ABSTRACT
BACKGROUND: Primary malignant cardiac tumors rarely occur in clinical care. Little is known about the impact of a parameter on postoperative survival. METHODS: From May 1991 to May 2014, a total of 24 patients underwent surgical treatment of a primary cardiac sarcoma in our center. We analyzed our clinical database retrospectively for information on patient characteristics and treatment data. The follow-up could be completed to 91.7%. RESULTS: Angiosarcoma and non-otherwise-specified sarcoma were the most common tumor entities. R0 resection was achieved in most cases. Postoperative mortality within the first 30 days was 20.8% (n = 5). In four of these five cases, postoperative low-output cardiac failure was the leading cause of death. The cumulative survival rate was 77.3% after 30 days, 68.2% after 3 months, 50.0% after 6 months, 45.0% after 12 months, and 18.0% after 24 months. The mean survival time in the whole group was 47.0 months. A low tumor differentiation was associated with low mean survival, but this was not statistically significant. Mean survival of sarcoma was higher after R0 resection. There was no significant rate of survival difference regarding the adjuvant therapy concept. CONCLUSION: Extended surgery alone or in combination with chemo- and/or radiotherapy may be successful in certain cases and may offer a satisfactory quality of life. The establishment of a multicenter heart tumor register in Germany is necessary to increase the number of cases in studies, get more remarkable study results, and standardize the diagnosis and therapy.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Neoplasms/surgery , Postoperative Complications/etiology , Sarcoma/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Cardiac Surgical Procedures/mortality , Chemotherapy, Adjuvant , Child , Databases, Factual , Female , Germany , Heart Neoplasms/mortality , Heart Neoplasms/pathology , Humans , Male , Middle Aged , Postoperative Complications/mortality , Quality of Life , Radiotherapy, Adjuvant , Retrospective Studies , Risk Factors , Sarcoma/mortality , Sarcoma/pathology , Time Factors , Treatment Outcome , Young AdultABSTRACT
A ventricular septal defect in transposition of the great arteries is frequently closely related to the cardiac valves. The valvar function after arterial switch operation of patients with transposition of the great arteries and ventricular septal defect or intact ventricular septum was compared. We analysed the function of all cardiac valves in patients who underwent the arterial switch operations pre- and post-operatively, 1 year after the procedure and on follow-up. The study included 92 patients - 64 with transposition of the great arteries/intact ventricular septum and 28 with transposition of the great arteries/ventricular septal defect. The median age at surgery was 5.5 days in transposition of the great arteries/intact ventricular septum (0-73 days) and 7.0 days in transposition of the great arteries/ventricular septal defect (4-41 days). Follow-up was 51.7 months in transposition of the great arteries/intact ventricular septum (3.3-177.3 months) and 55 months in transposition of the great arteries/ventricular septal defect (14.6-164.7 months). Neo-aortic, neo-pulmonary, and mitral valvar function did not differ. Tricuspid regurgitation was more frequent 1 year post-operatively in transposition of the great arteries/ventricular septal defect (n = 4) than in transposition of the great arteries/intact ventricular septum. The prevalence of neo-aortic regurgitation and pulmonary stenosis increased over time, especially in patients with transposition of the great arteries/intact ventricular septum. The presence of a ventricular septal defect in patients undergoing arterial switch operation for transposition of the great arteries only has a minor bearing for the development of valvar dysfunction on the longer follow-up.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Septal Defects, Ventricular/epidemiology , Heart Septal Defects, Ventricular/surgery , Heart Valves/physiology , Transposition of Great Vessels/epidemiology , Transposition of Great Vessels/surgery , Age Factors , Cardiac Surgical Procedures/adverse effects , Chi-Square Distribution , Cohort Studies , Comorbidity , Echocardiography, Doppler , Female , Follow-Up Studies , Heart Septal Defects, Ventricular/diagnostic imaging , Humans , Infant , Infant, Newborn , Male , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Recovery of Function , Retrospective Studies , Risk Assessment , Survival Rate , Time Factors , Transposition of Great Vessels/diagnostic imaging , Treatment Outcome , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/epidemiologyABSTRACT
Left ventricular assist device (LVAD) implantation has become an established therapy in adults as well as in children as a bridge to heart transplantation or to aid myocardial recovery. We describe the first case worldwide of an infant suffering from Bland-White-Garland syndrome successfully treated with a left ventricular assist device (Berlin Heart(R); Excor(R) Pediatric) as a bridge to heart transplantation for a period of more than one year.
