Objectives: Some patients with coronary artery disease, caused by a characteristic pathology are not elegible for coronary artery bypass. Therefore we investigated the benefit of arterialisation of a cardiac vein under the circumstances of a combination of microangiopathy with significant macroangiopathy, like it is found in diabetics, in an animal model.

OBJECTIVE:Among the complications after cardiac surgery the development of postoperative pulmonary distress is a serious problem. Typically, the patients leave the operating theatre with good blood gas values and O(2)-saturation, but develop their respiratory problems within the next hours/days. We investigated whether extracorporeal circulation may induce biochemical and histological changes in the lungs which may help to explain this development. METHODS:Piglets (6-10 kg) were anaesthetized using isoflurane and underwent extracorporeal circulation (ECC) with hypothermic (25-28 degrees C) cardioplegic arrest for 90 min followed by 3h reperfusion. An additional group received a poly(ADP-ribose) polymerase (PARP)-Inhibitor, INO1001. Cardiopulmonary monitoring was performed during the whole procedure. Finally, lungs were explanted and investigated by histomorphometry and immunohistology for heat shock protein HSP70 (indicator for cellular damage) and TNFalpha in comparison to normal piglets without ECC. RESULTS:Histologically we found significant swelling of the type I alveocytes (thickness increased from 2.4 to 3.2 microm), interstitial oedema, intra-alveolar erythrocyte (4.8 versus 0.4 erythrocytes/alveole) and granulocyte accumulation and fibrinous exudates. There was a significant up-regulation of TNFalpha and of the cellular repair enzyme HSP70, while in control piglets only minimal levels were observed. INO1001 significantly reduced ECC-induced elevation in TNFalpha and in HSP70. Despite the dramatic changes after heart-lung-machine (HLM), blood gases and gas transport were almost not affected at that time. CONCLUSIONS:ECC can lead to early significant histological and histochemical changes which have similarities with a beginning early stage shock lung, although - at 3h reperfusion - gas transport is still sufficient. INO1001 can partially antagonize these changes.

