OBJECTIVES:The wearable cardioverter defibrillator (WCD) is an established, safe, effective solution, protecting patients at risk of sudden cardiac death. We specifically investigated WCD use in cardiac surgery patients since data for this patient group are rare. METHODS:Retrospective data analysis in 10 German cardiac surgery centres was performed. Cardiac surgery patients with left ventricular ejection fraction (LVEF) ≤35% or after implantable cardioverter defibrillator (ICD) explantation who received WCD between 2010 and 2020 were assessed using LifeVest Network data. RESULTS:A total of 1168 patients with a median age of 66 years [interquartile range (IQR) 57-73] were enrolled; 87% were male. Clinical indications included coronary artery bypass grafting (43%), valve surgery (16%), combined coronary artery bypass graft/valve surgery (15%), ICD explantation (24%) and miscellaneous (2%). The median wear time of WCD was 23.4 h/day (IQR 21.7-23.8). A total of 106 patients (9.1%) exhibited ventricular tachycardia. A total of 93.2% of episodes occurred within the first 3 months. Eighteen patients (1.5%) received 26 adequate shocks. The inadequate shock rate was low (8 patients, 0.7%). LVEF improved from a median of 28% (IQR 22-32%) before WCD prescription to 35% (IQR 28-42%) during follow-up. Excluding ICD explant patients, 37% of patients received an ICD. CONCLUSIONS:The risk of sudden cardiac death is substantial within the first 3 months after cardiac surgery. Patients were protected effectively by WCD. Due to significant LVEF improvement, the majority did not require ICD implantation after WCD use. Compliance was high despite sternotomy. This multicentre experience confirms existing data regarding effectiveness, safety and compliance. Therefore, WCD should be considered in cardiac surgery patients with severely reduced LVEF.

Question Extended partial hepatectomiy carries a high risk of post-surgery liver failure (ePHx), a serious complication for the patient. The pig liver features high anatomical and physiological similarity to the human liver. In a pig model of ePHx, systemic delivery of mesenchymal stromal cells (MSC) supported blood circulation and prevented multiorgan failure. The mechanisms mediating the beneficial MSC effects are largely unknown.

Objectives: Patients undergoing cardiac surgery procedures like CABG, valve replacement or reconstruction or CIED extraction and coexisting severe reduced left ventricular ejection fraction (EF < 35%) are at high risk of developing ventricular arrhythmias (VA). Therefore, the position paper of the working group on cardiac arrhythmias of the German Society for Thoracic and Cardiovascular Surgery recommends the prophylactic use of a wearable cardioverter defibrillator vest (WCD) for transient prevention of sudden cardiac death (SCD) in this patient cohort. This study aimed to analyze the incidence of postoperative VA and the role of WCD after cardiac surgery.

Objectives: Lead endocarditis is a challenging disease because extraction of long time cardiac leads can be demanding. We investigated feasibility and success of transvenous laser lead extraction with a Spectranetics SLS II 40 Hz laser sheath in lead endocarditis.

Objectives: Transcatheter aortic valve implantation (TAVI) after stentless valve replacement is discussed controversially. Implantation can be challenging due to missing radiopaque marking of the valve plane to fluoroscopically guide implantation depth. Moreover as valve migration was observed early postoperatively, there is concern about sufficient resistance of stentless tissue. We investigated feasibility and success in that scenario.

AimAccording to the demographic development of our society, the numbers of octogenarians referred to cardiac surgery are continuously growing. Although the benefit of first-time cardiac procedures for these patients is well documented, the fate of octogenarians after redo-procedures, with special regard to long-term survival, functional status and quality of life, is poorly investigated.MethodsWe retrospectively identified 84 consecutive patients aged 80 years, who underwent a cardiac reoperation at the department for Cardiothoracic Surgery in the Heart & Vessel Center Bad Bevensen between January 2007 and 2013. Demographic profiles as well as operative data were analyzed, and the patients were prospectively followed. Patient's functional status and quality of life were assessed with the Barthel Index, New York Heart Association class and the short form-12 questionnaire.ResultsThe mean age of the study group (61 men, 23 women) was 81.91.9 years. Most redo-procedures were carried out after primary coronary artery bypass grafting (65%), primary aortic valve replacement (21%) and primary mitral valve replacement (6%). The most frequent actual surgical procedures were combined coronary artery bypass grafting and aortic valve replacement (26%), isolated coronary artery bypass grafting (19%), and isolated aortic valve replacement (19%). The mean length of hospital stay was 17 +/- 15 days. In-hospital mortality counted for 32.1%. During follow up (29 +/- 20 months) a further 19.0% of the patients died. The Barthel Index of the survivors was 89 +/- 17 and their mean New York Heart Association class was 2 +/- 1. A total of 93% of the patients were living at home. Summary scores of physical and mental health of the short form-12 questionnaire equalled those of an age- and sex-matched normative population.ConclusionsDespite high perioperative mortality, results document a sustainable recovery of the survivors offering the prospect of a highly independent and satisfying life. Therefore, advanced age alone should not be a contraindication for redo cardiac interventions. Geriatr Gerontol Int 2016; 16: 1138-1144.

