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W Wandschneider

Publications and source records attributed to W Wandschneider.

9 recordsLinked to original sources
PubMed2000

Off-pump coronary bypass operations significantly reduce S100 release: an indicator for less cerebral damage?

BACKGROUND: Cardiac operations using extracorporeal circulation bear a risk of cerebral complications. The aim of our study was to investigate if off-pump operations without heart-lung machines can reduce cerebral injury. METHODS: S100, a protein specific for cerebral tissue, was used as a marker for cerebral impairment in 108 randomized patients undergoing coronary bypass operation: 67 patients (group A) were operated on with extracorporeal circulation and cardioplegic cardiac arrest, and 41 patients (group B) underwent off-pump beating heart revascularization. Both groups were similar regarding age, sex, ejection fraction, and number of anastomoses. S100 levels were measured from induction of anesthesia until 24 hours after the operation. RESULTS: Data collection was 100% complete. There was no in-hospital death. Nonfatal myocardial infarctions occurred in 2 patients in group A, and 1 patient in group B required resternotomy for bleeding. There was no neurologic deficit in either group. S100 levels increased only slightly in the off-pump patients (group B), whereas in group A there was a sharp rise in S100 concentration during extracorporeal circulation, only returning to baseline 6 hours after the end of the operation. Peak S100 levels were four times higher in group A than in group B (2.1 microg/L versus 0.5 microg/L; p < 001). CONCLUSIONS: The results of our study suggest that perioperative cerebral impairment is reduced in cardiac operations without the use of extracorporeal circulation. Further large-scale studies are needed to show whether this result is reflected by fewer neurologic deficits.

Aged↗
PubMed1995

Arterial grafts for coronary artery surgery.

Fifty specimens of left internal mammary artery, right gastroepiploic artery and right inferior epigastric artery were examined for length, diameter and frequency of atherosclerotic changes. Mean usable length was 132.4 mm for internal mammary arteries, 127.9 mm for gastroepiploic arteries and 128.4 mm for inferior epigastric arteries. One gastroepiploic artery was occluded. Histological examination revealed atherosclerotic plaques in seven internal mammary arteries (14%), 12 gastroepiploic arteries (24%) and 14 inferior epigastric arteries (28%). These findings emphasize the superiority of the inferior epigastric artery as the graft of choice for coronary artery bypass grafting. Gastroepiploic artery and inferior epigastric artery should only be used as additional grafts if 'all-arterial-grafting' is intended.

Aged↗
PubMed1995

Fatal fungal infection of an ascending aortic graft.

In a 57-year-old male with aortic valve stenosis and severe poststenotic dilation of the ascending aorta an aortic valve replacement and interposition of the dilated aortic segment with a Dacron prosthesis were carried out. Perioperative course was uneventful. Four months after dismission the patient presented with septic fever and recurrent arterial emboli. Histological evaluation of the thrombotic material found fungal masses of Aspergillus flavus. Although adequate antimycotic treatment was started immediately the patient died two days later. Postmortem examination revealed massive fungal infection of the Dacron prosthesis while the aortic allograft appeared free from infection. The symptoms of a fungal infection and possible diagnostic strategies are discussed.

Aortic Aneurysm↗
PubMed1994

Crystalloid versus blood cardioplegia in coronary by-pass surgery. A prospective, randomized, controlled study in 100 consecutive adults.

In a prospective randomized trial we investigated the benefit of blood versus asanguinous cardioplegia in routine coronary by-pass grafting. One hundred consecutive adult patients were randomly assigned to two groups: Group A (53 patients) received cold blood cardioplegia and group B (47 patients) had standard St. Thomas solution. In all patients we combined ante- and retrograde administration, in group A warm reperfusion was carried out before aortic declamping. Aortic cross clamp times, amount of cardioplegic solution and blood potassium levels at the end of cardio-pulmonary by-pass were higher in group A than in group B. The need for inotropic support at the end of the operation as well as in the postoperative period was more frequent in the crystalloid cardioplegia group. The occurrence of atrial fibrillation showed no clear correlation to the kind of cardioplegia used. Perioperative infarction was less frequent in the blood cardioplegia group (3.7% vs 6.3%; p < 0.01) and 30-day-mortality was nil (0% vs 3.2%; p < 0.01). Hospital stay did not differ between the two groups. In this clinical trial we could demonstrate the superiority of blood versus crystalloid cardioplegia in routine coronary by-pass grafting. Ante- and retrograde delivery of cold blood cardioplegia followed by warm reperfusion is a safe and simple method yielding satisfactory results.

Adult↗
PubMed1990

[Therapy of carotid stenosis in contralateral occlusion of the internal carotid artery].

From January 1985 up to December 1987 sixteen patients with unilateral stenosis of the internal carotid artery (ICA) and concomitant chronic contralateral carotid occlusion underwent surgical correction of the stenosis. 31.2% were asymptomatic, 18.7% had transient ischemic attacks and 50% had suffered a stroke. On the occluded side 31.2% had had a stroke. Angiography showed intracerebral shunting to the occluded side in 43.7%; 56.2% of the patients had concomitant stenoses of intracerebral vessels. Surgical correction consisted of endarterectomy and patch-plasty of the ICA-stenosis in local anesthesia under protection of an intraluminal shunt. There was no mortality and no perioperative stroke. After a mean interval of 32 months life table analysis showed a stroke-free rate of 92% from 6 to 24 months on the operated side and of 84% from 12 to 24 months on the occluded side. We conclude that ICA-endarterectomy in patients with contralateral ICA-occlusion can be done without increased perioperative risk and yields satisfactory long time results.

Arterial Occlusive Diseases↗
PubMed1988

Anastomotic aneurysms--an unsolvable problem.

Despite the advances in reconstructive vascular surgery anastomotic pseudoaneurysms have remained a serious problem. Even if a faultless operative technique is used this complication cannot always be averted. In order to avoid rupture or thromboembolism and to improve the patient's prognosis we suggest that all pseudoaneurysms are treated surgically except in poor risk patients. Between 1981 and 1986 119 anastomotic aneurysms in 68 patients were operated on in our department. 31.0% presented as infected aneurysms. 13.1% were recurrent after preceding aneurysm repair. The most common site was the femoral region following aortobifemoral bypass. Host vessel degeneration and acute inflammation of the anastomotic site seem to be the most important causative factors. Surgical repair usually consisted of resecting the anastomosis together with part of the host artery; in septic aneurysms limb salvage was attempted using extra-anatomic bypass. Postoperative mortality was 8.8%, minor complications occurred in 10.9%; 9 patients (13.1%) had to have an amputation.

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