1131 Norman Edward Shumway, MD (1923–2006) D. A. Cooley 1133 Five-year cognitive outcomes: Surgical effects or natural progression of vascular disease▴ J. W. Hammon, Jr and D. A. Stump 1135 The vertical vein: To ligate or not to ligate▪ J. S. Tweddell 1137 Endothelin-1 accentuates the proatherosclerotic effects associated with C-reactive protein D. Ramzy, V. Rao, L. C. Tumiati, N. Xu, R. Sheshgiri, J. Jackman, D. H. Delgado, and H. J. Ross 1147 Cellular coating of the left ventricular assist device textured polyurethane membrane reduces adhesion of Staphylococcus aureus T. Asai, M.-H. Lee, C. Arrecubieta, M. P. von Bayern, C. A. Cespedes, H. M. Baron, M. Cadeiras, T. Sakaguchi, C. C. Marboe, Y. Naka, M. C. Deng, and F. D. Lowy 1154 Hemodynamic effects of vacuum-assisted closure therapy in cardiac surgery: Assessment using magnetic resonance imaging R. Petzina, M. Ugander, L. Gustafsson, H. Engblom, J. Sjögren, R. Hetzer, R. Ingemansson, H. Arheden, and M. Malmsjö 1163 Enhanced intimal thickening of expanded polytetrafluoroethylene grafts coated with fibrin or fibrin-releasing vascular endothelial growth factor in the pig carotid artery interposition model B. H. Walpoth, P. Zammaretti, M. Cikirikcioglu, E. Khabiri, M. K. Djebaili, J.-C. Pache, J.-C. Tille, Y. Aggoun, D. Morel, A. Kalangos, J. A. Hubbell, and A. H. Zisch 1171 Warm nondepolarizing adenosine and lidocaine cardioplegia: Continuous versus intermittent delivery K. L. Sloots, J. Vinten-Johansen, and G. P. Dobson 1179 Induction chemoradiotherapy (carboplatin-taxane and concurrent 50-Gy radiation) for bulky cN2, N3 non–small cell lung cancer H. Yokomise, M. Gotoh, T. Okamoto, Y. Yamamoto, S. Ishikawa, T. Nakashima, D. Masuya, D. Liu, and C. Huang 1186 Results of esophagectomy for esophageal cancer in elderly patients: Age has little influence on outcome and survival A. Ruol, G. Portale, G. Zaninotto, M. Cagol, F. Cavallin, C. Castoro, V. C. Sileni, R. Alfieri, S. Rampado, and E. Ancona 1193 Synchronous multiple primary lung cancer: An increasing clinical occurrence requiring multidisciplinary management D. Trousse, F. Barlesi, A. Loundou, A. M. Tasei, C. Doddoli, R. Giudicelli, P. Astoul, P. Fuentes, and P. Thomas 1201 Surgical aspects of thoracoscopy and efficacy of right thoracoscopy in minimally invasive repair of pectus excavatum A. K. Saxena, C. Castellani, and M. E. Höllwarth 1206 Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: Five-year follow-up of a randomized trial▴ H. J. Nathan, R. Rodriguez, D. Wozny, J.-Y. Dupuis, F. D. Rubens, G. L. Bryson, and G. Wells 1212 Perioperative outcomes of cardiac surgery in kidney and kidney–pancreas transplant recipients R. John, K. Lietz, S. Huddleston, A. Matas, K. Liao, S. Shumway, L. Joyce, and R. M. Bolman 1220 Angiographic evidence for reduced graft patency due to competitive flow in composite arterial T-grafts D. Pevni, I. Hertz, B. Medalion, A. Kramer, Y. Paz, G. Uretzky, and R. Mohr 1226 A classification system for the bicuspid aortic valve from 304 surgical specimens H.-H. Sievers and C. Schmidtke 1234 Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus I. M. Wagner, W. B. Eichinger, S. Bleiziffer, F. Botzenhardt, I. Gebauer, R. Guenzinger, R. Bauernschmitt, and R. Lange 1242 Coronary artery bypass graft surgery—care globalization: The impact of national care on fatal and nonfatal outcome E. Ott, C. D. Mazer, I. C. Tudor, L. Shore-Lesserson, S. A. Snyder-Ramos, B. A. Finegan, P. Möhnle, C. B. Hantler, B. W. Böttiger, R. D. Latimer, W. S. Browner, J. Levin, and D. T. Mangano, for the Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation 1252 Selective arterialization of a cardiac vein in a model of cardiac microangiopathy and macroangiopathy in sheep M. E. Resetar, C. Ullmann, P. Broeske, K. Ludwig-Schindler, N. K. Doll, A. Salameh, S. Dhein, and F. W. Mohr 1257 Comparison of recovery after mitral valve repair and replacement L. Zhao, P. Kolm, M. A. Borger, Z. Zhang, C. Lewis, G. Anderson, C. T. Jurkovitz, A. M. Borkon, R. H. Lyles, and W. S. Weintraub 1264 Significant reduction in annuloplasty operative time with the use of nitinol clips in robotically assisted mitral valve repair R. C. Cook, L. W. Nifong, J. E. Enterkin, P. J. Charland, C. C. Reade, A. P. Kypson, S. Masroor, and W. R. Chitwood, Jr 1268 Autologous fibrin-coated small-caliber vascular prostheses improve antithrombogenicity by reducing immunologic response T. Hasegawa, K. Okada, Y. Takano, Y. Hiraishi, and Y. Okita 1277 Have we gone too far? Endovascular stent-graft repair of aortobronchial fistulas G. H. Wheatley III, A. Nunez, O. Preventza, V. G. Ramaiah, J. A. Rodriguez-Lopez, J. Williams, D. Olsen, and E. B. Diethrich 1286 Rechanneling of total anomalous pulmonary venous connection with or without vertical vein ligation: Results and guidelines for candidate selection▪ U. K. Chowdhury, K. G. Subramaniam, K. Joshi, S. Varshney, G. Kumar, R. Singh, and P. Venugopal 1295 Optimal timing of the Fontan conversion: Change in the P-wave characteristics precedes the onset of atrial tachyarrhythmias in patients with atriopulmonary connection M. Koh, T. Yagihara, H. Uemura, K. Kagisaki, I. Hagino, T. Ishizaka, and S. Kitamura 1303 Results of the 1.5-ventricle repair for Ebstein anomaly and the failing right ventricle L. G. Quinonez, J. A. Dearani, F. J. Puga, P. W. O’Leary, D. J. Driscoll, H. M. Connolly, and G. K. Danielson 1311 Intermediate-term results of repair for aortic, neoaortic, and truncal valve insufficiency in children J. A. Hawkins, P. C. Kouretas, R. Holubkov, R. V. Williams, L. Y. Tani, J. T. Su, L. M. Lambert, C. R. Mart, M. D. Puchalski, and L. L. Minich 1318 Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections: Risk analyses in 189 patients T. Shin’oka, H. Kurosawa, Y. Imai, M. Aoki, M. Ishiyama, T. Sakamoto, S. Miyamoto, K. Hobo, and Y. Ichihara 1329 Early repair of hemitruncus: Excellent early and late outcomes M. Nathan, D. Rimmer, G. Piercey, P. J. del Nido, J. E. Mayer, E. A. Bacha, and F. A. Pigula 1336 Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: A twelve-year experience J. W. Brown, M. Ruzmetov, P. Vijay, M. D. Rodefeld, and M. W. Turrentine 1344 Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery J. W. Gaynor, G. Wernovsky, G. P. Jarvik, J. Bernbaum, M. Gerdes, E. Zackai, A. S. Nord, R. R. Clancy, S. C. Nicolson, and T. L. Spray 1354 Life-supporting function of genetically modified swine lungs in baboons B.