Background: ERAS (enhanced recovery after surgery) is an integrative, interdisciplinary perioperative protocol aiming to improve recovery and reduce complications after major surgery. Core elements are appropriate patient selection, minimally invasive approach, immediate extubation after surgery in the operating room, transfer to the recovery unit, intensive physiotherapy under adjusted pain medication, and early discharge from hospital. We aimed to analyze initial results of ERAS in minimally invasive heart surgery (MIHS) which was implemented in university hospital without previous ERAS experience.

Objectives: Coronary artery aneurysms are uncommon and in many cases incidental findings during coronary angiography. Etiology remains often unclear. Known reasons are atherosclerosis, congenital abnormalities, infections (syphilis, mycotic), rheumatic diseases (lupus erythematosus, Kawasaki disease), trauma or iatrogenic. Most aneurysms are asymptomatic but they can be associated with chest pain. There is no consensus on its management.

Objectives: The major drawback of isolated annuloplasty in the treatment of functional mitral regurgitation (FMR) with restricted leaflet motion during systole (type IIIb) is the reoccurrence of MR, leading to an impaired long-term outcome. Additional realignment of both papillary muscles specifically addresses leaflet tethering to durably restore MV geometry. We aimed to prospectively compare the long-term outcome of annuloplasty with simultaneous realignment of both papillary muscles versus isolated annuloplasty.

Objectives: Mechanosensation and mechanotransduction belong to the most fundamental processes in biology. Especially in the cardiovascular system a mechanosensitive feedback mechanism is essential to adapt to different physiological demands. Piezo2 is a mechanosensitive ion channel and has a role in rapidly adapting mechanically activated currents in somatosensory neurons. Its expression in cardiac tissue is low but stable detectable and we found a significant increase of Piezo2 expression in heart tissue of mice 2 weeks after transverse aortic constriction (TAC) and 3 weeks after continuous angiotensin II infusion in comparison with the control groups. Also in engineered heart tissue model of cardiac hypertrophy we found a rise of Piezo2 expression.

Objectives: The possibilities for studying force development or arrhythmias in human ventricular myocardium is very limited. So far, it was only possible in tissue from explanted organs after heart transplantation. Because of a general decrease in transplant numbers and the impossibility to schedule these operations, the chance to perform experiments on human heart tissue becomes less. For that reason, most of the experiments were done with animal tissue or computer models. To break new ground, we tried to use left ventricular tissue out of an apical punch after implantation of a left ventricular assist device (LVAD).

Objectives: Aortic valve (AV) diseases leads to progressive pressure and/or volume overload of the left ventricle (LV) resulting into valvular cardiomyopathy, while progressive downregulation of β-adrenoceptors occurs. LV dysfunction may persist in one-fourth of patients after AV surgery, leading to terminal heart failure. We aimed to investigate whether differential remodeling in the protein kinase-A dependent inotropic response in myocytes and myocardial tissue is associated with the LV reremodeling after surgery.

Objectives: Mechanosensation and mechanotransduction belong to the most fundamental processes in biology. Especially, in the cardiovascular system, a mechanosensitive feedback mechanism is essential to adapt to different physiological demands. Although it plays such an important part, there is little knowledge about it. Piezo2 is a mechanosensitive ion channel and has a role in rapidly adapting mechanically activated currents in somatosensory neurons. Its expression in cardiac tissue is low but stable detectable.

Abstract Background Diseases of the aortic valve are a common reason for heart surgery. Aortic stenosis (AS) is associated with pressure and aortic regurgitation (AR) with a volume overload of the left ventricle (LV). Over time both pathologies lead to systolic and diastolic heart failure, while progressive downregulation of β-adrenoceptors occurs. While LV re-remodeling occurs in the majority of patients after aortic valve surgery, LV dysfunction persists in one fourth of such patients and leads to a terminal heart failure. We aimed to investigate whether differential remodeling in the protein kinase A (PKA) dependent inotropic response in myocytes and myocardial tissue obtained from patients undergoing aortic valve surgery is associated with the LV re-remodeling after surgery. Methods Preoperatively, pro BNP levels were measured and left ventricular strain analysis via echocardiography was performed. Interventricular septal biopsy was obtained intraoperatively in 10 patients who underwent aortic valve surgery. In-vitro contractility was analyzed in myocardial tissue paced with 4 Hz at 37 °C. Freshly isolated cells were transduced with an adenovirus expressing a cytosolic Förster resonance energy transfer (FRET) based cAMP biosensor (Epac1-camps). After 48 hours of culture, Föster-resonance energy transfer (FRET) was used for the first time to measure cAMP in 60 isolated human ventricular myocytes. Isoprenaline (10 nM – 10 μM) was used for β-adrenoceptor activation and forskolin (10 μmol) to activate adenylyl cyclase directly. Results We found a significantly downregulated β-adrenergic sensitivity in cardiomyocytes of patients with aortic valve disease, although contractile response to forskolin was maintained. Furthermore, we found a clear association between reduced sensitivity to isoprenaline (i.e., high EC50 values) and low maximum effect size to isoprenaline in myocardial tissue of patients with aortic valve disease, pointing out relevant β-adrenoceptor dysfunction. There were no significant differences in basal myocardial force between tissue samples of patients with AR and AS. Conclusion Collectively, our data show a profound remodelling in the cAMP/PKA pathway in patients with aortic valve disease. These disturbances may have an impact on the postoperative ventricular function and possibly on the long-term LV re-remodelling after aortic valve surgery.

