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R Autschbach

Publications and source records attributed to R Autschbach.

At least 19 recordsLinked to original sources
PubMed2006

APOE alleles are not associated with calcific aortic stenosis.

OBJECTIVES: To analyse the association of APOE alleles with aortic stenosis (AS) in a large study population. METHODS: Patients with AS (n = 538) and a control group of the same age without heart disease (n = 536) were recruited. Left heart catheterisation was performed and mean gradient, aortic valve area, presence of stenotic coronary artery disease (CAD) and cardiovascular risk factors (hypercholesterolaemia, hypertension, smoking, diabetes mellitus and family history of CAD) were assessed. The frequency of the APOE major alleles e2, e3 and e4 was assessed by genotyping the polymorphisms APOE334 and APOE472 with a 5' exonuclease assay (TaqMan). RESULTS: Mean gradient across the aortic valve in cases was 50 (SD 20) mm Hg corresponding to a mean aortic valve area of 0.84 (SD 0.34) cm(2). 270 patients with AS had stenotic CAD. Among patients with AS, the prevalence of hypercholesterolaemia (64% v 40%, p < 0.001), smoking (43% v 27%, p < 0.001), diabetes (27% v 17%, p < 0.01), family history of CAD (30% v 21%, p </= 0.05), and male sex (65% v 44%, p < 0.001) was higher in those with than in those without CAD. The frequency of the major alleles was not different between cases and controls (APOE e2: 104 (19.3%) v 94 (17.5%); APOE e3: 319 (59.3%) v 332 (61.9%); APOE e4: 115 (21.3%) v 110 (20.5%); all p > 0.10). CONCLUSION: APOE e4 is not associated with AS, reflecting the different genetic backgrounds of CAD and AS.

Aged↗
PubMed2006

[The cardiac surgeon's role in intensive care].

During recent years there has been an ongoing process of profound change in German hospitals to save money because of governmental directives. This is also true for the management of hospitals and their departments, leading to new interdisciplinary wards. Therefore this article discusses the management of intensive care units from the cardiac surgeon's view and presents the "Aachen Model" as a possible solution.

Clinical Competence↗
PubMed2006

Perioperative risk of aortic valve replacement after coronary artery bypass grafting.

OBJECTIVE: To evaluate the operative risk of aortic valve replacement (AVR) after coronary artery bypass grafting (CABG). METHODS: Twenty patients (sixteen male, four female) underwent AVR 1.5-20 years (mean: 8.2) after CABG. RESULTS: Patients had received a mean number of four bypass grafts (2-5) with the use of the left internal thoracic artery in seventeen patients. Mean age at the time of AVR was 70.5 years (57-82). All patients suffered from an aortic stenosis with a mean orifice area of 0.74 cm (2) (0.34-1.1) and a mean pressure gradient of 52.4 mm Hg (22-78). Ten mechanical (mean diameter 23.6 mm, 21-27) and ten biological (22.1 mm, 19-25) prostheses were implanted. Mean duration of surgery, cardiopulmonary bypass (CPB) and cross-clamp time were 322.1 (205-645), 169.2 (87-411), and 77.1 (46-128) minutes, respectively. Fourteen patients had an uneventful postoperative course. A temporary neurological impairment, renal failure, and re-intubation for respiratory insufficiency for nine hours occurred in one patient each. Two patients died postoperatively (day 3 and 10) due to multiple cerebral infarctions. One patient required a replacement of the ascending aorta in deep hypothermia and re-implantation of the bypasses. He suffered from gastrointestinal bleeding on postoperative day 14 and expired on day 81 because of multi-organ failure. CONCLUSION: Aortic valve replacement after coronary artery bypass grafting is associated with an enhanced perioperative risk requiring meticulous decision-making and a sophisticated operative technique.

Aged↗
PubMed2006

Impact of pressure recovery in the evaluation of the Omnicarbon tilting disc valve.

BACKGROUND: Pressure recovery is not taken into account when calculating trans-prosthetic gradients after mechanical valve replacement using Doppler echocardiography. This may lead to underestimation of valvular performance. METHODS: Simultaneous measurement of Doppler and direct trans-prosthetic gradients was performed in a circulatory mock loop simulator with physiologic parameters at different heart rates and cardiac outputs for small-sized aortic Omnicarbon tilting disc valves (19 - 21 mm). RESULTS: In all adjustments the Doppler gradient significantly overestimated the net transvalvular gradient. The amount of pressure recovery averaged 59.3 %. CONCLUSIONS: Doppler echocardiography does not allow for pressure recovery, which is a significant phenomenon in the hemodynamic function of the Omnicarbon tilting disc valve. Valve performance is much better than expected from Doppler gradients.

