Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a complex cardiac condition characterized by dynamic left ventricular outflow tract (LVOT) obstruction and often co-existing abnormalities of the mitral valve (MV), that may alter the surgical methods used. This study aims to investigate postoperative and long-term follow-up of patients undergoing surgical treatment at our institution.

Background: Previous studies have suggested that women tend to suffer from acute aortic dissection at a smaller aortic diameter when compared with men. We hypothesized that this higher dissection risk in women might be caused by a lower aortic elasticity and/or a more severe histological aortic wall degeneration and therefore tested these parameters in female versus male patients with aortopathy.

Background: Bicuspid aortic valve (BAV) related aortopathy is known to significantly increase the rate of thoracic aortic aneurysms. Whether BAV or tricuspid aortic valve (TAV) aortopathy patients have a higher risk of dissection at the same diameter is the subject of current scientific discussions. Therefore, we compared histological changes of aortic tissue and aortic elasticity between BAV and TAV patients.

Background: The risk for acute aortic dissection (AAD) increases with ascending aortic diameter especially above a cut-off of 60 mm. Therefore, ESC/EACTS guidelines recommend prophylactic replacement of the ascending aorta from a diameter of 55 mm. However, 60% of AAD occur at small aortic diameters (defined as maximum diameter of ascending aorta / aortic root < 55 mm). To identify patients at risk, we sought to evaluate predictors for AAD in patients with aortic diameters < 55 mm.

Die Notwendigkeit der zerebralen Protektion im Rahmen der offenen Aortenbogenchirurgie ergibt sich aus der Unterbrechung des Blutflusses in den zuführenden Kopfgefäßen und der Hirnperfusion. Je nach Ischämiezeit kann es zu irreversiblen Zellschädigungen des Gehirns kommen. Um dies zu vermeiden, wurden verschiedene Techniken der zerebralen Protektion entwickelt. Der hypotherme Kreislaufstillstand (HCA) nimmt eine zentrale Rolle bei der Vermeidung eines neurologischen Defizits (ND) ein und gilt als sichere Technik bei kurzen Kreislaufstillstandzeiten. Aufgrund der hohen Inzidenz zerebraler Komplikationen bei länger andauerndem Kreislaufstillstand wurden zusätzliche Techniken der zerebralen Perfusion entwickelt, mit dem Ziel, die Sicherheit auch bei komplexen Eingriffen zu erhöhen. Wichtig für die Planung der Prozedur sowie zur Abschätzung des Operationsrisikos und eines ND ist die Kenntnis der zugrunde liegenden anatomischen Situation und der pathologischen Veränderungen der Aorta. Im Rahmen der präoperativen Diagnostik erfolgt neben den üblichen präoperativen Untersuchungen die bildgebende Untersuchung der gesamten Aorta, einschließlich der Darstellung der supraaortalen Gefäße. Hierzu eignet sich v. a. die Computertomographie bzw. die CT-Angiographie mit 3D-Rekonstruktion. Als Goldstandard zur Technik der zerebralen Protektion hat sich der moderate HCA in Kombination mit der selektiven antegraden zerebralen Perfusion (SACP) etabliert. Knapp zwei Drittel aller perioperativen Schlaganfälle in der Aortenchirurgie sind auf Embolien zurückzuführen. Den unterschiedlichen zerebralen Risiken der Patienten sollte durch die Wahl der zerebralen Protektion und der Kanülierungstechnik Rechnung getragen werden. Das Neuromonitoring mithilfe der Nah-Infrarot-Spektroskopie (NIRS) ist hilfreich; die NIRS misst jedoch lediglich die Sauerstoffsättigung eines kleinen Areals im Frontalhirn. Dennoch kann die NIRS auf eine zerebrale Ischämie durch Minderperfusion hinweisen. Trotz der zerebralen Protektion durch HCA und SACP stellt der Zeitfaktor ein Risiko für das Outcome des Patienten in der Aortenbogenchirurgie dar. Eine Verkürzung der HCA- und SACP-Zeit kann durch eine Vereinfachung der chirurgischen Techniken und Anastomosen erreicht werden.

