Coronary artery disease represents a leading cause of death worldwide, to which the coronary artery bypass graft (CABG) is the main method of treatment in advanced multiple vessel disease. The use of the internal mammary artery (IMA) as a graft insures an improved long-term survival, but impairment of chest wall perfusion often leads to surgical site infection and increased morbidity and mortality. Infrared thermography (IRT) has established itself in the past decades as a non-invasive diagnostic technique. The applications vary from veterinary to human medicine and from head to toe. In this study we used IRT in 42 patients receiving CABG to determine the changes in skin surface temperature preoperatively, two hours, 24 h and 6 days after surgery. The results showed a significant and independent drop of surface temperature 2 h after surgery on the whole surface of the chest wall, as well as a further reduction on the left side after harvesting the IMA. The temperature returned to normal after 24 h and remained so after 6 days. The study has shown that IRT is sufficiently sensitive to demonstrate the known, subtle reduction in chest wall perfusion associated with IMA harvesting.

Purpose: To explore the effect of undergoing coronary artery bypass grafting on sexual quality of life as an integral part of patients’ health-related quality of life. Methods: This cross-sectional study included 265 men ages 18 to 60 years (median age, 55) who underwent coronary artery bypass grafting 1 to 5 years before the study. Standardized questionnaires were implemented to evaluate participant pre- and postoperative sexual quality of life and the quality of counseling provided to patients. Results: Among the patients, 77% were in a steady relationship. The general health score was 5.5 ± 2.8 (mean ± standard deviation) preoperatively and 6 ± 2.2 at follow-up (P = .01). No sexual counseling was given to 83% and 77% of the patients pre- and postoperatively, respectively. The mean sexual satisfaction score dropped from 6.5 ± 2.6 preoperatively to 4.7 ± 3 postoperatively (P < .001). The decline in sexual intercourse frequency and masturbation frequency was significant (P < .001 and P = .006, respectively). Linear regression analysis showed that general health status (P = .008), higher-quality counseling (P = .027), and preoperative sexual quality of life (P < .001) correlated positively with sexual quality of life, whereas sternal pain (P < .001), erectile dysfunction (P < .001), and fear of excessive cardiac burden (P < .001) correlated negatively. Conclusions: Middle-aged men experience decreased sexual quality of life after coronary artery bypass grafting. Preoperative sexual quality of life, general health, and higher-quality counseling positively affect postoperative sexual quality of life, whereas sternal pain, fear, and erectile dysfunction play a negative role. Pre- and postoperative care guidelines should be improved. Further prospective large cohort studies for males and females are required.

Objective: Aortic valve (AV) stenosis is characterized by fibrosis and cusp calcification. Fibrous thickening can result in reduced oxygen supply of internal tissue and cells. It is hypothesized that reduced oxygen availability in AV tissue contributes to pathological differentiation leading to calcification. In a setup using human valvular interstitial cells (VIC) a closed micro-physiological circulation system (MPS) with implemented oxygenator was adopted for culturing in culture-medium oxygen concentrations of 1%, 4%, 13% and 19%, reflecting hypoxic, tissue normoxic, arterial blood and cell incubator situation. In future, the study aims to incubate AV tissue in fluid culture modulating oxygen concentration in MPSs.Methods: In a MPS human VICs were cultured for 24h at oxygen concentrations 1%,4%,13% and 19%, respectively and at a flow rate of 2.74µl/s, not to simulate physiological settings but to regulate oxygen. Cell viability was monitored using LDH-assay. After RNA-isolation qRT-PCR was performed for quantification of mRNA expression of: Hif1α, Hif2α, EGLN1,2 and 3, pVHL, LDHA, FN1, ACTA2, COL1a1, Col3a1, Runx2, SSP1, Sox9. Hif1α nuclear localization was determined via immunofluorescence.Results: VICs can be cultured in MPS under varying oxygen concentrations without changes in cell viability. Hif1α nuclear localization was significantly higher (72.3±9.5%) in 1% oxygen compared to 4%,13% and 19% (0.7±1.1%; 2.9±3.4%; 0.2±0.4%) but there was no induction of Hif1α mRNA expression. Hif2α and EGLN2 mRNA also were unaffected. EGLN1/3 were upregulated after culturing in 1% oxygen. LDHA mRNA, regulated via Hif1α induced transcription was significantly induced at 1% oxygen. Expression of mRNA related to fibrosis or osteogenesis did not change significantly.Conclusions: MPS-culture of VICs adjusting oxygen concentrations is feasible; Hif1α nuclear localization rate at 1% oxygen was elevated. After 24h of incubation, no significant changes in mRNA expression of genes involved in ECM-remodeling or osteogenesis was observed. MPS is further adapted to incubate AV tissues.

Imaging photoplethysmography (iPPG) is a contact-free monitoring of the cutaneous blood volume pulse by RGB (red-green-blue) cameras. It detects vital parameters from skin areas and is associated to cutaneous perfusion. This study investigated the use of iPPG to quantify changes in cutaneous perfusion after major surgery. Patients undergoing coronary artery bypass grafting (CABG) were scanned before surgery and in three follow-up measurements. Using an industrial-grade RGB camera and usual indoor lighting, a contact-free imaging plethysmogram from the chest was obtained. Changes of the iPPG signal strength were evaluated in view of both the operation itself as well as the unilateral preparation of the internal thoracic artery (ITA) for coronary artery grafting, which is the main blood source of the chest wall. iPPG signal strength globally decreased after surgery and recovered partially during the follow up measurements. The ITA preparation led to a deeper decrease and an attenuated recovery of the iPPG signal strength compared to the other side of the chest wall. These results comply with the expected changes of cutaneous perfusion after CABG using an ITA graft. iPPG can be used to assess cutaneous perfusion and its global changes after major surgery as well as its local changes after specific surgical procedures.

