receiving less invasive surgical procedure, including minithoracotomy in combination with cardiopulmonary bypass (group 1), was compared to a group of patients receiving conventional bypass surgery (group 2) for the treatment of coronary artery disease. Methods . Group 1 included 85 patients (71 men, 14 women, aged 39 to 82 years, median 61.1 ± 9.0 years); group 2 included 53 patients (38 men, 15 women, aged 51 to 79 years, median 62.0 ± 6.1 years). Results . There were no perioperative deaths in the whole series of patients. Time of operation was 256 ± 43 minutes in group 1 and 150.0 ± 53.6 minutes in group 2. Hospitalization was 6.0 ± 1.4 days and intensive care unit stay 1 day for both groups. Back pain assessment on postoperative day 3 showed less pain in group 1. Three-month follow-up revealed ischemia in stress electrocardiogram in 2 patients (2.5%) in group 1 and in 2 patients (4.1%) in group 2. Coronary angiograms confirmed the stress-electrocardiogram findings. Conclusions . Surgical results are equal for both techniques. Even though time of operation is longer in patients receiving less invasive procedures, intensive care unit stay and hospital stays are the same length. Early postoperative back pain is less in group 1 and combined with faster convalescence.

Concomitant microwave ablation for curative treatment of atrial fibrillation (AF) was performed in 18 patients with history of chronic atrial fibrillation and indication for open heart surgery, 11 patients with mitral valve replacement and 7 patients with coronary artery bypass grafting. There were no perioperative complications. During the postoperative period most of the patients had intermittent AF, they received low dose Sotalol therapy and electric cardioversions. Up to now seven patients have reached follow-up day 90. One patient has persistent AF. Two patients had typical atrial flutter that was electrically converted to sinus rhythm (SR), isthmus ablation is planned. The other four patients have SR, one patient without cardioversions. These four patients show recovered atrial function with observed A-wave for transmitral flow. Under visual guidance the continuous atrial lesion lines could be induced effectively and safely by the intraoperative device Lynx.

Objective: The treatment of coronary single vessel disease under minimally invasive surgical conditions was followed by the treatment of coronary multivessel disease using a new technique. Methods: Using this technique 100 patients (80 male, 20 female, median age 61.0 ± 8.9 years, ranged from 39 to 82 years) with coronary single vessel disease, double vessel disease or multivessel disease were treated between November 1996 and December 1997. Via a small (6-9 cm) left lateral chest incision in the second or third intercostal space, the left internal thoracic mammary artery (LIMA) was harvested and access to the central portion of the heart including the ascending aorta was obtained. In parallel, saphenous vein segments were harvested. Arterial cannulation was instituted via the ascending aorta, thus avoiding retrograde flow. In all patients except three the LIMA was used for the left anterior descending artery (LAD). In addition vein grafts were used for revascularization of the other coronary arteries. All cardiac anastomoses were performed during cardioplegic arrest after external aortic cross clamping and antegrade application of cardioplegia. Results: No death or intraoperative complications were observed in this series. The median hospital stay was 6.0 ± 1.4 days (median ± SEM). Postoperative complications were reexplored for bleeding (n = 1), delayed wound healing (n = 2), wound infections (n = 4), lymphatic fistulas (n = 4), and a chest wall hernia (n = 1). Conclusions: This minimally invasive surgical technique presents a safe alternative to conventional coronary artery surgery avoiding sternotomy related complications and decreasing hospital stay and morbidity.

Grundlagen: Um die mediane Sternotomie und die mit ihr verbundenen Komplikationen zu vermeiden, wurden in der Herzchirurgie minimal-invasive-chirurgische Techniken — mit und ohne Einsatz der Herz-Lungen-Maschine (HLM) — eingefuhrt.

Background: Patients with permanent atrial fibrillation have a clearly higher risk for thromboembolic events than people with sinus rhythm. Because also anticoagulant therapy, which is the therapy of choice in chronic atrial fibrillation, has its risks, intra operative ablation therapy as a concomitant procedure has become more and more important. Nevertheless this option is not available for all patients and little is known whether the operation by its self is able to restore sinus rhythm and about the fate of these patients. Therefore we created a registry to follow the clinical course of patients with atrial fibrillation after heart surgery. Method: All consecutive patients with permanent atrial fibrillationwho were operated in our center and who were not eligible for ablation therapy were included into the registry. The patients were monitored up to postoperative month 12 with regard to their clinical outcome especially rhythm course and survival. These data were evaluated during in-hospital visits 30, 90, 180 and 360 days after operation. Results: A total of 287 (151 male/136 female) consecutive patients with permanent atrial fibrillation were included into the registry. During the follow-up period, approximately 10% of the patients converted to sinus rhythm. 13 patients, or 4.9%, were in stable sinus rhythm, which means that they were in sinus rhythm at every follow-up visit. 30-day mortality was 6.9% (20 of 286 patients) while it was 14.9% after one year (43 of 263 patients). Of the 13 patients who were in stable sinus rhythm after one year, only one patient died (7.7%), while of the 185 patients who where still in atrial fibrillation 43 died (23.2%). Conclusion: Our results demonstrate that also correction of the heart disease by it self is able to restore sinus rhythm in a few patients. Nevertheless the rate of patients with continuous atrial fibrillation was approximately 90%, the rate of stable sinus rhythm, which is suspected to improve prognosis was only 4.9%. Therefore, an attempt to treat atrial fibrillation with intra operative ablation therapy is strongly justified, respecting the fact that, even if conservatively calculated, a success rate of at least 50% can be accomplished. We believe, that this applies even for endocardial and for the epicardial approach. 278 M. Knaut, S. Norkus, S. M. Tugtekin, S. Brose, F. Jung, K. Matschke with intelectual limited capacity without an appropriate social sphere, which in the meantime represent a large portion of patients scheduled for heart surgery [14, 20]. Overdosage poses a risk of hemorrhages [21], whereas underdosage can lead to thromboembolic complications. Additionally, even adequate anticoagulation therapy is not a guarantee of adequate protection [1]. Since only an insufficient amount of data currently exist regarding whether heart surgery alone i.e. bypass and/or valve operations leads to a spontaneous recovery of sinus rhythm, a prospective case study was performed including a sufficiently large group of patients who underwent operations without specific operative antiarrhythmic therapy with preoperative atrial fibrillation. These patients were monitored for up to 12 months postoperatively with regard to rhythm course and survival.