AimThe general assumption that non-elective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life (QOL) might lead to a non-justified exclusion of elderly patients from surgical treatment. The aim of the present study was to assess survival, functional outcome and quality of life of octogenarians undergoing non-elective cardiac surgery.MethodsBetween 2009 and 2011, 62 consecutive octogenarians (mean age 83.53.5 years) underwent urgent (n=33) or emergency (n=29) cardiac surgery. In 69% of patients, coronary artery bypass grafting was carried out, and 24% of patients underwent coronary artery bypass grafting plus valve surgery. Preoperative risk, as well as the postoperative course, was analyzed. All discharged patients were contacted to gain information about survival, functional capacity and QOL using the Barthel Mobility Index and the Short Form 12 Health Survey questionnaire. Results were compared with age-adjusted population data.ResultsIn-hospital mortality was 32.3% overall, 9.3% in urgent cases and 56.7% in emergency cases. After a mean follow-up period of 447 +/- 359 days, survival of the discharged patients was 93.1% (urgent) and 76.9% (emergency), respectively. QOL measures of the survivors were equivalent to those of the general elderly population. Functional capacity, calculated with Barthel Index, was high in both groups (86 +/- 13 and 81 +/- 21). A total of 92% of the patients were living at home.ConclusionsAlthough non-elective cardiac surgery in the elderly is related to high in-hospital mortality, physical and psychological recovery of the survivors is encouraging. QOL equals that of the general elderly population, and good functional status offers a highly independent life. Therefore, age per se should not disqualify patients from urgent or emergency cardiac surgery. Geriatr Gerontol Int 2016; 16: 416-423.

Der Anstieg der Morbiditäts- und Mortalitätsrate im Zusammenhang mit einem akuten Nierenversagen (ANV) konnte für ein weites Spektrum klinischer Komplikationen gezeigt werden. Besonders die akute Schädigung der Niere nach Ischämie-Reperfusion der Leber ist weit verbreitet (40 – 85%). Sie erhöht die Mortalität und Morbidität der Patienten signifikant und ist durch renale Dysfunktion und Polaritätsverlust sowie Nekrosen der proximalen Tubuluszellen charakterisiert. Der Polaritätsverlust geht mit einer signifikant verringerten N-Cadherin Expression in den proximalen Tubuluszellen einher. In der Literatur werden neben dem Abfall der glomerulären Filtrationsrate und des Serumkreatinins auch frühe prognostische Marker wie KIM1 und NGAL für ein ANV beschrieben.

Objectives: Rising prevalence of multimorbid patients in cardiac surgery often leads to prolonged postoperative ICU treatment. The fate of these patients after discharge is poorly investigated. Aim of this study was to assess long-term survival, functional outcome and quality of life in patients after an ICU stay ≥ 5 days after cardiac surgery.

Background: The objective of this collaborative, multicenter, European effort was to evaluate the outcomes of the convergent procedure for the treatment of persistent and long-standing persistent atrial fibrillation (AF) in consecutive patients at 4 European centers.Methods: Outcomes of consecutive patients, undergoing the convergent procedure at 4 European centers, were evaluated in this study. Epicardial ablation was performed before endocardial ablation. Convergent procedure outcomes were recorded by interrogation of implanted loop recorders or Holter monitors. Rhythm status and required interventions ( antiarrhythmic drugs, cardioversions, and repeat ablations) were quantified 6 and 12 months after the procedure. Outcomes, monitoring type, and patient baseline characteristics were analyzed and reported.Results: Seventy-three consecutive patients presenting with persistent AF (30.1%) or long-standing persistent AF (69.9%) underwent the convergent procedure between January 2010 and December 2011. At 6 months, 82% (56/ 68) were in sinus rhythm. At 12 months, 80%(53/ 66) were in sinus rhythm; single-procedure maintenance of sinus rhythm without postblanking period interventions was 76%(50/ 66); 52%(34/ 66) were in sinus rhythm and not receiving antiarrhythmic drugs.Conclusions: This multicenter European collaborative effort demonstrated that the convergent procedure is a safe and efficacious treatment option for persistent and long-standing persistent AF.