Objective: Calcific aortic valve stenosis (CAVS) is characterized by early fibrotic remodeling of extracellular matrix and hypertension is associated with faster progression of CAVS. Treatment with...

Objective: The main pathological feature of Aortic valve (AV) stenosis is calcification. Molecular pathways leading to mineralization are research focus. The limitations of animal models point out the need for in vitro setups investigating human valvular interstitial cells (hVIC). Project aim is the detailed characterization of hVIC culture mineralization in comparison to AV calcification by IR-spectroscopy and therewith the validation of the in vitro setup for basic research. Methods: hVICs were ADGMedium induced in vitro. Three VIC culture pellets and sclerotic AV tissue samples were cryosectioned on CaF2 slides. IR-spectroscopy: FT-IR spectrometer Vertex 70; infrared microscope Hyperion 3000; MCT focal plane array detector. The spectral region between 950 and 1800 cm−1 was evaluated by Matlab. Different vibration modes of hydroxyapatite (HAP) phosphate groups were identified by curve fitting and 2nd derivative spectroscopy. Parallel sections were stained by HE and von Kossa. Results: Initial datasets of in vitro calcified hVIC samples reveal IR absorption bands mainly centered at 1020, 1061 and 1112 cm−1 which are assigned to carbonate-substituted HAP. A band at 1095 cm−1 results from reduced carbonate incorporation in comparison to carbonate-substituted HAP of hAV tissue and correlates with a lower carbonate/phosphate ratio in IR-spectra of hVIC compared to hAV. Other IR absorption bands located at 1112 and 1140 cm−1 resulting from acid phosphate substitution in apatite crystal and a lower intensity of HAP at 1060 cm−1 lead to the assumption that octacalciumphosphate-like apatitic mineral deposits in culture. IR-spectroscopic images reveal a heterogeneously distribution of the extracted molecular information across the samples reflecting the heterogeneity of hVIC preparations. Conclusions: Increased acid phosphate incorporation is described for freshly precipitated bone minerals whereas higher carbonate content in HAP characterizes mature bone mineral. Therefore initially IR-spectroscopy analysis of calcified VIC culture reveals early stages of biomineralisation comparable to common bone formation process.

Camera-Based Photoplethysmography is a measuring technique that permits the remote assessment of vital signs by using cameras. The face is the preferred area of measurement (region of interest: ROI) that has to be selected automatically for convenient application. Most works use common face detection algorithm for this purpose. However, these approaches often fail if the face is partly occluded or distorted. In this work, we propose an automatic method for ROI detection and tracking that does not rely on facial features. First, a Bayesian skin classifier was applied. Second, the detected areas were refined and tracked by level set segmentation. We tested our method on videos of 70 patients. The determined ROIs were used for signal extraction and heart rate (HR)estimation. The results showed that our method can detect and track suitable skin regions. We achieved a median HR detection rate of 80% which was only 6% lower than when applying manually defined ROIs.

AbstractDiseases of heart valves often make a prosthetic replacement therapy necessary. Long term goal is the development of artificial leaflet material with defining properties of mechanical prostheses (i.e. durability) with complete biocompatibility without the need for any anticoagulation therapy whatsoever. In order to achieve this aim, objective efforts are being made to use a new material that is still in the process of development. It is a film-like tissue, made of pure carbon in the form of carbon-nanotubes, which are characterized by their excellent mechanical properties (tensile strength 65GPa in comparison to steel with 0.6Gpa). The woven material has also a very small mesh width, which can be influenced by the spinning method. Due to the nature of this material, which is associated with a high surface energy, there is a need for adaptions for the use in vivo according to the requirements. Plasma Enhanced Chemical Vapor Deposition PECVD has proven to be the appropriate method for such a functionalization. It is possible to deposit amorphous hydrocarbon coatings below 60°C and in a thickness range from a few nanometers up to several microns, while at the same time providing a very low Young's modulus that ensures to withstand mechanical stress. In addition, this method allows to influence regional properties e.g. by incorporating silicon into the matrix to prevent adhesion of thrombocytes and/or to add nitrogen to give the ability to endothelial cell growing. The first project step is to evaluate in high resolution and accuracy the parameter characteristic of native valves and prostheses. Therefore the elastic modulus, flexibility, extension, expansion, banding stress, banding elasticity, banding rigidity, reversed banding strength, cantilever load, surface tension, surface structure, surface tension and intensity of surface loading are under investigation. A mix of physical, chemical and visual analysis methods are used. The parameter characteristic of the nanotube material has to match these results. In cases of mismatch a technical adjustment, e.g. during weaving or coating, is possible. At least two big advantages of this new composite material exist: The possibility to produce a compound material with regional different main characteristics by using a two-phase coating process. And on the other hand the abandonment of exogenous substances during the production process and so the material has a distinct advantage over those currently used Teflon fabrics.