Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, F-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). F-18-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

The aim of this study was to analyze long-term outcomes after heart transplantation (HT) using a normothermic ex-vivo perfusion device the Organ Care System (OCS) for donor heart preservation and compare this with standard cold cardioplegia (CC).

Despite the moving target indication to a population with lower clinical risk, early right ventricular (RV) failure (eRVF) after left ventricular assist device (LVAD) implantation for terminal heart failure remains a frequent complication.Most of the clinical models to predict eRVF after LVAD are assessed in Intermacs(InM) 1-2 candidates, and cannot be extrapolated to patients in a lower risk status.This study analyzes the preoperative predictors of eRVF after LVAD in stable patients in InM risk status >=3.

Device thrombosis (PT)is one of the main complications related to the use of left ventricular assist devices (LVAD).The optimal treatment remains unclear and there is limited data available for the use of direct thrombin inhibitors (DTI) as a treatment option.

Objectives: In general, higher graded (>60%) Carotid-artery-stenosis (CAS) is associated with a stroke rate up to 9% when operated without any stroke prophylaxis. CAS therefore is accepted as an independent risk factor for mortality, morbidity and stroke and is associated with coronary artery disease up to 30%.The goal of our study is to compare the stroke rate and the long-term mortality of CAS and no CAS for patients undergoing OPCAB with aortic-no-clamp- (ANC) and no-touch technique (ANTT).

Objective: Thoracic injuries after accidents with horses include chest lung contusions, rib fractures, and rarely cardiac involvement including right heart perforation, avulsion of the tricuspid or mitral valve and aortic dissections. We report a unique case of a traumatic ventricular septal defect.

Objectives: Evidence is accumulating that in cardiac surgery the avoidance of transfusion of red blood cells (RBCs) is not superior to a liberal transfusion regimen when leukocyte-depleted (LD) RBCs are used. We investigated whether these findings can be translated to the subgroup of patients undergoing open-heart valve surgery.

Objectives: Endomyocardial biopsy (EMB) is still considered the gold standard for allograft rejection surveillance after heart transplantation (HTx). EMB however is invasive and associated with significant morbidity. AlloMap® offers a non-invasive alternative to monitor graft rejection and was shown to achieve excellent negative predictive values. The aim of this study was to investigate, whether AlloMap® predicts long-term survival in patients after HTx.

Background and aim: Low vitamin D status, i.e. circulating 25-hydroxyvitamin D (25OHD) levels <50 nmol/l, is independently associated with increased CVD risk. Medication use may influence 25OHD levels. We therefore investigated the association of circulating 25OHD with medication use in patients scheduled for cardiac surgery.Methods and results: A total of 11,256 patients were included in this cross-sectional study. We compared 25OHD levels of medication users (18 groups of continuously used and 5 groups of intermittently used medications) with levels of non-users. Moreover, we assessed variables (medications, demographic and clinical parameters) that were independently associated with 25OHD levels <50 nmol/l. The prevalence of 25OHD levels <50 nmol/l was 65.7%. The use of statins and immunosuppressive agents was significantly associated with higher 25OHD levels and lower odds ratios of 25OHD levels <50 nmol/l. The use of ACE-inhibitors, catecholamines and antibiotics was associated with lower 25OHD levels and higher odds ratios of 25OHD levels <50 nmol/l. However, only use of antibiotics, immunosuppressive agents and catecholamines showed clinically relevant differences in 25OHD levels, i.e. differences of more than +4 nmol/l or -4 nmol/l, compared with respective non-users. These medications were prescribed either intermittently (antibiotics, catecholamines) and/or infrequently (<2%; immunosuppressive agents, catecholamines) and/or its causal relationship with circulating 25OHD is questionable (antibiotics). Female sex and blood drawing during wintertime were associated with the highest odds ratios of 25OHD levels <50 nmol/l.Conclusion: Data indicate that in patients with high cardiovascular risk profile medication use does not substantially contribute to 25OHD levels <50 nmol/l. (C) 2014 Elsevier B.V. All rights reserved.