Aortic Valve↗
PubMed2006

Intrathoracic implantation of a continuous flow left ventricular assist device--the microdiagonal blood pump.

AIM: All existing ventricular assist devices are associated with a considerable number of serious complications. We report on our first animal tests with a newly developed microdiagonal blood pump (MDP). METHODS: Six female calves underwent MDP implantation. The inflow and outflow conduit were anastomosed to the left atrium and the descending aorta. The MDP was placed in the left phrenicocostal sinus. Pump flow was adjusted to 2-3 L/min. Hemodynamic and echocardiographic data as well as blood samples were measured over the test period of 7 days. Thereafter, all internal organs and the pump were explanted for thorough examination. RESULTS: Mean arterial (90.5+/-12.1102.7+/-8.7 mmHg) and mean pulmonary arterial (17.3+/-2.420.6+/-2.7 mmHg) pressures remained stable during the test period. Cardiac output (5.4+/-0.5 = or >3.5+/-0.5 L/min) decreased postoperatively due to partial unloading of the heart. Left ventricular end-diastolic (4.4+/-0.5= or >3.8+/-0.4 cm) and end-systolic (3.4+/-0.5 =or >2.9+/-0.4 cm) diameters decreased after MDP implantation and did not change during the test period. Mean number of platelets (550+/-57 =or >350+/-86 x 103/microL) and hemoglobin (13.2+/-1.3 = or >11.9+/-0.8 g/dL) decreased perioperatively due to surgical reasons and recovered in the postoperative course. Free hemoglobin was slightly enhanced in the postoperative course. CONCLUSION: Our results demonstrate that the MDP is suitable for intrathoracic implantation and provides a reliable left ventricular unloading.

Animals↗
PubMed2005

Successful use of recombinant factor VIIa in a patient with intractable bleeding during extracorporeal membrane oxygenation.

Bleeding is still the most common complication during extracorporeal membrane oxygenation (ECMO) for temporary cardio-circulatory support. We present a case of a young man suffering from intractable hemorrhage during ECMO support, who was pre-treated with glycoprotein IIb/IIIa receptor antagonist Tirofiban due to a suspicion of myocardial ischemia. After failure of conventional hemostatic means, hemostasis was achieved by the donation of recombinant Factor VIIa (rFVIIa). Aspects of bleeding control during extracorporeal circulatory support, the use of Tirofiban and rFVIIa are discussed.

Adolescent↗
PubMed2005

A new cryoablation device for surgical therapy of atrial fibrillation.

During the last years, atrial fibrillation was treated more and more by surgical ablation. Due to serious complications with the available devices, new tools were developed. We report on the first successful cryoablation procedure with a new device in a patient with a high-grade mitral valve insufficiency (III-IV) and paroxysmal atrial fibrillation.

Atrial Fibrillation↗
PubMed2005

Influence of venous drainage and hemofiltration on hypercirculatory instability after high volume crystalloid cardioplegia during coronary artery bypass surgery.

AIM: The etiology of hypercirculatory instability following cardiac surgery with cardiopulmonary bypass has not yet been completely investigated and its clinical impact remains unclear. This prospective study was undertaken in order to investigate the impact of the systemic infusion of high volume crystalloid cardioplegia on the incidence of hypercirculatory instability and inflammatory mediator release in patients undergoing coronary artery bypass grafting. METHODS: Forty patients with single-atrial cannulation (group A), 40 patients with single-atrial cannulation and intraoperative hemofiltration (group B), and 40 patients with bicaval cannulation and complete removal of the cardioplegic solution from the right atrium (group C) were analyzed for hemodynamic changes and inflammatory mediator release until the postoperative day 2. Myocardial protection was performed using 2,000 mL cold crystalloid cardioplegia. RESULTS: A higher incidence of hypercirculatory instability in group A (39.2%) and B (42.8 %) was noted when compared to group C (18%, P = 0.032). Cardiac index was lower in group C when compared with group A (P = 0.001; 95% CI: 4.1, 15.57) and group B (P = 0.02; 95% CI: 1.13, 15.25). Systemic vascular resistance was higher in group C when compared with group A (P = 0.0001; 95% CI: 7108.7, 3131) and group B (P < 0.005; 95% CI 7598.9; 2830.6). High levels of tumor necrosis factor alpha, interleukin-6, interleukin-8, interleukin-10, and intercellular adhesion molecule-1 with no significant differences between the groups were measured early postoperative. CONCLUSIONS: High volume crystalloid cardioplegia under use of single-atrial venous cannulation is associated with a higher incidence of hypercirculatory failure. Hemofiltration during cardiopulmonary bypass offers no benefit on the incidence of hypercirculatory instability and to the release of inflammatory mediators.