Background: In patients undergoing FET surgery for chronic aortic dissections (CAD), secondary interventions may become necessary to treat the remaining aortic disease.

Background: Early mortality after surgery for type A aortic dissection (ATAD) ranges between 16 and 37%. Thus, the aim of the study was to determine risk factors for early mortality in this cohort.

Background: Acute type A aortic dissection (TAAD) is a life-threatening condition which requires immediate surgical intervention at any time of day or night. We hypothesize that during nighttime, these procedures often are performed by surgeons less experienced in aortic surgery. Therefore, our aim was to investigate whether nighttime surgical procedures for TAAD are associated with adverse acute outcome.

The necessity for cerebral protection during open aortic arch surgery is due to the interruption of the blood flow in the afferent cephalic vessels and in the brain perfusion. Irreversible cell damage can occur in the brain depending on the ischemia time. To avoid this, various techniques have been developed for cerebral protection. Hypothermic circulatory arrest (HCA) plays a central role in the avoidance of neurological deficits (ND) and is a safe technique for short periods of circulatory arrest. Due to the high incidence of cerebral complications during prolonged circulatory arrest, additional techniques of cerebral perfusion were developed, with the aim of increasing the safety even in complex interventions. Knowledge of the underlying anatomical situation and the pathological alterations to the aorta is important for the planning of the procedure and for estimation of the surgical risk and NDs. During the preoperative diagnostics, imaging examinations of the complete aorta, including the visualization of the supra-aortic vessels are carried out in addition to the routine preoperative investigations. Computed tomography (CT) or CT angiography with 3-D reconstruction is particularly suited for this. Moderate HCA in combination with selective antegrade cerebral perfusion (SACP) has become established as the gold standard for the technique of cerebral protection. Nearly two thirds of all cases of perioperative stroke in aortic surgery can be attributed to embolisms. The selection of the cerebral protection and the cannulation technique should take the different cerebral risks of patients into account. Neuromonitoring using near infrared spectroscopy (NIRS) is helpful, but NIRS only measures the oxygen saturation in a small area of the frontal brain. Nevertheless, NIRS can provide indications of cerebral ischemia due to reduced perfusion. Despite cerebral protection by HCA and SACP, the time factor represents a risk for the outcome of the patient in aortic arch surgery. A reduction of the HCA and SACP times can be achieved by a simplification of the surgical techniques and anastomoses.

Abstract Background Hypertrophic obstructive cardiomyopathy (HOCM) represents a clinically and morphologically diverse hereditary cardiac disease that is frequently associated with poor prognosis. Nationwide data on septal reduction therapy (SRT), alcohol septal ablation (ASA) and septal myectomy (SM), remains scarce. The aim of this study was to investigate (i) temporal trends, (ii) patient characteristics, (iii) in-hospital outcomes, and associations between institutional procedural volumes and outcomes after ASA and SM in a large-scale nationwide cohort. Methods Using data from the German Federal Bureau of Statistics, this study analyzed all patients with HOCM who were hospitalized for ASA or SM in a nationwide inpatient database in Germany between January 1, 2006, through December 31, 2019. Rates of adverse in-hospital events (in-hospital mortality, need for permanent pacemaker) were examined. Multivariate logistic regression analysis was performed to compare overall outcomes after each procedure based on tertiles of hospital volumes of ASA and SM. Results A total of 8,514 patients underwent SRT, of whom 5,293 (62.2%) underwent ASA and 3,221 (37.8%) SM. Annual numbers for SM and ASA steadily increased over time: ASA procedures increased from 329 in 2006 to 451 in 2019 and SM procedures increased from 191 in 2006 to 222 in 2019, respectively. Patients with SM were older (mean 67.4 vs. 60.2 years), less likely female (56.4% vs. 49.9%), and had a higher burden of comorbidities (e.g., diabetes, atrial fibrillation, heart failure, chronic kidney disease) compared to patients with ASA. Over an observational period of 14 years, the majority of both ASA and SM procedures were performed at hospitals in the lowest volume category (≤20 procedures). The overall in-hospital mortality was higher in patients with SM (6.8%) compared to patients with ASA (0.8%), whereas the need for pacemaker implantation was more often observed in patients with ASA (19.3% vs. 13.1%; p<0.001). The lowest tertile of SM volume among hospitals was independently associated with an increased risk of in-hospital mortality (adjusted odds ratio (lowest vs. highest tertile), 2.64; 95% confidence interval, 1.49-4.66), whereas being in the lowest vs. the highest tertile of ASA by volume was not independently associated with risk of in-hospital mortality and adverse events. Conclusion In this contemporary cohort with more than 8,500 cases of SRT between 2006 and 2019, the majority of SRT was performed at centers with a low volume of SM and ASA procedures. Low SM volume was independently associated with increased in-hospital mortality, whereas low ASA volume was not associated with adverse outcomes. Our findings may help to further understand how institutional SRT procedural volumes affects outcomes and might encourage referral of patients with HOCM to centers of excellence for SRT.

