Minimal-invasive Myokardrevaskularisation am schlagenden Herzen mittels inferiorer Reversed-J-Ministernotomie

MIDCAB (minimally invasive direct coronary artery bypass) has been controversially discussed as a surgical therapy concept for one-vessel coronary artery disease in recent years. The recently published meta-analysis showed that MIDCAB grafting has become an interesting alternative to conventional coronary artery bypass grafting, especially in patients with a high-grade left anterior descending coronary artery (LAD) stenosis unsuitable for balloon angioplasty [17]. Our patients (n=182) underwent myocardial revascularization using the MIDCAB procedure in the manner of an inferior reversed-J ministernotomy. In 94 patients (51.4%), the target vessel was the LAD and in 28 patients (15.4%) the LAD because of symptomatic LAD-muscle bridging. In 15 patients (8%), the target vessel was the LAD and obtuse marginal artery or RCA (right coronary artery). In 45 patients (25%), the operation was performed as part of a hybrid therapy. The present retrospective study shows the midterm results of minimally invasive bypass surgery for coronary artery disease and symptomatic LAD-muscle bridging on the beating heart via inferior reversed-J ministernotomy between June 2005 and October 2009. Nearly all patients operated on had a cardio-CT performed on postoperative day 7. In 3 patients (1.6%), a bypass revision was performed. After bypass surgery, 91% reported that the angina pectoris had resolved and 148 patients (92%) reported that their quality of life had increased. Postoperatively, there was a significant improvement in the functional NYHA and CCS classification. During the observation period, coronary angiography was performed in 11 patients (6%) due to symptomatic angina pectoris: in 6 patients, open bypass surgery was performed, 1 patient had bypass stenosis needing treatment, and 4 patients were reoperated due to bypass occlusions. The risk of elective bypass surgery on the beating heart is low. In this retrospective study, the 30-day mortality was 0.5% and late mortality was 4.2%.     

Koronare Bypasschirurgie am schlagenden Herzen bei Patienten mit Porzellanaorta

Background:

Patients with porcelain aorta and severe calcification of the great vessels are a challenging problem regarding bypass technique, choice of conduit, and selection of proximal anastomotic and cardiopulmonary bypass (CPB) sites due to the high incidence of devastating thrombembolization, stroke, and aortic injury.

Methods:

Intra-op detection of porcelain aorta and subsequent change of operative techniques occurred in 49 patients over a period of 4 years (60-84 years of age, mean 76 ± 5, 29 % females, unstable angina (55 %), acute myocardial infarction (10 %), left main disease (38 %), decreased LV-function (EF < 35 %, 25 %).

Results:

The initial surgical plan was changed in all patients and a "no touch" technique was applied. In 27 % of CABG, CPB support was utilized through aortic arch (n = 2), axillary artery (n = 5) and femoral artery cannulation (n = 6) in combination of beating heart technology. The remaining 73 % patients underwent OPCAB. Overall 2.6 ± 0.6 distal anastomoses were constructed. Proximal anastomoses on the atherosclerotic aorta were avoided in all patients by total arterial grafting/composite art.-art. connections (28 %), or connected to the brachiocephalic trunk in 32 %. One new major neurological event was observed (2 %), one hospital death (2 %).

Conclusions:

Off-pump technology is the ideal indication for patients with heavily calcified ascending aorta. These high-risk patients benefit most from a team approach and the flexibility and skills of cardiovascular surgeons changing immediately from on-pump and aortic cannulation and clamping to "no-touch" and "no-clamping" heart-beating coronary revascularization techniques.     

106. Stoffwechseluntersuchungen am menschlichen Herzen bei intermittierender Coronarperfusion

Ohne Zusammenfassung     

Die Operation des Vorhofseptumdefektes am offenen Herzen im Tierexperiment

Ohne Zusammenfassung     

Operationen am offenen Herzen im Tierexperiment (Film)

Ohne ZusammenfassungManuskript niecht eingegangen     

Pathophysiologie und Indikationen der Hypothermie bei Operationen am offenen Herzen

Ohne Zusammenfassung Mit 13 Textabbildungen     

Operationen am offenen Herzen mit Herz-Lungen-Maschine (Stockholmer Modell)

Ohne Zusammenfassung Wegen Erkrankung vorgetragen von seinem MitarbeiterSenning-Stockholm     

Zellersatztherapie am Herzen: Fiktion oder reale Möglichkeit

Transmural cryolesions of a defined size were generated on the free left ventricular wall in mice. Using this approach, reproducible myocardial infarctions with a predictable decrease in myocardial function were generated. The potency of cellular cardiomyoplasty, employing different stem and progenitor cells, to improve contractility and impair electrical vulnerability was investigated. Intramyocardially injected fetal cardiomyocytes engrafted, showed further differentiation, increased left ventricular function and improved mid-term survival of the animals. Connexin 43 expressing cells coupled electrically to the host myocardium and reduced inducibility of ventricular arrhythmias.     

111. Klinische und experimentelle Untersuchungen über Ventrikulo-coronare Stomata am menschlichen Herzen

Ohne Zusammenfassung     

Palacos im Herzen

For more than 20 years percutaneous vertebroplasty has been used in the minimally invasive treatment of vertebral fractures. We report on a patient with embolisation of bone cement into the pulmonary artery and the right ventricle, which was perforated. The final diagnosis was delayed due to a combination of complications, previous disorders as well as a second embolisation.