Aged↗
PubMed2004

Prediction of fluid responsiveness in patients during cardiac surgery.

BACKGROUND: Left ventricular stroke volume variation (SVV) has been shown to be a predictor of fluid responsiveness in various subsets of patients. However, the accuracy and reliability of SVV are unproven in patients ventilated with low tidal volumes. METHODS: Fourteen patients were studied immediately after coronary artery bypass grafting (CABG). All patients were mechanically ventilated in pressure-controlled mode [tidal volume 7.5 (1.2) ml kg(-1)]. In addition to standard haemodynamic monitoring, SVV was assessed by arterial pulse contour analysis. Left ventricular end-diastolic area index (LVEDAI) was determined by transoesophageal echocardiography. A transpulmonary thermodilution technique was used for measurement of cardiac index (CI), stroke volume index (SVI) and intrathoracic blood volume index (ITBI). All variables were assessed before and after a volume shift induced by tilting the patients from the anti-Trendelenburg (30 degrees head up) to the Trendelenburg position (30 degrees head down). RESULTS: After the change in the Trendelenburg position, SVV decreased significantly, while CI, SVI, ITBI, LVEDAI, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) increased significantly. Changes in SVI were significantly correlated to changes in SVV (r=0.70; P<0.0001) and to changes in LVEDAI, ITBI, CVP and PAOP. Only prechallenge values of SVV were predictive of changes in SVI after change from the anti-Trendelenburg to the Trendelenburg position. CONCLUSIONS: In patients after CABG surgery who were ventilated with low tidal volumes, SVV enabled prediction of fluid responsiveness and assessment of the haemodynamic effects of volume loading.

Aged↗
PubMed2004

Late bilateral diaphragmatic rupture: challenging diagnostic and surgical repair.

A 67-year-old man was referred to our department, after a vehicle accident, with multiple bone fractures and a left blunt diaphragmatic rupture. An emergency laparatomy was performed, and the left diaphragmatic defect directly sutured. Postoperatively, a delayed right diaphragmatic rupture occurred due to progressive inflammation and muscle devitalisation. The diagnosis was challenging because the right rupture became clinically evident later after extubation. Diaphragmatic reconstruction was performed through a right thoracotomy. A high index of suspicion should always be observed for missed or delayed bilateral diaphragmatic ruptures.

Abdominal Injuries↗
PubMed2002

Coronary artery bypass grafting supported with intracardiac microaxial pumps versus normothermic cardiopulmonary bypass: a prospective randomized trial.

OBJECTIVE: To analyze the difference in coronary artery bypass grafting (CABG) performed with normothermic cardiopulmonary bypass (CPB) and CABG supported with the intracardiac microaxial pump (ICP, Impella, Aachen, Germany). METHODS: A prospective randomized study was conducted in seven centers. The study population consists of 199 patients undergoing isolated primary CABG (CPB group 94 patients, ICP group 105 patients). Both groups are equal in demographic variables, number of bypasses performed, and Euroscore predicted mortality. We analyzed clinical outcome, myocardial enzymes and blood parameters of hemolysis, organ function and inflammatory response. RESULTS: Seventeen patients (16%), randomized in the ICP group, were switched to the CPB group. This was due to the inability to position the right side catheter adequately (n=8), to a pump failure (n=1) or to the perioperative decision that beating heart surgery is technically not possible (n=8). There was no significant difference between the two study arms regarding the pump assistance time (CPB 67.1+/-22.9 min; ICP 67.7+/-30.3 min; P=0.88861), the number of grafts (CPB 2.4+/-0.7; ICP 2.3+/-0.8) and the number of grafts to the back wall (CFX; both groups n=37). There is no significant difference in clinical outcome, evolution of myocardial enzymes, indices of organ function and hemolysis. There is a reduced inflammatory response in the ICP group as indicated in the postoperative release of granulocyte elastase (CPB 259+/-195; ICP 150+/-126 microg/l; P<0.00001) and complement C3 (CPB 0.73+/-0.2; ICP 0.65+/-0.2g/l; P=0.008). CONCLUSION: The intracardiac pump for the right heart is difficult to introduce. As a consequence the right side pump underwent design modifications. There were no differences in clinical outcome between both groups. The inflammatory response is significantly reduced in the ICP group.