-N. H. Nguyen, A. M. Azimzadeh, T. Zhang, G. Wu, H.-J. Shuurman, D. H. Sachs, D. Ayares, J. S. Allan, and R. N. Pierson III 1364 Delayed hemolytic transfusion reaction by a Kidd antibody after heart surgery: Case report and review of the literature V. Kazakou, A. Kousoulakou, and E. Melissari 1365 Sternal tuberculosis after sternotomy for coronary artery bypass surgery: A case report and review of the literature K. Gopal, A. Raj, M. R. Rajesh, S. K. Prabhu, and J. Geothe 1367 Allograft carotid artery as a systemic-to-pulmonary conduit B. J. Evans and S. Westaby 1368 Unusual systemic venous return with absence of superior caval veins P. Ou, G. Calcagni, D. Marini, J. Le Bidois, P. Gallo, F. Brunelle, and D. Bonnet 1370 Emergency surgery after failed device closure of the atrial septal defect I. E. Konstantinov, P. Saxena, L. Friederich, and M. A. J. Newman 1371 Reversal of increased pulmonary arterial pressure associated with systemic venous collaterals after tonsillectomy in a Fontan candidate after the Glenn procedure: Impact of obstructive sleep apnea on Fontan circulation H. Sawada, Y. Mitani, H. Ohashi, H. Hayakawa, Y. Ikeyama, S. Takabayashi, H. Shimpo, K. Maruyama, and Y. Komada 1373 Postconditioning in cardiac surgery for tetralogy of Fallot W. Luo, B. Li, G. Lin, and R. Huang 1375 Minimally invasive implantation of a cardioverter-defibrillator in a small patient C. S. Snyder, V. Lucas, T. Young, R. Darling, G. Dalal, and J. E. Davis 1376 Argatroban anticoagulation for renal replacement therapy in patients with heparin-induced thrombocytopenia after cardiovascular surgery A. Koster, T. Hentschel, T. Groman, H. Kuppe, R. Hetzer, S. Harder, and K.-G. Fischer 1378 Benign bronchoesophageal fistula: Report of four cases S. Griffo, P. Stassano, G. Iannelli, L. Di Tommaso, M. Cicalese, M. Monaco, and G. Ferrante 1380 Right diaphragmatic eventration associated with dextrocardia, hypoplasia of the right lower pulmonary lobe, and agenesis of the inferior vena cava E. H. Kabiri, A. Zidane, A. Arsalane, and F. Atoini 1382 Giant mediastinal teratoma—bull in a china shop: Management strategies L. S. Vohra, R. Talwar, M. Mathur, C. V. R. Mohan, N. Chawla, and R. S. Bharathi 1384 Necessary resection of the left lower lobe due to systemic arterial supply R. Jaspers, W. Barendregt, G. Limonard, and F. Visser 1385 False-positive mediastinal lymph node activity on positron emission tomographic scan after adjuvant treatment of gynecologic malignancies B. A. Whitson, S. J. Runge, S. S. Groth, and M. A. Maddaus 1387 Lung fibrosis as a potential complication of the hemostatic tissue sealant, biologic glue (Bioglue) S. Haj-Yahia, T. Mittal, E. Birks, M. Carby, M. Petrou, J. Pepper, G. Dreyfus, and M. Amrani 1389 The feasibility of organ procurement at a hospital-independent facility: A working model of efficiency N. Moazami, O. H. Javadi, D. F. Kappel, J. Wagner, and M. D. Jendrisak 1391 Letters to the Editor 1399 Events of Interest 1401 Announcements 35A Reader Services 1256 Change of address 1310 Interactive eLearning Activities Cover PhotographUpper left: Intraoperative view of a bicuspid aortic valve with 1 completely developed non-coronary cusp, 2 completely developed commissures (small arrows), and 1 raphe extending to the corresponding malformed commissure (large arrow) between the malformed left and right coronary cusps. This bicuspid aortic valve is classified in the main category as TYPE 1 (1 raphe).Upper right: Intraoperative view of a bicuspid aortic valve with 2 raphes, developmental anlagen of 3 cusps, and 1 completely developed and 2 underdeveloped commissures. This bicuspid aortic valve is classified in the main category as TYPE 2 (2 raphes).Bottom: Intraoperative view of a “purely” bicuspid aortic valve with only 2 equal-sized cusps, sinuses, and 2 commissures (arrows) and no raphe (Left: before and Right: after excision of the valve). This bicuspid aortic valve is classified in the main category as TYPE 0 (no raphe).Sievers and Schmidtke 2007Sievers H.-H. Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens.J Thorac Cardiovasc Surg. 2007; 133: 1226-1233Abstract Full Text Full Text PDF PubMed Scopus (621) Google Scholar Upper left: Intraoperative view of a bicuspid aortic valve with 1 completely developed non-coronary cusp, 2 completely developed commissures (small arrows), and 1 raphe extending to the corresponding malformed commissure (large arrow) between the malformed left and right coronary cusps. This bicuspid aortic valve is classified in the main category as TYPE 1 (1 raphe). Upper right: Intraoperative view of a bicuspid aortic valve with 2 raphes, developmental anlagen of 3 cusps, and 1 completely developed and 2 underdeveloped commissures. This bicuspid aortic valve is classified in the main category as TYPE 2 (2 raphes). Bottom: Intraoperative view of a “purely” bicuspid aortic valve with only 2 equal-sized cusps, sinuses, and 2 commissures (arrows) and no raphe (Left: before and Right: after excision of the valve). This bicuspid aortic valve is classified in the main category as TYPE 0 (no raphe).Sievers and Schmidtke 2007Sievers H.-H. Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens.J Thorac Cardiovasc Surg. 2007; 133: 1226-1233Abstract Full Text Full Text PDF PubMed Scopus (621) Google Scholar

