Cardiac Surgery in Germany during 2009. A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery

Jf, Gummert; Funkat, Anne-Kathrin; Beckmann, Andreas; Schiller, Wolfgang; Hekmat, Khosro; Ernst, Moritz; Beyersdorf, Friedhelm

doi:10.1055/s-0030-1250294

Cited by 49 publications

(19 citation statements)

References 22 publications

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“…Despite these well-established benefits, however, less than 65% of diseased mitral valves are repaired [2], largely owed to the many surgical/technical challenges associated to this procedure, and also to a variety of clinical scenarios which make the patient ill-suited for conventional repair [3]. The rate of repair could vary from 10% to 90% depending on the type of mitral valve pathology [4].…”

Section: Introductionmentioning

confidence: 99%

Mitral valve restoration using the No-React(R) MitroFix™: a novel concept

Oertel

Golczyk

Pantele

et al. 2012

J Cardiothorac Surg

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BackgroundMitral Valve Repair (MVRP) has been shown to be significantly superior to Mitral Valve Replacement (MVR). Since the majority of repairs involve the Posterior Mitral Leaflet (PML) and not the Anterior Mitral Leaflet (AML), the monocuspidalisation of the Mitral Valve (MV) can be achieved with a bio-posterior leaflet that imitates a closed PML. This approach may have the benefit of restoring the competence of the MV without reducing its effective orifice area.MethodsWe have used a new concept and device, the MitroFixTM, to correct MV regurgitation due to pathology of the PML. The device comes with functional sizers both of which have identical shape and size. This allows the surgeon to pre-test the success of the restoration. From December 2006 to October 2011, 51 MitroFixTM devices were implanted at three institutions.ResultsThe mean age of the patients (32 males and 19 females) was 67.7 years. 37 of them were in NYHA class III or IV and all patients suffered from severe mitral valve regurgitation (MR). 31 patients underwent combined surgery. Successful implantation of the MitroFix™ device was performed in 51/53 patients.Mean cross-clamp time was 63.6 min (range: 29-118 min). Six patients had additional reconstructive procedures of the AML (chordae transfer, neo-chordae, triangular resection). At discharge, 33 patients showed no MR in the TTE and 17 patients exhibited trivial (I) or moderate (II) MR. The mean gradient was 4.0 mmHg and mean EOA was 2.52cm^2 (range: 1.5-4.0cm2). All patients were classified as being in NYHA class I or II.ConclusionThe MitroFixTM Mitral Valve Restoration Device is a new concept that offers an effective treatment of MR. The restoration of the mitral valve with the MitroFix™ device offers the advantage of preserving the AML and providing good coaptation with a prosthetic PML. Importantly, this preliminary evaluation indicates a mean effective orifice area ( EOA ) of 2.5cm2 in MV receiving a MitroFix™ device, witch is higher than EOA resulting from MVR or MVRP. The present study has also shown that severe regurgitation due to ischemic/rheumatic MR, endocarditis and complex prolapse of the PML are clear candidates for correction with the MitroFix™. Larger studies and a longer follow up period are needed to validate these promising results.

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Section: Introductionmentioning

confidence: 99%

Mitral valve restoration using the No-React(R) MitroFix™: a novel concept

Oertel

Golczyk

Pantele

et al. 2012

J Cardiothorac Surg

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“…In 2009 in Germany, 50.8% of patients undergoing cardiac surgery with cardiopulmonary bypass were older than 69 years and 11.8% older than 80 years [3]. The number of patients > 70 years with preoperative chronic kidney disease steadily increased and acute kidney injury (AKI) still remains a frequent complication in up to 30% of patients after cardiac surgery [4].…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in septua- and octogenarians after cardiac surgery

Ried

Puehler

Haneya

et al. 2011

BMC Cardiovasc Disord

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BackgroundAn increasing number of septua- and octogenarians undergo cardiac surgery. Acute kidney injury (AKI) still is a frequent complication after surgery. We examined the incidence of AKI and its impact on 30-day mortality.MethodsA retrospective study between 01/2006 and 08/2009 with 299 octogenarians, who were matched for gender and surgical procedure to 299 septuagenarians at a university hospital. Primary endpoint was AKI after surgery as proposed by the RIFLE definition (Risk, Injury, Failure, Loss, End-stage kidney disease). Secondary endpoint was 30-day mortality. Perioperative mortality was predicted with the logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE).ResultsOctogenarians significantly had a mean higher logistic EuroSCORE compared to septuagenarians (13.2% versus 8.5%; p < 0.001) and a higher proportion of patients with an estimated glomerular filtration rate (eGFR) < 60 ml × min-1 × 1.73 m-2. In contrast, septuagenarians showed a slightly higher median body mass index (28 kg × m-2 versus 26 kg × m-2) and were more frequently active smoker at time of surgery (6.4% versus 1.6%, p < 0.001). Acute kidney injury and failure developed in 21.7% of septuagenarians and in 21.4% of octogenarians, whereas more than 30% of patients were at risk for AKI (30% and 36.3%, respectively). Greater degrees of AKI were associated with a stepwise increase in risk for death, renal replacement therapy and prolonged stays at the intensive care unit and at the hospital in both age groups, but without differences between them. Overall 30-day mortality was 6% in septuagenarians and 7.7% in octogenarians (p = 0.52).The RIFLE classification provided accurate risk assessment for 30-day mortality and fair discriminatory power.ConclusionsThe RIFLE criteria allow identifying patients with AKI after cardiac surgery. The high incidence of AKI in septua- and octogenarians after cardiac surgery should prompt the use of RIFLE criteria to identify patients at risk and should stimulate institutional measures that target AKI as a quality improvement initiative for patients at advanced age.

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“…1 Reportedly, in 2009, 50.8% of individuals undergoing cardiac surgery with cardiopulmonary bypass (CPB) were over 69 years of age and 11.8% were older than 80 years. 2 Age is an established independent risk factor for morbidity, mortality and adverse events following coronary artery bypass grafting (CABG) and a review of the Society of Thoracic Surgeons (STS) database showed increased mortality of nonagenarians undergoing cardiac surgery. 3 Conventional CABG using CECC can be associated with severe complications, such as stroke, peripheral embolization, acute kidney injury and systemic inflammatory response syndrome (SIRS).…”

Section: Introductionmentioning

confidence: 99%

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly

et al. 2015

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Advanced age is a known risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial assesses the impact of MECC on the outcome of elderly patients undergoing CABG. Eight hundred and seventy-five patients (mean age 78.35 years) underwent isolated CABG using CECC (n=345) or MECC (n=530). The MECC group had a significantly shorter extracorporeal circulation time (ECCT), cross-clamp time and reperfusion time and lower transfusion needs. Postoperatively, these patients required significantly less inotropic support, fewer blood transfusions, less postoperative hemodialysis and developed less delirium compared to CECC patients. In the MECC group, intensive care unit (ICU) stay was significantly shorter and 30-day mortality was significantly reduced [2.6% versus 7.8%; p<0.001]. In conclusion, MECC improves outcome in elderly patients undergoing CABG surgery.

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Cardiac Surgery in Germany during 2009. A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery

Cited by 49 publications

References 22 publications

Mitral valve restoration using the No-React(R) MitroFix™: a novel concept

Mitral valve restoration using the No-React(R) MitroFix™: a novel concept

Acute kidney injury in septua- and octogenarians after cardiac surgery

Minimized extracorporeal circulation is improving outcome of coronary artery bypass surgery in the elderly

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