Aged↗
PubMed2002

Epicardial echocardiography for correct placement of the intracardial biventricular assist device (Impella).

BACKGROUND: Correct placement of the intracardial biventricular assist device (Impella) as a supporting system for off-pump coronary surgery is routinely checked by transesophageal echocardiography and invasive pressure measurements. However, it remains difficult to verify the accurate position of the right heart system when the posterior wall is exposed. METHODS: In 23 patients undergoing augmented beating heart CABG surgery, the correct placement of the lmpella-system was controlled by TEE as well as by a new 15-6 L epicardial echotransducer (EE) (Agilent, Andover, MA). RESULTS: TEE assisted well in inserting the system in all patients. The correct placement of the distal end of the right heart system 1.5 cm behind the pulmonary valve was verified in 18/23 cases by TEE vs. 23/23 cases by EE. Dislocation of the devices during tilting of the heart could only be verified by EE. CONCLUSIONS: Epicardial echocardiography is a useful, innovative method for monitoring the correct placement of the new intracardial biventricular assist device during beating-heart surgery.

Coronary Artery Bypass↗
PubMed2002

Comparison of ultrasonic scalpel versus argon-beam and conventional electrocautery for internal thoracic artery dissection.

BACKGROUND: We used an ultrasonic scalpel (USS) and an argon beam coagulator (ABC) to test their effectiveness and feasibility in comparison to conventional electrocautery for Internal Thoracic Artery (ITA) takedown, time for takedown, number of clips, thermal impact, along with morphological integrity assessed by histology. PATIENTS AND METHODS: Ninety-three patients undergoing elective coronary bypass surgery were prospectively randomized into three groups. In thirty-one patients, either an ultrasonic scalpel (USS, group A), an argon-beam coagulator (ABC, group B) or conventional electrocautery (CEC, group C) was used for ITA harvesting. RESULTS: Harvest times for ITA takedown using CEC (16.7 +/- 6 min) was significantly faster compared to ABC (21.6 +/- 8.1 min; p = 0.02) and USS (24.1 +/- 8.1 min; p < 0.001). There was no significant difference comparing harvest times of USS and ABC (p = 0.1). The number of hemostatic clips used was significantly lower when using USS (5.5 +/- 4.6 clips) compared to both CEC (16.6 +/- 6.2 clips; p < 0.001) and ABC (20.4 +/- 6.5 clips; p < 0.001) and significantly lower using CEC compared to ABC (p < 0.007). There were no significant differences in bleeding points within the tissue bed among the groups (ABC 11/31 patients, CEC 11/31 patients and USS 12/31 patients). CONCLUSION: This study demonstrates that dissection of the ITA pedicle can be safely done with USS, ABC, and CEC. However, USS is associated with less hemostatic clip demand but prolonged harvest time compared it to ABC and CEC; histological assessment revealed no significant difference when comparing groups and equipment used. A variety in design of the hooks may probably ease ultracision practicability.

Aged↗
PubMed2002

[First experiences with a miniaturized heart-lung-machine].

Conventional heart-lung-machines (HLM) used for many cardiosurgical procedures lead to an impaired function of nearly all organs. This deleterious effect may be reduced by miniaturized HLMs. Therefore we report on our first experiences in 9 patients (4 women, 5 men) undergoing beating heart coronary artery bypass grafting from 10/01 to 04/02 in our department employing a miniaturized HLM with the Deltastream extracorporeal rotary blood pump. Eight patients had an uneventful postoperative course, one patient died on the first postoperative day. Using this miniaturized HLM beating heart coronary artery bypass grafting was successful in all patients. Further studies are necessary to support these results.

Aged↗
PubMed2001

Regression of left ventricular hypertrophy after surgical therapy for aortic stenosis is associated with changes in extracellular matrix gene expression.