Zusammenfassung Gegenstand und Ziel: Vorhofflimmern ist die häufigste Ursache für kardiale Arrhythmien beim Menschen. Die Erzeugung zirkulärer transmuraler Läsionen mittels verschiedener Energieformen dient der elektrischen Isolation der autonomen Foci. Ziel der Studie war daher, am Tiermodell Schaf die Effektivität und die Risiken verschiedener Ablationstechniken systematisch zu vergleichen. Material und Methoden: Bei 39 Merinoschafen wurden zirkuläre Läsionen im Bereich des linken Atriums und der Pulmonalvenen erzeugt. Kryotechnik (n = 12), Mikrowellen (n = 9), Laser (n = 6) sowie unipolare (n = 6) und bipolare (n = 6) Hochfrequenz (HF) wurden von endokardial bzw. von epikardial eingesetzt und die Temperatur im Lumen des Ösophagus gemessen. Elektrophysiologische Untersuchungen unmittelbar sowie zwei Stunden nach der Ablation dienten dem Nachweis der erfolgreichen Reizleitungsblockade. Repräsentative Proben von linkem Atrium, Pulmonalvenen und Ösophagus wurden histopathologisch untersucht. Ergebnisse: Alle endokardialen Ablationstechniken führten zu elektrophysiologisch effektiven transmuralen Nekrosen. Im Gegensatz zu Kryoablation und unipolarer HF erzeugten Mikrowellen- und Laserenergie starke Thromben. Die epikardiale Ablation mit Kryotechnik und Mikrowellen war in acht von neun Fällen nicht effektiv, während die bipolare HF zu effektiven transmuralen Läsionen, jedoch mit deutlichen Thromben führte. In 24 von 39 Fällen wurden histologisch auch Alterationen des Ösophagus nachgewiesen. Insbesondere von endokardial applizierte unipolare HF und Kryotechnik führten zu Nekrosen der Ösophaguswand. Schlussfolgerung: Epikardial applizierte bipolare HF war das Verfahren zur Vorhofablation, das von den getesteten Methoden die geringsten Risiken der Ösophagusperforation bei bester Effektivität der Ablation aufwies. Diese Ergebnisse aus den Akutversuchen sollten jedoch noch in Langzeitversuchen überprüft werden.

