Objectives: The Ross-procedure is an established method to treat aortic valve disease, offering excellent hemodynamic characteristics, growth potential, low risk of thromboembolism and no need for anticoagulation. Limitation of homograft quality and availability led to the use of different xenografts. Long-term outcome and implications are yet to be addressed.

s der 2. Fokustagung Herz Intensivmedizin, Rhythmustherapie und EKZ 30.09.–02.10.2010 in Duisburg Sitzung 2 Blutkomponententherapie

Objective Aim of the study was to analyze changes over a ten years observation period regarding demography, indication for support and clinical outcome in patients treated with short-term mechanical circulatory support (MCS) for cardiogenic failure. Methods 39 patients treated with MCS between 2006–2008 (2008 group) were analyzed, assessing demography, complication rates and survival. Results were compared with 36 consecutive patients that had received centrifugal MCS between 1996–1998 (1998 group) at our institution. Results Mean age was 59.9 ± 12.9 (1998 group) and 60.9 ± 13.9 years ( P = 0.74). Mean logEuroScores rose from 12.0% ± 14.6% (1998 group) to 26.9% ± 20.5% (2008 group); P < 0.001. Postcardiotomy low output syndrome was the main cause for MCS. However the percentage of patients in cardiogenic shock prior to surgery increased from 19.4% (1998 group) to 33.3% (2008 group); P = 0.17. Complexity and urgency of the primary surgical procedure increased significantly. 16.7% (1998 group) vs. 41.0% (2008 group); P = 0.02 of interventions were classified “salvage/emergent”. Mean duration of support was 2.9 ± 1.9 days (1998 group) and 3.8 ± 3.1 days (2008 group); P = 0.14. Significantly more biventricular support was implemented in the 2008 group (23.1% vs. 5.6% in the 1998 group); P = 0.03. The incidence of complications, including device failure, thromboembolism and infection remained the same in both groups. 63.9% (1998 group) and 61.5% (2008 group) of the patients were successfully weaned from the device ( P = 0.83), 12% (1998 group) and 3% (2008 group) of the VAD patients were bridged to long-term VAD ( P = 0.12). Overall 30-day survival rates were similar (22.2% 1998 group vs. 28.2%; 2008 group); P = 0.55, however, survival rate in BVAD supported patients improved significantly. Conclusion These data demonstrate the beneficial effect of MCS to salvage patients with cardiac failure. Taking into consideration that the severity of illness, the complexity and urgency of the primary surgical procedure have steadily increased a comparable improvement in MCS outcome over the past decade was observed. Nevertheless, in-hospital mortality and VAD related complication rates such as bleeding remain high.

Objectives: The implantation of stentless porcine aortic valves may be technical demanding due to the stiffness of the prosthesic aortic wall. To investigate stentless pericardial prostheses for aortic valve replacement in the clinical routine.

Aims: To report on clinical and early hemodynamic results in isolated valve replacement using the Freedom Solo valve (Sorin Group, Saluggia, Italy).

Aims: The Freedom Solo valve (Sorin Group, Saluggia, Italy) is a pericardial stentless valve designed for suprannular implantation in aortic valve replacement. We want to report on clinical and early hemodynamic results in Octogenerians.

Objective: The Ross operation is still limited by availability and poor performance of devices for the pulmonary valve replacement. Tissue engineering of valves conduits could offer a solution to this problem.

Objectives: Ablation is increasingly performed for treatment of atrial fibrillation (AF). To elucidate the role of different technology applied, we evaluated microwave (MW) and radiofrequency (RF) energy in terms of clinical results.

Objective: Commonly the Ross operation is performed in children and young adults with isolated aortic valve disease. We report our experience with patients after aortic valve replacement according to the Ross technique in combination with concomitant cardiac procedures.

Objectives: Ablation has become an effective treatment of atrial fibrillation (AF). We evaluated its results in octogenarians.

Aims: To report on clinical and early hemodynamic results of the new Freedom Solo valve™ (Sorin Group, Saluggia, Italy).

Objectives: To report on the experience with a supraannular implantation technique and early hemodynamic results of the new Freedom Solo valve (Sorin Group, Saluggia, Italy).

A 63-year-old man who had undergone coronary bypass surgery 2 months before was admitted to the emergency department in hemorrhagic shock. Initial chest radiography demonstrated subtotal shadowing of the left lung that suggested a hemothorax.After adequate volume substitution therapy, he underwent a 16-slice computed tomography whole body scan (Aquilion, Toshiba Medical Systems, Otawara, Japan) with a gantry rotation time of 0.4 seconds, a collimation of 0.5 mm, and a voxel size of 0.35 mm. Scanning was initiated by bolus tracking after the intravenous administration of 120 mL of iopromide with an iodine content of 370 mg/mL and a flow of 3 mL/s. Figure 1 demonstrates a huge fluid collection on the left (asterisk) and active intrathoracic bleeding (arrows). The bleeding (arrows) originates directly behind the tip of a broken sternal wire loop from a small vessel (arrowhead) on the anterior surface of the heart as demonstrated in Figure 2.Fig 2View Large Image Figure ViewerDownload (PPT)Without further diagnostic procedures, the patient underwent immediate emergency surgery, which showed that the vessel was presumably fed by a twig of the right coronary artery. Probably this vessel had been injured by the broken wire loop (arrow), which is shown in Figure 3. The postoperative course was uneventful.Fig 3View Large Image Figure ViewerDownload (PPT) A 63-year-old man who had undergone coronary bypass surgery 2 months before was admitted to the emergency department in hemorrhagic shock. Initial chest radiography demonstrated subtotal shadowing of the left lung that suggested a hemothorax. After adequate volume substitution therapy, he underwent a 16-slice computed tomography whole body scan (Aquilion, Toshiba Medical Systems, Otawara, Japan) with a gantry rotation time of 0.4 seconds, a collimation of 0.5 mm, and a voxel size of 0.35 mm. Scanning was initiated by bolus tracking after the intravenous administration of 120 mL of iopromide with an iodine content of 370 mg/mL and a flow of 3 mL/s. Figure 1 demonstrates a huge fluid collection on the left (asterisk) and active intrathoracic bleeding (arrows). The bleeding (arrows) originates directly behind the tip of a broken sternal wire loop from a small vessel (arrowhead) on the anterior surface of the heart as demonstrated in Figure 2. Without further diagnostic procedures, the patient underwent immediate emergency surgery, which showed that the vessel was presumably fed by a twig of the right coronary artery. Probably this vessel had been injured by the broken wire loop (arrow), which is shown in Figure 3. The postoperative course was uneventful.