BACKGROUND: Regression of left ventricular hypertrophy (LVH) after surgical correction for aortic stenosis is not fully understood on the molecular level. The aim of this study was to examine whether there is an association between LVH regression and extracellular matrix (ECM) gene expression. METHODS AND RESULTS: A standard model of controlled LVH induction by supracoronary banding (A=baseline) was applied in 44 growing sheep (age, 6 to 8 months). Surgical correction to release the pressure gradient was performed 8.3+/-1 months later (B). The animals were killed after another 10.1+/-2 months (C). At all time points, hemodynamic evaluations and quantitative analysis of mRNA and protein expression for matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) was performed. Left ventricular mass index was 82+/-21 (A) versus 150+/-33 (B), P<0.01, and 78+/-18 g/m(2) (C), P<0.01. Left ventricular function and cardiac index remained stable. Myocardial fiber diameter index was 9.1+/-1.2 (A) versus 12.3+/-1.4 (B), P<0.01, and 8.4+/-1.3 micrometer/m(2) (C), P<0.01. In parallel to the development of LVH at B, gene expression was increased significantly for MMP-1, MMP-2, MMP-3, and MMP-9 and for TIMP-1 and TIMP-2 and decreased significantly for TIMP-3. After surgical correction (C), there was a complete regression of gene expression to baseline measures. CONCLUSIONS: Controlled induction of compensated LVH leads to significant increase in ECM gene expression. The regression of LVH after surgical therapy is associated with complete regression of ECM gene expression. However, no cause-and-effect relation could be demonstrated.

Animals↗
PubMed2001

Extracellular matrix gene expression correlates to left ventricular mass index after surgical induction of left ventricular hypertrophy.

The cardiac extracellular matrix (ECM) is a dynamic entity maintaining the structural and functional properties of the myocardium. Little is known about alterations in ECM regulation during controlled induction of compensated left ventricular hypertrophy (LVH) using experimental aortic stenosis. Fifteen growing sheep received supra-coronary banding at an age of 7 +/- 1 months whereas 10 age-matched sheep served as the control group (C). Explantation of the hearts was performed 8.3 +/- 1 months after banding. Gene sequences for sheep matrix metalloproteinase (MMP)-1,-2,-3,-9 and tissue inhibitors (TIMP)-1,-2,-3 were isolated and cloned. Then mRNA and protein gene expression analyses were performed. Concentric LVH with no evidence of heart failure was diagnosed at explantation. Left ventricular mass index (LVMI) was 150 +/- 33 g/m2 (LVH) versus 88 +/- 23 (C) and 82 +/- 21 (baseline) (p < 0.01 versus LVH). Parallel to LVH there was a significant increase in mRNA and protein expression for MMP-1,-2,-3, -9 and for TIMP-1,-2 whereas there was a significant decrease in TIMP-3 gene expression. A close correlation between changes in LVMI and ECM gene expression was found. Compensated LVH goes along with a significant modification of MMP and TIMP gene expression. Alterations in ECM gene expression may be part of the adaptive process during left ventricular remodeling.

Animals↗
PubMed2001

Early angiographic control of perioperative ischemia after coronary artery bypass grafting.

OBJECTIVE: To assess the impact of immediate angiography in patients with defined clinical and laboratory criteria of perioperative myocardial infarction after coronary artery bypass operation. PATIENTS AND METHODS: Between January 1999 and December 1999 2052 patients underwent coronary artery bypass grafting in our institution. Out of this cohort 131 (6.4%) patients met the criteria of perioperative myocardial ischemia, which was defined as: (a) increase in the isoenzyme ratio of creatinine phosphokinase (CK/CK-MB] above 10%; (b) ischemic electrocardiographic episodes (defined as a new onset of elevated ST-segment change lasting at least 1 min and involving a shift from baseline of greater than or equal to 0.1 mV of ST-depression and a new association of a postoperative Q; (c) recurrent episodes of, or sustained ventricular tachyarrhythmia as well as ventricular fibrillation; (d) hemodynamic deterioration despite adequate inotropic support. RESULTS: Angiography was performed in 108 patients (5.3%, group A) whereas 23 patients (1.1%, group B) were immediately re-operated due to severely compromised hemodynamics. Angiographic results in group A showed regular grafts in 45 patients (2.2%); 63 patients (3.1%) had either an occlusion (n=41), incorrect anastomosis (n=29), graft stenosis (n=14), graft spasm (n=6), displaced graft (n=6), poor distal run-off (n=5) or incomplete revascularization (n=2). In group A 43 patients underwent a re-operation (34 patients) or an early angioplasty (nine patients). Due to poor coronary artery status no intervention was performed in the remaining 20 patients with angiographic findings. Operative findings in group B showed graft occlusion in ten patients (43.5%), incorrect anastomosis in five patients (21.7%), bleeding, stretched graft, venous graft spasm and displaced graft in one patient (4.3%) each, and no patho-morphological finding in 4 patients (17.4%). Thirty-day mortality rate was ten patients in group A (9.3%), all of them with angiographic findings, as opposed to nine patients (39.1%) in group B. CONCLUSION: ST-change and elevated CK/CK-MB enzyme ratio is highly indicative for possible graft failure and should be followed early angiographic control to assess the need for reintervention.

Adult↗