Objective: In heart transplantation a well-preserved ultrastructure and a well-adjusted ATP and HSP levels are important. The study compared the ultrastructural and metabolic findings in a developed explantation algorithm and extracorcoreal perfusion protocol.

Preserved ultrastructure is an important precondition for functional regeneration after heart transplantation. We investigated the effectiveness of a newly developed modified Langendorff system in extracorporeal heart perfusion. (Experiment I) Cardioplegia and cold ischaemia were performed in six pigs. Hearts were connected to a modified Langendorff system, and perfused with leucocyte depleted autologous blood. (Experiment II) The untreated hearts of three healthy pigs served as controls. Forty-seven myocardial biopsies at different timepoints (I: n = 29, II: n = 18) were investigated by transmission electronmicroscopy. Cardioplegia/hypothermia (I) induced mild-to-moderate mitochondrial swelling, mild myofibrillar degeneration in cardiomyocytes and moderate endothelial oedema. After 4 h reperfusion cardiomyocytes showed moderate myofibrillar and mild sarcolemmal damage. Moderate endothelial degeneration, mild interstitial oedema and haemorrhages appeared. Untreated hearts (II) showed severely damaged mitochondria and nuclei after 30 min while the myofibrillar structure remained unaffected until 4 h later. This is a promising model for extracorporeal heart perfusion. However, ultrastructural findings indicated that some necessary modifications to prevent cellular damages during reperfusion were needed.

Aims: The inflammatory response induced by extracorporeal circulation (ECC) is thought to be responsible for postoperative complications. Aim of this study was to evaluate the direct impact of different perfusion modalities on circulatory inflammatory response in a standard experimental model.