Nowadays, increasing numbers of procedures jointly conducted by cardiac surgeons and cardiologists are performed as minimally invasive surgical procedures or interventions. Transcatheter aortic valve implantation, endovascular aortic aneurysm repair and a large variety of hybrid procedures for congenital heart disease have become current standards. Some of these hybrid procedures were shown to improve the therapeutic safety and efficacy, effects particularly true for high-risk patients and complex interventions. Hybrid procedures require indirect imaging, commonly provided by an angiography system in the hybrid operation theatre. This article describes the technical prerequisites required for a hybrid operation theatre as well as indications and rationales for hybrid procedures conducted in this environment. It is likely that the indications for cardiovascular hybrid procedures will continue to be expanded and that the hybrid operation theatre may become a laboratory for developing innovative approaches in the cardiovascular field. Therefore, the hybrid operation theatre will not only be the working environment for hybrid surgeons and interventionalists but also help to evolve their future.

Purpose Aquired von Willebrand (vW) disease is induced by continuous flow ventricular assist devices (VAD) in patients under mechanical circulatory support (MCS). However, the influence of different MCS on the degradation of high molecular weight vW aggregates is less investigated. In addition the influence of intensive care therapy on vW-multimere analysis before MCS is not known. Methods and Materials We analysed the vW-antigene (vWA), ristocetin-(RCA) and collagen binding activity (CBA) and the vW multimers in patients supported by different MCS-systems: Thoratec biventricular VAD (THOB, n=30), Syncardia total artificial heart (TAH, n=40); LVADs: Thoratec (THOL, n=39), Novacor (NOV, n=37), Heartmate II (HM2, n=40) and Heartware (HW, n=38). vW-factor was analysed before and about 14 days after implantation. The data were compared to healthy blood donor controls (BDC). Results vWA, RCA and CBA was highly increased at the time of MCS-system implantation. Pulsatile LVADs and TAH had no influence on vWA, RCA and CBA during the observation period. BVAD-patients revealed significant reduction of CBA during MCS (p=0.0001). In contrast support with the axial flow HM2 was associated with reduced CBA (p Conclusions vW disease is prevalent in terminal heart failiure patients before MCS-system implantation. Continuous flow systems seem to have an increased effect on vW-factor activity compared to pulsatile devices. Centrifugal pumps may exert increased shear stress on blood components compared to other systems.

Purpose Ventricular assist devices (VAD) are implanted in patients for bridging to heart transplantation (BTT) or nowadays in an increasing number of cases for destination therapy. However, about 2% of the patients develop spontaneously myocardial recovery for unknown reasons (BTR). Currently, myocardial recovery is not predictable, since reliable biomarkers are lacking. The aim of our study was the identification of novel biomarkers for myocardial recovery. Methods and Materials Total-RNA from left ventricular (LV) samples of 7 rejected donor hearts (NF), and LV-apex samples of 7 BTR- and 7 BTT-patients from VAD-implantation were isolated. NF-, BTR-, BTT-patients were matched according to age, gender and etiology. We analysed the myocardial transcriptome using Affymetrix-chips for the identification of secretory proteins. Differentially expressed transcripts were confirmed by real time RT-PCR. Expression profiling was evaluated by principal component analysis (PCA) and target gene identification. Transcripts of secretory proteins were analysed by enzyme linked immunosorbant assay (ELISA) for differences in the plasma at the time VAD-implantation. Results The principal component analysis (PCA) did not reveal clear separation of the HF samples. However, transcripts related to the immune system like plasma TNF-alpha stimulated gene 14 (TSG14) and interferon inducible protein 10kD (CXCL10) are by trend increased in BTR-samples compared to controls. Of note, TSG14 and CXCL10 were not different between BTR and BTT patients. However, both proteins were significantly elevated in VAD-patients before device implantation. Conclusions Molecular differences in the myocardium of patients with and without myocardial recovery are small. However, the identified transcripts such as TSG14 or CXCL14 related to immune-modulatory functions may indicate an uncomplete cardiac remodelling in patients weaned from the device. Both markers are significantly increased in heart failure patients.

