Objectives: In 2019 the coronavirus SARS-CoV-2 began to spread rapidly. According to the World Health Organization 25 million COVID-19 cases were confirmed globally with over 850,000 deaths. To contain the pandemic Bavaria introduced a lockdown in 20.03.2020. To avoid further morbidity and mortality preclinical facilities with diagnostic tools, triage protocols and supplementary isolated intensive care units focused on corona related patients.

Eine 24-jährige Patientin aus Sierra Leone wurde nach unklaren intrazerebralen Blutungsereignissen und einer echoreichen Auflagerung an der Aortenklappe vorstellig. Die Patientin war bei paroxysmalem Vorhofflimmern und Non-compaction-Kardiomyopathie antikoaguliert. In der weiteren Diagnostik gelang durch Fluoreszenz-in-situ-Hybridisierung in Kombination mit Polymerase-Kettenreaktion und Sequenzierung der Nachweis einer durch Bartonellaquintana verursachten Mitral- und Aortenklappenendokarditis. Retrospektiv waren die intrazerebralen Hämorrhagien als septische Embolien mit sekundärer Einblutung unter neuen oralen Antikoagulanzien zu werten. Nach biologischem Mitral- und Aortenklappenersatz sowie mehrwöchiger Doxycyclin- und Gentamicingabe zeigte sich die Patientin in ihren Beschwerden deutlich gebessert und ohne weitere Blutungsereignisse.

Objectives: Infective endocarditis (IE) with visible vegetations often requires urgent surgical treatment. However, in some cases due to recent cerebral infarction, patients have an increased risk of cerebral hemorrhage during extracorporal circulation. No suitable guideline exists in order to clarify the best surgical timing after cerebral embolization/hemorrhage, but neurosurgeons usually recommend to wait a couple of weeks due to heparinization during surgery. We evaluated endocarditis patients with urgent surgical indication and recent cerebral infarction directly postsurgically by CCT scan, evaluating the risk of subsequent hemorrhage due to complete heparinization.

Indications for TF-TAVI (transfemoral transcatheter aortic valve implantation) are rapidly changing according to increasing evidence from randomized controlled trials. Present trials document the non-inferiority or even superiority of TF-TAVI in intermediate-risk patients (STS-Score 4–8%) as well as in low-risk patients (STS-Score < 4%). However, risk scores exhibit limitations and, as a single criterion, are unable to establish an appropriate indication of TF-TAVI vs transapical TAVI vs SAVR (surgical aortic valve replacement). The ESC (European Society of Cardiology)/EACTS (European Association for Cardio-Thoracic Surgery) guidelines 2017 and the German DGK (Deutsche Gesellschaft für Kardiologie)/DGTHG (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie) commentary 2018 offer a framework for the selection of the best therapeutic method, but the individual decision is left to the discretion of the heart teams. An interdisciplinary TAVI consensus group of interventional cardiologists of the ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte e.V.) and cardiac surgeons has developed a detailed consensus on the indications for TF-TAVI to provide an up-to-date, evidence-based, comprehensive decision matrix for daily practice. The matrix of indication criteria includes age, risk scores, contraindications against SAVR (e.g., porcelain aorta), cardiovascular criteria pro TAVI, additional criteria pro TAVI (e.g., frailty, comorbidities, organ dysfunction), contraindications against TAVI (e.g., endocarditis) and cardiovascular criteria pro SAVR (e.g., bicuspid valve anatomy). This interdisciplinary consensus may provide orientation to heart teams for individual TAVI-indication decisions. Future adaptations according to evolving medical evidence are to be expected. Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI).

Objectives: An 84-year-old female with severe aortic stenosis and dyspnea NYHA class III underwent a transcatheter aortic valve implantation with a 27 mm Lotus valve (Boston Scientific, Marlborough, MA, USA) with no residual valvular or paravalvular regurgitation (PAR). After discharge the patient was asymptomatic with freedom from dyspnea (NHYA I) and in good health condition. Three months later she felt breathless again and was readmitted to our hospital with cardiac decompensation and NYHA class IV.