Aims: Stem cell transplantation and preconditioning of the myocardium during off- pump bypass surgery are two methods to reduce the size of ischemic myocardium. In this study we investigated the benefit of a combination of these two techniques in an animal model.

Objective: Atrial fibrillation is a common cause of cardiac arrhythmia in humans. Creation of circulartrans mural lesions by the use of different energy sources results in the insulation of autonomous focal triggers or macro re-entry circuits. The aim of this study was the evaluation of the effectiveness and risks of various ablation methods in a sheep model. Material and methods: Experiments were performed in 39 Merino sheep. Circular lesions were created endo- and epicardially in the oesophagus, left atrium and pulmonary veins using different energy sources: Cryo (n = 12), microwave (n = 9), laser (n = 6), unipolar radio frequency(RF) (n = 6) and bipolar RF(n = 6). The temperatures inside the oesophagus were measured. Electrophysiological examinations were performed post treatment and two hours after ablation to prove the conduction block. Specimens of the atria and pulmonary veins were investigated histopathologically, Results: Endocardial ablation resulted in transmural lesions, confirmed by electrophysiological examinations in all cases. In contrast to cryoablation and unipolar RF, microwave and laser induced intensive endocardial thrombus formation. Epicardial cryoablation and microwave energy were not successful in eight of nine animals. However, epicardial bipolar RF was efficient but induced marked thrombi. In 24 of 39 sheep alterations of the oesophagus were detected histologically. Especially endocardial unipolar RF and cryoablation induced necroses of the oesophagus wall. Conclusion: Epicardiai bipolar RF was the method in our study, which resulted in best effectiveness of ablation and smallest risk of oesophagus perforation. Further mid- and long-term studies are necessary to confirm these results.

Objectives: Oxidative stress leads to activation of Poly-ADP-ribose-polymerase (PARP) affecting cell energetics and initiating cell death. We evaluated the potential of PARP inhibition to prevent ischemia – reperfusion injury.

Objectives: Intraoperative graft flow measurement using Thermal Coronary Angiographie (TCA) based on Dynamic Infrared Imaging (DIRI) enables only qualitative information in graft patency. Additional quantification would be desirable in order to facilitate excellence. The aim of this experimental study was to develop a heat-transfer-model for quantitative flow estimation. First clinical results in CABG are reported.

Objectives: Controlled hypoperfusion during hypothermia is required for the correction of complex congenital cardiac defects. Aim of this study was to evaluate the potential for cerebral protection by using selective cerebral perfusion (SCP).

Kern 1227 Optimal management of patients with non-small cell lung cancer with ipsilateral mediastinal lymph node metastases ■

OBJECTIVE:The aim of this study was the evaluation of histologic changes induced on the esophagus by surgical ablation therapy for atrial fibrillation.METHODS:Experiments were performed on 39 sheep. Circular lesions were created endocardially or epicardially in the left atrium and at the pulmonary veins by using different energy sources: cryoablation, microwave, laser, and unipolar or bipolar radiofrequency. Temperatures inside the esophagus were measured, and esophageal tissue was investigated macroscopically and histopathologically.RESULTS:Esophageal damage was seen histologically in 24 of 39 cases. The epithelium was intact in all cases. Unipolar radiofrequency induced the most intensive esophageal lesions in 4 of 6 cases. The affected areas were small (1.56-3.01 mm) but reached deep into the tissue. Endocardial cryoablation resulted in wider lesions (2.01-8.54 mm), which were intensive in only 2 of 6 cases. Epicardial cryoablation and bipolar radiofrequency induced wide (1.11-6.8 mm) but mainly mild alterations. Endocardial and epicardial microwave energy affected the esophagus in single cases, and lesions were small (0.97-2.81 mm). Only in 1 case did laser energy induce a moderate alteration (5.30 mm) of the esophageal wall.CONCLUSIONS:Esophageal alterations were found in numerous cases. However, marked lesions were especially induced by endocardial unipolar radiofrequency and cryoablation.