BACKGROUND AND AIM OF THE STUDY:Stentless aortic valve prostheses usually require two separate suture lines. The Freedom Solo valve (Sorin Group, Saluggia, Italy), by using a minimized implantation technique, requires only a single running suture line of 4-0 polypropylene. Herein are reported the surgical experience and early hemodynamic results obtained with this new valve.METHODS:Following annular decalcification, the Freedom Solo prosthesis was implanted in the supraannular aortic position in the sinuses of Valsalva of 82 patients (52 females, 30 males; mean age 76.6 +/- 7.0 years). Echocardiography was performed to monitor gradients and regurgitation.RESULTS:The logistic EuroSCORE was 12.8 +/- 9.9. Isolated aortic valve replacement was performed in 48 patients; concomitant procedures included coronary artery bypass grafting, mitral procedures, subvalvular myectomy, and atrial ablation. The mean valve size implanted was 26.4 +/- 2.1 mm, and cross-clamp time was 39.0 +/- 7.0 min in primary isolated valve replacement. Non-valve-related 30-day mortality was 3.6%. At discharge, hemodynamic parameters were favorable, with low peak (16.2 +/- 8.0 mmHg) and mean (8.3 +/- 4.5 mmHg) gradients, and without paravalvular leakage and only minimal regurgitation (grade < I degrees) in 10 patients.CONCLUSION:Supraannular implantation of the Freedom Solo stentless valve is safe and reliable, using a single suture line. The valve provides excellent hemodynamics at hospital discharge, without paravalvular leakage. The reduced cross-clamp time represents an attractive surgical alternative in elderly patients.

BACKGROUND AND AIM OF THE STUDY:The 3F equine aortic bioprosthesis is a new stentless valve which is currently undergoing evaluation in a multicenter clinical trial and is considered to have superior hemodynamic performance. Herein is reported the authors' initial experience with the 3F valve, focusing on the hemodynamic performance of the device.METHODS:Between March 2002 and October 2003, 35 patients (age range 61-86 years) underwent aortic valve replacement with the 3F valve implanted in the subcoronary position. Evaluation of valve hemodynamic performance was assessed at discharge (postoperative day 5 +/- 2), at 3-6 months, and at 11-14 months' follow up by means of transthoracic echocardiography. The mean preoperative transvalvular pressure gradient was 63 +/- 14 mmHg. Before surgery, all patients were in NYHA class III or IV, despite aggressive medical treatment. Five patients underwent concomitant coronary artery bypass grafting.RESULTS:The implanted valve sizes ranged from 21 to 29 mm. There were no operative deaths and no major perioperative complications. After 12 months, mean pressure gradients for the 23-, 25-, 27- and 29-mm valves were 13, 13, 12 and 9 mmHg, respectively. Mean systolic pressure gradients and NYHA class were improved significantly after surgery. Mild signs of hemolysis and minimal central regurgitation were detected in some patients, but were of no clinical importance. Valve dysfunction or mechanical failure did not occur during the follow up period.CONCLUSION:Because of its flexible structure, the 3F aortic bioprosthesis is simple to implant, and no major adverse effects have been associated with such valve implantation at the authors' center. Transprosthetic gradients appeared to regress at 6-12 months' follow up. The durability of the device is yet to be established in ongoing long-term trials.

Aims: The present study was performed to investigate hemodynamic behaviour of the Shelhigh SuperStentless® aortic valve.

Objective: This study was performed to collect prospective safety and effectiveness data of a tissue engineered heart valve to reconstruct the right ventricular outflow tract during Ross procedure.

BACKGROUND The Pericarbon Freedom stentless valve has shown excellent hemodynamic results in the midterm course. However, there is no information as to whether a continuous or interrupted suture technique at the inflow site has an impact on postoperative hemodynamics. METHODS 139 patients were enrolled in a non-randomized, prospective matched trial. An interrupted suture line technique was used in 68 patients and a continuous suture line technique was used in 71 at the inflow site. Isolated valve replacement was performed in 70.4% of the continuous and 67.6% of the interrupted suture group. Pre- and postoperative hemodynamics and one-year follow-up were obtained by echocardiography and expressed as mean and peak gradients and grade of regurgitation. RESULTS No significant difference between continuous and interrupted suture techniques were noted with respect to mean (11.8 +/- 6.3 vs. 12.5 +/- 6.2 mm Hg, p = 0.251) and peak gradients (21.0 +/- 9.6 vs. 22.0 +/- 10.9 mm Hg, p = 0.292) as well as to the degree of regurgitation. Bypass and cross-clamping times decreased by 22.4 and 20.6 minutes, respectively, with the use of the continuous suture technique. One year follow-up showed a further, significant decrease of mean and peak gradients. CONCLUSIONS The Pericarbon Freedom stentless valve appears to offer excellent postoperative performance. The suture line technique at the inflow site does not result in any hemodynamic differences.