Coronary artery bypass grafting (CABG) is the recommended type of revascularization procedure in patients with left main or three-vessel disease and is considered an alternative when percutaneous coronary intervention is not feasible. We evaluated registry data to obtain long-term outcome data.All patients ≤45 years in whom CABG was performed between 2009 and 2019 were selected from the Heart and Diabetes Center NRW, Germany. Cox regression analysis was applied to estimate the incidence risk of events after surgery.A total of 209 patients (81.8% male) were included. Mean (standard deviation) follow-up duration was 5.8 (3.1) years. The combined outcome of death, stroke, myocardial infarction, or repeated revascularization occurred in 31 patients (14.8%). Estimated mean time to event was 8.5 (standard error: 0.22) years. By the end of the follow-up period, 8 patients (3.8%) had died, among whom 2 (1.0%) died within 1 month after surgery, 1 (0.5%) within 1 year, 1 (0.5%) within 2 years, and 4 (1.9%) after 2 years.Risk factors independently associated with postsurgery events were angina pectoris CCS (Canadian Cardiovascular Society) class IV (adjusted hazard ratio [HR]: 4.954; 95% confidence interval [CI]: 1.322-18.563; p = 0.018) and STS (Society of Thoracic Surgeons) score (adjusted HR: 1.152 per scoring point; 95% CI: 1.040-1.276; p = 0.007).After performing CABG in patients ≤45 years, event-free long-term outcomes were observed in the majority of patients. Presence of angina pectoris CCS class IV and higher STS scores were independently associated with adverse postsurgery events.

Background— This study aimed to assess if clampless off-pump coronary artery bypass grafting (CABG) decreases risk-adjusted mortality, stroke rate, and morbidity in unselected patients in comparison to conventional CABG. Methods and Results— Between July 2009 and November 2010, data of 1282 consecutive patients undergoing isolated CABG were prospectively recorded. In 30.8% (n=395), clampless off-pump revascularization was used, either with the PAS-Port automated central venous anastomosis system (n=310) or as total arterial revascularization without central anastomoses (n=85). Propensity score (PS) matching was performed based on 15 preoperative risk variables to correct for selection bias. In-hospital mortality and stroke rate as primary end point, as well as major complications and follow-up outcome of clampless off-pump (lessOPCAB) and conventional CABG (cCABG) were compared in 394 matched patient pairs (total: 788 patients). The clampless off-pump technique decreased the in-hospital rate of death (odds ratio, 0.25; 95% confidence interval, 0.05–1.18, P=0.080) and stroke (odds ratio, 0.36; 95% confidence interval, 0.13–0.99, P=0.048) significantly. Complications such as low cardiac output syndrome, prolonged ventilation and rethoracotomy were also reduced by lessOPCAB. Over a 2-year follow-up period overall survival, cerebrovascular and major adverse event rate were significantly lower in the lessOPCAB group, while the repeat revascularization rate was comparable. Conclusions— In a retrospective PS-matched analysis, clampless off-pump CABG lowers mortality, stroke rate and other morbidity in an unselected group of patients with coronary artery disease.

Introduction: Interventional closures of atrial septal defects (ASD) and paravalvular leaks (PL) represent attractive treatment options to prevent surgical procedure. Nevertheless, there remains a small number of pitfalls after interventional closure of ASD or PL which requires surgical therapy.

Aim: To minimize complications of percutaneous drive lines and increase patient's mobility, a transcutaneous energy and data transfer system is to be developed with high tolerance of transmission and a convenient external carrier system.

Introduction: A 61-year-old patient with a history of hepatocirrhosis, esophageal varices, alcoholism and pelvis vein thrombosis developed a hepatic mass. Biopsies revealed only micronodual cirrhosis without further information. Abdominal ultrasound showed a massive congestion with ascites and edema. Echokardiography revealed a huge tumor of the right atrium with extension into the inferior vena cava and prolapsing into the right ventricle causing a severe tricuspid valve stenosis. The patient was transferred to our center for diagnosis and resection of the intraatrial mass.

Continuous blood perfusion of donor hearts for transplantation has been the focus of an increasing amount of research, but the optimal preparation and perfusion techniques have not been clearly defined. Therefore, we investigated the effectiveness of different preservation strategies using continuous, normothermic heart perfusion after donor heart harvesting. Hearts of 12 pigs were randomly assigned to two groups receiving a constant pressure perfusion in a modified Langendorff system after different preparation techniques. In Group 1, six hearts were arrested with Bretschneider HTK cardioplegia (4 degrees C) and then reperfused with a circulating pressure of 80 to 90mmHg using leukocyte depleted autologous blood. In Group 2, beating hearts of six pigs were explanted while being perfused, without cardioplegic arrest. Post-harvesting perfusion was similar to Group 1 except for a lower circulating pressure (40-50 mm Hg). At different time points (baseline and 1, 6, and 12 h after reperfusion), myocardial biopsies were taken, and contractility was assessed by measuring the maximum rate of left ventricular pressure rise (Delta p/Delta t (max)). Adenosine triphosphate (ATP) concentration was measured in all biopsies using a bioluminescence technique. Additionally, ultrastructural alterations were investigated using electron microscopy. Hypothermic cardioplegia and a higher reperfusion pressure (Group 1) were associated with an earlier and sharper decline in contractile function and intracellular ATP concentration. Ultrastructural alterations in Group 1 appeared earlier and were more distinctive than in Group 2. Endothelial ultrastructure, in particular, was better preserved in Group 2. Significant alterations were present in both groups after 12 h of perfusion but were more severe in Group 1. Blood perfusion provides protection against severe ischemic damage for a limited time. The use of a lower perfusion pressure, as well as avoiding cardioplegia and hypothermia, led to significantly better and longer preservation of perfused hearts.

The application of rotary blood pumps in patients with end-stage heart failure reveals a significantly reduced infectious complication rate as compared to the rate observed with pulsatile devices. The remaining adverse event rate relates mainly to thromboembolic complication with neurological consequences. We investigated the dependence of the neurological adverse event rate on the length of the inflow cannula.

Background: Primary graft dysfunction is a still poorly understood complication after cardiac transplantation. Ischemia/reperfusion injury contributes to different disorders resulting in impaired graft function.Methods: In a heterotopic rat heart transplantation model we extended graft ischemic time up to 8 hours.Results: Using immunochemistry we detected an up to 4-fold increase in intracellular adhesion molecule-1 (ICAM-1) expression during 4 hours of reperfusion, independent of ischemic time (30-minute ischemia: 7.65 +/- 2.15 without reperfusion, 19.46 +/- 4.6 after 4-hour reperfusion; 240-minute ischernia: 5.6 +/- 1.99 and 22.3 +/- 3.77; 480-minute ischen-iia: 3.7 +/- 1.56 and 13.1 +/- 2.2). Eight-hour ischemic allografts had an increase in CD8-positive cells 0.37 +/- 0.5 and 2.3 +/- 0.77) and a significant increase in MHC II expression (11.48 +/- 2.1 and 18.27 +/- 1.34) during 4 hours of reperfusion.Conclusions: We hypothesize that these findings reflect an early inflammatory reaction in the allograft possibly triggered by oxidative stress. During therapeutic interventions, both of these pathways must be considered.

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.