Purpose German allocation system prioritizes (“HU”) patients with complications (compl.) during VAD-support. The impact of “HU” indications on survival was evaluated. Methods and Materials We performed a retrospective chart analysis of all pts. Transplanted in “HU”-status. Results 01/2000-10/2012 932 HU-pts. (305 VAD/627 no VAD) received a HTx. Used were Syncardia TAH (60/19,7%), Thoratec BVAD (36/11,8%), DuraHeart LVAD (34/11,1%), Thoratec LVAD (28/9,2%), Novacor LVAD (26/8,5%), HeartMate II LVAD (25/8,2%), HeartWare LVAD (21/6,9%), Ventrassist (15/4,9%), TCI LVAD (14/4,6%) and others (46/15,1%). In the VAD infection group, reasons for death were rejection (7/10.8%), abdominal compl. (4/6.25), sepsis (4/6.2%) and MOF (2/3.1%), in the neurological compl. group rejection (3/8.3%), abdominal compl. (2/5,6%) and technical compl. (2/5,6%). In the technical failure group MOF (5/9.1%), neurological compl. (3/5.5%) and rejection (3/5.5%) occurred. Within the VAD-related compl.group MOF (5/13.5%) was predominant. In the right heart failure group reasons for death included MOF, tumor, sepsis and abdominal compl. (all 1/6.3%). The main causes of death for HU patients without MCS were sepsis (24/6.2%), graft rejection (16/4.1%), malignant tumors (10/2.6%), neurological compl. and MOF (both 8/2.1%). Worst outcomes occurred in the infection and neurological compl.group (p=0,026), especially in 2000-2006 with more frequent use of pulsatile VAD (p Conclusions VAD-infection and neurological compl.group had significantly higher mortality. In infection, neurological and technical compl.group mortality steadily increased until 5 years. Results improved with a lower rate of pulsatile VAD use. Mortality stratified for HU reason HU group 3 months (%) 1 year (%) 5 years (%) VAD infection (n=65) 6,2 14,3 38,8 VAD neurological compl. (n=36) 8,3 33,3 43,9 VAD technical problem (n=56) 17,9 19,6 30,2 VAD-related compl. (n=37) 13,5 27,7 27,7 VAD right heart failure (n=17) 12,5 27,3 27,3 VAD various indications (n=25) 8,3 27,8 27,8 no VAD (n=697) 1,6 18,8 27,0

Purpose Ventricular assist devices (LVADs) are used for bridge to heart transplantation (BTR) and long term destination therapy (DT) for patients with end stage heart failure. Due to the growing number of patients with terminal heart failure and a decrease in suitable donor organs, timespans on mechanical circulatory support (MCS) of patients are continuously increasing. Methods and Materials Since 2006 283 patients received LVAD support with HeartMate II (HM2; n=160), Duraheart (DUH; n=74) and Ventrassist (VA; n=46). We analysed 34 patients (12.01%) who were supported with a device for more than 1000 days. The patients were divided into two groups, DT (n=11: VA n=5, HM2 n=4, DUH n=2) and BTR (n=22: HM2 n=9; VA n=7; DUH n=6). Patients were analysed retrospectively with regard to neurologic, infectious and gastrointestinal complications. Results Mean duration of support of all patients was 1278 days. 7 out of 34 patients, were succesfully transplanted, 4 died and 1 was successfully weaned and 22 patients are still on support. Major complications during support were driveline infections (n=7), gastrointestinal bleedings (n=7), technical failure (n=6/cable breakage n=4), neurologic events (n=6). First hospitilization after inital discharge home was after 9.8 months, the mean frequency of hospitilizations being 4.1 times. The overall mean duration of hospital stay was 65 days. Reasons for high urgency transplantation were neurologic complications (n=3; TIA,intracerebral bleeding, stroke), cable breakage (n=3) and hemolysis (n=1). Five patients expired (min. 1063days/max. 1392days) under support because of malignant tumors (n=2), late right heart failure (n=1), intracerebral bleeding (n=1) and one patient becuase of primary graft failure post heart transplantation. Conclusions In the light of substantial donor organ shortage and the growing number of heart failure patients prolonged MCS has become a more frequent treatment modality. Here we show that this can be achieved with acceptable longterm results.

Right ventricular failure (RVF) after ventricular assist device (VAD) placement is a significant risk factor for mortality in LVAD recipients. Nevertheless, the management of the appearance of RVF during VAD placement is not standardised. The aim of the study was to report the Bad Oeynhausen (BO) experience concerning the management of VAD patients with RVF. We wanted to compare the BiVAD patients and the LVAD patients with postoperative RVF treated by medicament or temporary RVAD in terms of mortality/outcome and complications.

The development of right ventricular failure (RVF) after left ventricular assist device (LVAD) insertion confers significant morbidity and mortality. Nevertheless, the management of the appearance of RVF during VAD placement is not standardised. The rationale for use of a BiVAD is still controversial because of its association to a worse survival and high rates of serious adverse events. Some authors have described the interest of temporary RVAD but the data are insufficient. The aim of the study was to report the Bad Oeynhausen (BO) experience concerning the management of VAD patients who developed post operative RVF, with temporary RVAD.