Objectives: Recently, several groups have reported minimal-to-no clinical value of balloon aortic valvuloplasty (BAV) for transcatheter aortic valve implantation (TAVI). For a distinct subset of patients, the transaortic (TAo) access route is a well-accepted alternative to traditional access sites. We aimed to evaluate the clinical value of BAV in patients undergoing TAo-TAVI.

Objectives: Complications during transcatheter aortic valve implantation (TAVI) might require surgical intervention and in severe cases cardiopulmonary bypass (CPB). Therefore, it is still mandatory to perform TAVI-procedures in a heart team, consisting of a heart surgeon and interventional cardiologist to increase patient survival. We aim to look at the management and outcome of TAVI complications requiring surgical intervention at our institution.

Ein 43-jähriger Patient stellte sich bei akuter respiratorischer Insuffizienz in der zentralen Notaufnahme vor. Im Rahmen der Notfalldiagnostik wird der Patient zunächst intubations- und dann reanimationspflichtig. Das Thorax-CT zeigt ein grotesk vergrößertes Aortenaneurysma, das den Pulmonalarterienhauptstamm stranguliert. Als Ursache des Aneurysmas konnte eine bis dato nicht therapierte Syphilis diagnostiziert werden. Nach initialer Stabilisierung des Patienten wurde das Aneurysma operativ durch einen Ascendens- und Bogenersatz behandelt.

Objectives: Despite the superior patency of internal thoracic artery (ITA)- grafting compared with saphenous veins, frequency of bilateral ITA- grafting (BITA) amounts to ∼20% within Germany.The aim of the present study was to compare the early outcome of patients receiving either BITA or SITA (single ITA).

Objective: With cardiac surgery patients becoming increasingly older and improving treatment options there is a new field of cardiac surgery emerging for patients formerly considered inoperable. Patients with combined aortic valve disease and coronoary artery disease (CAD) can be treated by a surgical hybrid treatment using off-pump CABG and TAVI.

Great debates revolve around the hemodynamic performance of prosthetic tissue valves. It is influenced by the design and the specific sizing strategy. Design determines the actual geometric opening area of the valve (GOA), sizing strategy the actual size of the selected valve. Currently, hemodynamic performance is generally assessed by determining the effective orifice area (EOA, derived from the continuity equation by relating flow velocities and LVOTarea). The question whether a valve is too small (patient-prosthesis-mismatch, PPM) is then addressed by relating EOA to body surface area (EOAi). However, this relation may not be reasonable because the EOAi relates flow velocity to patient-specific anatomic parameters (LVOTarea and body surface area) twice. Considering this potential methodological flaw, debate and confusion regarding PPM is easily understood, despite the fact that, intuitively, leaving a gradient behind after aortic valve replacement cannot be irrelevant. PPM becomes even more relevant in times of valve-in-valve transcatheter implantation, where a second prosthesis is taking up inner space of a valve that may have been too small in the first place. Thus, a reliable and comparable method to determine the presence of PPM is needed. The Prosthesis -to-Annulus Relation (PAR I) trial is a German multicenter study assessing the relation between the true prosthetic GOA and the LVOTarea as potentially new parameter for the prediction of hemodynamic outcome, to possibly guide future valve size selection (incl. valve-in-valve) and to allow the detection of functionally relevant PPM. We will demonstrate the shortcomings of the currently applied EOAi for assessment of hemodynamic relevance and present the rationale for the PAR I trial. The trial recently started recruiting patients and will assess in 300 conventional aortic valve replacements how the anatomic dimensions of patients and implanted valves relate to each other and whether they allow the prediction of hemodynamic outcome.