Objectives: Diseases of the aortic valve are a common reason for heart surgery. Aortic stenosis (AS) is associated with pressure and aortic regurgitation (AR) with a volume overload of the left ventricle (LV). Over time both pathologies lead to systolic and diastolic heart failure, while progressive downregulation of β-adrenoceptors occurs. As recovery of the LV function is obvious in many patients after valve surgery, LV dysfunction sometimes persists or even proceeds. Therefore we aimed to evaluate in vitro protein kinase A dependent inotropic response in myocardial tissues obtained from patients undergoing aortic valve surgery.

Objectives: The optimal surgical treatment of functional mitral regurgitation (FMR) with restricted leaflet motion during systole (Type IIIb) is still controversial. The major drawback of isolated undersized mitral annuloplasty in type IIIB MR is the re-occurrence of FMR due to ongoing ventricular remodeling with progressive papillary muscle displacement. Subannular repair techniques have been developed to address this drawback. We aimed to prospectively compare the results of isolated annuloplasty versus annuloplasty with simultaneous standardized subannular repair.

Objectives: Akrinor is a widely used drug to treat intraoperative hypotension. The drug consists of three different compounds: norepinephrine, norephedrine and theophylline. However, compounds in Akrinor are covalently linked to each other and the mechanism of action is unclear. To estimate whether arterial vasoconstriction contributes to Akrinor's blood pressure rising effects we measured the intrinsic effects of Akrinor and some of its constituents on tension of human arterial rings. In addition, we estimated the impact on vasoconstriction evoked by the natural agonist on α-AR, norepinephrine.

Objectives: Improved quality of life is one of the most important tasks of cardiac surgery. But as patient population becomes older, severe comorbidities are no curiosity. Patients older than 80 years are common and belong to daily routine. Although improving quality of life is such an important goal of cardiac surgery, there are only a few studies on this topic and most of them are retrospectively.

Objectives: Akrinor® is a widely used drug to treat intraoperative hypotension. The drug consists of three different compounds: norepinephrine, norephedrine and theophylline. Norepinephrine and norephedrine are expected to exert sympathomimetic actions. Theophylline should inhibit PDE and therefore sensitize for cAMP-dependent positive inotropic interventions, like catecholamines. However, theophylline in Akrinor® is covalently linked to norepinephrine and norephedrine. It is not known if the potency of theophylline to inhibit PDE is preserved in such a formulation. Therefore, we have measured whether clinically used concentrations of Akrinor® inhibit PDE in human heart muscle.

Objectives: Improved quality of life is one of the most important tasks of cardiac surgery. But as patient population becomes older, severe comorbidities are no curiosity. Although improving quality of life is such an important goal of cardiac surgery, there are only a few studies on this topic and most of them are retrospectively.

Background: A correlation between aortic valve calcium load and paravalvular regurgitation after transcatheter aortic valve implantation (TAVI) has been demonstrated for first-generation transcatheter heart valves. With the recent availability of several second-generation devices relying on different fixation and sealing mechanisms within the calcified aortic annulus, performance remains to be investigated. We aimed to approach this issue by retrospective assessment of aortic valve calcium and hemodynamic performance of different transcatheter heart valves.

Introduction: In long-term follow-up structural valve degeneration becomes one of the most frequently occuring problems in patients with bioprosthetic aortic valves. Known risk factors for early degeneration are patient-prosthesis mismatch, valve design, valve tissue, anticalcification treatment and age of the recipient. The stentless aortic bioprosthesis provides hemodynamic superiority over a stented bioprothesis since the obstruction caused by sewing ring and the stent is eliminated. The disadvantage of a stentless valve is the implantation technique which is more demanding and also the removal in the case of reoperation.

Objectives: Transcatheter aortic valve implantation (TAVI) is an approved method in high risk patients with aortic stenosis unsuitable for surgical intervention. There are some reservations about transcatheter aortic valve replacement in patients with concomitant mitral stenosis because of the risk of intraoperative or postoperative cardiac decompensation and a benefit for these patients that is arguable. The risk for hemodynamic decompensation in TAVI with concomitant mitral stenosis is mainly caused by decreased periprocedural diastolic inflow in often severely hypertophic ventricles where a high preload is needed for sufficient hemodynamics. We have analyzed the outcome of 11 patients with mitral stenosis having undergone TAVI in our institution.

Cancer‐testis antigens (CTA) represent attractive targets for tumor immunotherapy. However, a broad picture of CTA expression in acute myeloid leukemia (AML) is missing. CTA expression was analyzed in normal bone marrow (BM) as well as in AML cell lines before and after treatment with demethylating agents and/or histone acetylase inhibitors. Presence of selected CTA with a strictly tumor‐restricted expression was then determined in samples of patients with AML before and after demethylating therapy. Screening AML cell lines for the expression of 20 CTA, we identified six genes (MAGE‐A3, PRAME, ROPN1, SCP‐1, SLLP1, and SPO11) with an AML‐restricted expression. Analyzing the expression of these CTA in blast‐containing samples from AML patients ( N = 64), we found all samples to be negative for MAGE‐A3 and SPO11 while a minority of patients expressed ROPN1 (1.6%), SCP‐1 (3.1%), or SLLP1 (9.4%). The only CTA expressed in substantial proportion of patients (53.1%) was PRAME. Following demethylating treatment with 5′‐aza‐2′‐deoxycytidine, we observed an increased or de novo expression of CTA, in particular of SSX‐2, in AML cell lines. In AML patients, we detected increased expression of PRAME and induction of SSX‐2 after demethylating therapy with 5‐azacytidine. With the exception of PRAME, CTA are mostly absent from AML blasts. However, demethylating treatment induces strong expression of CTA, particularly of SSX‐2, in vitro and in vivo. Therefore, we propose that CTA‐specific immunotherapy for AML should preferentially target PRAME and/or should be combined with the application of demethylating agents opening the perspective for alternative targets like CTA SSX‐2. Am. J. Hematol., 2011. © 2011 Wiley‐Liss, Inc.