Background: Inherited thoracic aortic disease defines a group of disorders characterized by aortic aneurysm or dissection and high mortality. The most common genetic causes of thoracic aortic disease are heterozygous pathogenic variants in the FBN1 and ACTA2 genes. Heterozygous FBN2 variants have rarely been associated with aortic disease. Pathogenic variants in the central region (exons 24–35) of FBN2 cause a hereditary connective tissue disorder named congenital contractual arachnodactyly (CCA).

Abstract Fluorescent cardiac imaging can be applied for intraoperative quality control after a coronary bypass grafting surgery to ensure the myocardial perfusion by evaluating the increasing contrast agent enrichment in the heart. The motion due to the beating heart impedes the interpretation of the contrast agent enrichment in the vessels and leads to noisy enrichment curves. We propose tracking of the heart surface features to compensate for the motion of the beating heart and thereby improve the analysis of the contrast agent enrichment. Furthermore, we propose a vessel segmentation pipeline for a local evaluation of contrast agent enrichment directly in the vessels.

Objectives: The aim of this study was to compare the overall outcome of patients undergoing frozen elephant trunk (FET) as an emergency/urgent procedure versus an elective procedure.

Objectives: This study analyses the frequency of reinterventions after frozen elephant trunk surgery (FET) in a 10-year single-center patient cohort.

Objectives: The pathogenicity, origin, and development of atherosclerosis in the ascending aorta are not well understood. However, during lifetime the aortic tissue has to cope with metabolic, toxic and mechanic stress, which can lead to intracellular DNA damage. The aim of the project is to elucidate the amount of accumulating somatic mutations and inadequate metabolic consequences within the aortic tissue and its implication for the atherosclerotic pathogenesis.

Objectives: Acute kidney injury (AKI) is still a common complication after aortic surgery with a reported incidence of 19.0 to 29.1%. Thereby, AKI is associated with increased perioperative morbidity and mortality. In this study, we therefore aimed to identify risk factors for the development of an AKI after aortic surgery.

Objectives: Frozen elephant trunk (FET) surgery is a modern treatment modality which is recommended for acute and chronic aortic dissections, as well as thoraco-abdominal aneurysm. Due to a rising life expectancy and hence, an aging society, we retrospectively evaluated surgical outcomes in patients aged 70 and above.

Die Therapie von Aneurysmen der deszendierenden thorakalen Aorta hat in den vergangenen Jahren erhebliche Fortschritte gemacht. Die endovaskuläre Therapie (TEVAR) ist heute in diesem Aortenabschnitt als „golden standard“ anzusehen und ermöglicht die Behandlung auch älterer und kränkerer Patientengruppen. International gibt es zurzeit fünf zwischen 2010 und 2020 veröffentlichte Leitlinien zu Aneurysmen der deszendierenden thorakalen Aorta. Der folgende Artikel präsentiert eine Auswahl von 10 zentralen Empfehlungen der aktuellen Leitlinien im Rahmen der „Gemeinsam-Klug-Entscheiden“-Initiative der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) mit der Zielsetzung, Empfehlungen aus Leitlinien und anderen hochwertigen Quellen in die Praxis zu transferieren, die üblichen Versorgungspraktiken in Deutschland zu hinterfragen und eine Über- wie Unterversorgungen zu vermeiden.