Aims: Prospective data on the usage of 3-dimensional imaging based annulus sizing on the outcome of TAVI is not available yet and there is general uncertainty about the optimal degree of oversizing. In the current study we therefore assessed a 3-D MSCT guided over-sizing approach and evaluated the clinical outcome of different degrees of oversizing.Methods: TAVI-size-selection was done using systolic MSCT-annulus cross-sectional-area (CSA) measurements in 107 patients with severe aortic stenosis with the goal to oversize the 3rd generation balloon expandable Edwards Sapien XT (ESTV) device in relation to the native aortic annulus CSA.Results: Among different degrees of oversizing there were no differences in the occurrence of stroke, myocardial infarction and death. No aortic injuries were observed. The overall rate of > mild postprocedural aortic regurgitation (PAR) was 7.6%. Increasing oversizing ratios are associated with lower rates of > mild PAR (r = -0.236, p < 0.02) with the lowest rate of > mild PAR in patients with area based oversizing ratios >25% and the highest rate in patients with oversizing ratios <15% (0% vs. 15.8%, p < 0.02). The rate of postprocedural permanent pacemakers tended to be lower in patients with <15% oversizing compared to those with >25% oversizing (5.3 vs. 16.7%, p < 0.23).Conclusions: MSCT guided ESTV-device sizing is safe and is associated with significantly lower than previously reported rates for PAR. A device/annulus oversizing ratio of 15-25% based on area and 7-12% based on mean diameter appears to provide the best risk-benefit ratio in terms of PAR reduction and conduction disorders. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

Objectives: Suitability to drive can be impaired by various factors. Aim of the study was to evaluate personality traits in patients after cardiac surgery that might be relevant for behaviour in road traffic.

Objective: Even though Transcatheter aortic valve implantation (TAVI) is a promising treatment option for high-risk patients considered inoperable for surgical aortic valve replacement, use of the heart-lung-machine (HLM) is still necessary in some cases in order to control severe complications. We intended to evaluate incidence and outcome for TAVI patients requiring extra-corporal circulatory support during intervention in our institution.

Objectives: Psychological impairment is common after severe diseases. The mere metaphoric coherence between heart and soul indicates a distinctive correlation and intimate connection, suggesting that psychological stress in patients requiring cardiac surgery might be different from those with other severe diseases. This study investigates psychological traits and coping styles in the specific population after cardiac surgery, which might be relevant for psychological integrity and recovery.

Introduction: Paravalvular leakage after transcatheter aortic valve implantation (TAVI) is a fairly common complication. One reason for paravalvular leakage can be suboptimal valve placement during implantation procedure especially if strong calcification is present.

Introduction: Open thoracoabdominal aortic aneurysm (TAAA) repair carries a risk of significant morbidity and mortality. Thoracic endovascular aortic repair is an alternative, less invasive approach with lower morbidity and mortality and reduced paralysis rates are reported.

Pre-procedural device sizing is a critical step during the TAVI procedure using the Edwards-Sapien trans-catheter-aortic-valve (ESTV). The current standard for pre procedural annulus sizing is transesophageal echocardiography (TEE) although this method does not take into account the oval annulus anatomy. We therefore assessed clinical and functional outcome of a 3-dimensional MSCT guided sizing approach and also determined prosthesis geometry after this approach using MSCT. TAVI-size-selection was done using MSCT-annulus cross-sectional-area (CSA) measurements in 107 patients, so that the outer nominal prosthesis-CSA always exceeded the annulus-CSA. Intraprocedural and 30-day all-cause mortality was 1.8% and 6.5% respectively. The rate of > mild post-procedural AR (PAR) was 7.6%. Average device expansion-and circularity-index of the ESTV was 95% and 97%, with an almost complete circular shape (index>90%) in all patients. Over-sizing of the device by > 25% in relation to annulus-CSA was associated with a zero rate of > mild PAR compared to over sizing by <15% (0% vs. 16.2%, p<0.007) but also with a trend of a higher likelihood for post-procedural need of permanent pacemakers (5.2% vs. 16.6%, p<0.23). Pre- procedural TEE-measurements systematically underestimated annulus dimensions and would have lead to the selection of smaller sized devices in 35% of patients. MSCT guided ESTV-device sizing is associated with almost complete and symmetric expansion and with lower than previously reported rates for PAR. Rigorous ESTV over sizing reduces the rate of PAR, is however associated with a higher risk of pacemaker implantations and emphasizes the need for more available prosthesis sizes.