Objectives: According to the demographic development of society, the numbers of octogenarians referred to cardiac surgery are continuously growing. While the benefit of first-time cardiac procedures for these patients is well documented, the fate of octogenarians after redo procedures, with special regards to long-time survival, functional status and quality of life (QOL) is poorly investigated. Methods: We retrospectively identified 84 consecutive patients ≥80 years, who underwent cardiac reoperation at our institution between January 2007 and 2013. Demographic profiles as well as operative data were analysed and patients were prospectively followed. Patients' functional status and QOL were assessed with the Barthel index, NYHA class and the SF-12 questionnaire. Results: Mean age of the study group (61 male, 23 female) was 82 ± 2 years. Fifty-nine redo procedures were performed after primary CABG [Redo-CABG: 16, aortic valve replacement (AVR): 11, mitral valve replacement (MVR): 5, combined procedure: 26] and 18 cases after primary AVR (Redo-AVR: 3, CABG: 1, combined procedure: 14). In 7 patients, reoperation was performed after MVR (Redo-MVR: 1, AVR: 1, combined procedure: 5). Mean hospital stay was 17 ± 15 days. In-hospital mortality was 32%. During follow-up (29 ± 20 months) 28% of the patients died. The Barthel index of the survivors was 89 ± 17 and NYHA class 2 ± 1 in the mean. Ninety-three percent of the patients were living at home. Summary scores of physical and mental health of the SF-12 questionnaire equalled those of an age- and gender-matched norm population. Conclusion: Despite high perioperative mortality, results document a sustainable recovery of the survivors offering the prospect of a highly independent and satisfying life. Therefore, advanced age should not be a contraindication for redo cardiac interventions.

Abstract Background The rising prevalence of multimorbid patients undergoing cardiac surgery often leads to prolonged postoperative intensive care unit (ICU) treatment. The fate of these patients after discharge is poorly investigated. This study is aimed to assess survival, functional outcome, and quality of life (QOL) in patients after an ICU stay of at least 5 days. Materials and Methods Between August 2009 and July 2010, 1,092 patients underwent various cardiac procedures. Of these patients, 119 required ICU treatment of at least 5 days. Preoperative characteristics as well as postoperative course were analyzed and the discharged patients were contacted after 1 year to gain information about survival, functional capacity, and QOL. Results European system for cardiac operative risk evaluation I of the patients was 22.3 ± 16.7. Mean ICU stay was 19 ± 20 days. Forty three patients (36.1%) died in the hospital, 1-year overall survival was 46.2%, and 1-year survival of the discharged patients was 72.4%. Barthel mobility index was 85, showing a satisfactory mobilization. QOL, assessed with short form 12 questionnaire, was comparable with the reference group. Conclusion Long-term ICU treatment after cardiac surgery is related to a high in-hospital and follow-up mortality. The physical and psychological recovery of the survivors is encouraging, justifying the extensive engagement of hospital resources.

Objectives: The general assumption that nonelective cardiac procedures in octogenarians are related to poor postoperative outcomes and quality of life may lead to a non justified exclusion of elderly patients from surgical treatment. Aim of this study was to assess survival, functional outcome and quality of life (QOL) of octogenarians undergoing nonelective cardiac surgery.

OBJECTIVESIn accordance with the rising prevalence of octogenarians undergoing cardiac surgery, these patients utilize an increasing portion of intensive care unit (ICU) capacities, provoking economic and ethical concerns. In this study, we evaluated the outcomes and costs generated by the prolonged postoperative ICU treatment of octogenarians.METHODSBetween July 2009 and August 2010, 109 of 1063 patients required ICU treatment of at least 5 days after cardiac surgery. Patients were retrospectively assigned to either Group A (age <80, n = 86) or Group B (age ≥80, n = 23). Operative risk, mortality, length and costs of ICU treatment were analysed and compared. After 1 year, survival, quality of life (QOL) and functional status were assessed.RESULTSHospital mortality was 31.4% in Group A and 56.5% in Group B. Survivals of discharged patients after 1 year were 83% (Group A) and 80% (Group B), respectively. Log EuroSCORE I of octogenarians was significantly higher (30 ± 17 vs 20 ± 16, P < 0.001). No significant differences (Group A vs Group B) were found between the groups concerning length of ICU treatment (20 ± 21 vs 16 ± 14 days, P = 0.577) or costs (27 205 ± 29 316€ vs 21 821 ± 16 259€, P = 0.812). Functional capacity, calculated by using Barthel index, was high (Group A: 87 ± 22 and Group B: 67 ± 31, P = 0.108) and did not differ significantly between groups. QOL, measured with the short form-12 health survey, did not differ significantly between groups (physical health summary score: P = 0.27; mental health score: P = 0.885) and was comparable with values of the age-adjusted general population.CONCLUSIONSPresented data propose that advanced age is correlated with a higher mortality, but not with prolonged ICU treatment or higher costs after cardiac surgery. Considering the encouraging functional status and QOL of the survivors, the financial burden caused by octogenarians is justified.

Deep sternal wound infections are significant and severe complications following cardiac surgery and substantially influence perioperative morbidity and mortality. We present the experience of our department using two different surgical treatments over a three-year period.Between January 2009 and December 2011, a total of 3274 cardiac procedures with complete median sternotomy were performed in our department. In 94 patients (3%), a deep sternal wound infection occurred, including sternal instability with consecutive surgical treatment. The patients either received wound debridement with sternum refixation and suction-irrigation drainage (SID; n = 72) or sternum refixation only (RF; n = 22) if there was sternal instability with limited signs of infection. SID was routinely installed for 7 days: the irrigation solution contained neomycin. In all cases, swabs were taken and analysed. The different methods were evaluated in respect of their clinical outcomes.The success rate-defined as single, uncomplicated procedure-of the SID treatment was 74%, compared with 59% of the isolated sternum refixation. Complications included continuous infection, recurrence of sternal instability and wound necrosis. Eighty-eight percent of the swabs in the SID group were positive, compared with 32% in the sternal refixation only group. The dominating pathogenic germs were coagulase-negative staphylococci and staphylococcus aureus. Mortality was 10% for the SID group and 5% for the RF group.Contrary to accepted opinion, the suction-irrigation drainage is an appropriate therapy for deep sternal wound infections. Nevertheless, deep sternal wound infections after cardiac surgery remain severe complications and are related to increased morbidity and mortality.

OBJECTIVESPartial upper sternotomy is a routine approach to aortic valve surgery. For surgery of the ascending aorta or the aortic arch, this method is not well established yet.METHODSFrom October 2007 to October 2010, 50 consecutive patients underwent procedures of the ascending aorta and the aortic arch using partial upper sternotomy. Thirty-six patients underwent replacement or tightening of the ascending aorta, 11 patients received additional replacement of the proximal arch and in 3 cases, a complete replacement of the aortic arch was performed. Thirty-nine patients underwent additional aortic valve surgery.RESULTSMean operation time was 249 ± 51 min. Mean aortic cross-clamp and cardiopulmonary bypass time were 95 ± 27 and 141 ± 35 min, respectively. No conversion to conventional sternotomy was performed. All valves appeared competent on postoperative echocardiography. Survival was 100%. One re-exploration for bleeding was necessary. One stroke (2%) occurred, one pacemaker was implanted due to third-degree AV block and 16 patients (32%) experienced atrial fibrillation. One patient suffered from sternal wound infection. One patient needed reoperation due to severe aortic insufficiency on postoperative day 13. Median postoperative ventilation time was 13 h, median intensive care unit (ICU) and hospital stay were 22 h and 7 days, respectively.CONCLUSIONSResults show that minimally invasive surgical procedures of the ascending aorta and the aortic arch may be performed safely, with an excellent clinical outcomes and superior cosmesis. Short ICU and hospital stay indicate the beneficial effects of reduced surgical trauma for patient recovery.

Objectives: Extracorporeal membrane oxygenation support is a widely accepted treatment option for patients with cardiogenic shock but is still related with a high incidence of severe complications and death. We present a novel implantation technique to prevent life-threatening vascular complications.