Subject(s)
Heart Defects, Congenital/surgery , Heart-Assist Devices , Female , Heart Transplantation , Humans , Infant, Newborn , Male , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Full mechanical support with a left ventricular assist device (LVAD) is often limited to very sick patients, as the only survival option. This European multicenter study analyzes the effect of partial mechanical support as bridge-to-transplant in a less sick heart failure patient group. METHODS: The CircuLite Synergy device is implanted via a small right-sided thoracotomy with an inflow cannula in the left atrium and an outflow graft connected to the right subclavian artery without the use of extracorporeal circulation. The pump itself sits in a "pacemaker" pocket subcutaneously in the right clavicular groove. It is able to pump up to 3.0 l/min and partially unload the left ventricle. RESULTS: The device was implanted in 25 patients on the cardiac transplant waiting list (20 males), aged 55.5 +/- 9.6 yrs with an ejection fraction of 21.6 +/- 6.0 %, a mean arterial pressure of 73.5 +/- 8.5 mmHg, a pulmonary capillary wedge pressure of 27.2 +/- 7.8 mmHg and cardiac index of 1.9 +/- 0.4 l/min/m (2). Duration of support ranged from 6 to 238 days. Right heart catheterization showed significant hemodynamic improvement in the short- and intermediate-term after implantation with increases in arterial pressure from 72.6 +/- 11.0 to 79.4 +/- 8.6 mmHg ( P = 0.04) and in cardiac index from 2.0 +/- 0.4 to 2.7 +/- 0.6 l/min/m (2) ( P = 0.003) with a reduction in pulmonary capillary wedge pressure from 28.5 +/- 6.0 to 19.7 +/- 6.9 mmHg ( P = 0.012). CONCLUSIONS: The CircuLite Synergy device is a partial support pump, which is easy to implant and which provides hemodynamic benefits in bridging heart failure patients to cardiac transplant.
Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Adolescent , Adult , Aged , Female , Heart Failure/surgery , Heart Transplantation , Humans , Male , Middle Aged , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Left ventricular assist devices have been successfully used as a bridge to cardiac transplantation. Because many patients exhibit marked clinical improvement of their heart failure after LVAD implantation, we studied the physiological effect of pulsatile and non-pulsatile devices on the neurohormonal axis and exercise capacity. METHODS: We prospectively included 20 patients (17 men, 3 women) undergoing LVAD implantation between November 2001 and January 2004. Ten patients (1 woman and 9 men) were treated with the non-pulsatile INCOR-LVAD (Berlin Heart(c)) and ten patients received the pulsatile EXCOR LVAD (Berlin Heart(c)). Blood samples for plasma renin activity (PRA) were taken once a week over a period of ten weeks. All blood samples were collected in the morning before mobilization. Blood pressure, body weight, fluid intake and urine production were measured once a day. All patients received standard hospital diet with no limitation in fluid intake. RESULTS: Body weight remained constant in both groups throughout the ten weeks' examination, and fluid intake and urine production were balanced in all patients. Although there was no significant difference in mean blood pressure (INCOR: 70 +/- 10 mmHg; EXCOR: 73 +/- 10 mmHg), plasma renin activity was substantially elevated in patients with non-pulsatile left ventricular support (INCOR: 94.68 +/- 33.97 microU/ml; EXCOR: 17.06 +/- 15.94 microU/ml; P < 0.05). Furthermore plasma aldosterone levels were significantly higher in patients supported by non-pulsatile INCOR LVAD (INCOR: 73.4 +/- 9.6 microg/ml; EXCOR: 20.6 +/- 4.6 microg/ml; P < 0.05). CONCLUSIONS: Our data suggest that pulsatile as well as non-pulsatile left ventricular assist devices are equally able to treat chronic heart failure. However pulsatile devices seem to have a greater impact on reversing the changes in plasma renin activity and might thus offer a greater advantage when recovery of left ventricular function is expected.
Subject(s)
Heart Failure/physiopathology , Heart Failure/surgery , Heart-Assist Devices , Renin-Angiotensin System/physiology , Adult , Aged , Female , Humans , Male , Middle Aged , Severity of Illness Index , Treatment OutcomeABSTRACT
Left ventricular assist devices (LVADs) offer the opportunity to substantially improve the clinical condition and to interrupt the hospitalization of patients suffering from end-stage heart failure awaiting heart transplantation.We report a case of a 30-year-old patient (body surface area 2.49 m2) suffering from idiopathic dilative cardiomyopathy who was primarily given an LVAD with a free floating impeller pump and was finally switched to a total artificial heart due to the demand for a higher cardiac output.
Subject(s)
Cardiac Output , Cardiomyopathy, Dilated/surgery , Heart, Artificial , Heart-Assist Devices , Adult , Cardiomyopathy, Dilated/physiopathology , Heart Transplantation , Humans , Male , Treatment Outcome , Waiting ListsABSTRACT
We describe the case of a 39-year-old woman who received a self-made total artificial heart built of components from the Thoratec and ExCor Berlin Heart systems. The patient had a severe aortic/myocardial infection following replacement of the ascending aorta with a Shelhigh conduit due to type A aortic dissection. The surgical technique is described in detail in this article. This technique is feasible if a total artificial heart is not available and implantation of a biventricular assist device is not possible.
Subject(s)
Heart Failure/surgery , Heart, Artificial , Heart-Assist Devices , Postoperative Complications/surgery , Prosthesis Design/methods , Prosthesis Implantation/methods , Adult , Aortic Dissection/surgery , Aortic Valve Insufficiency/surgery , Female , Heart Failure/etiology , Heart Transplantation , Humans , Prosthesis Design/instrumentation , Reoperation , Treatment OutcomeABSTRACT
A simple surgical technique to insert an RVAD without the use of a heart-lung machine and without full anticoagulation is described here.
Subject(s)
Anticoagulants/adverse effects , Cardiomyopathy, Dilated/surgery , Heart-Assist Devices , Heparin/adverse effects , Prosthesis Implantation/methods , Thrombocytopenia/complications , Ventricular Dysfunction, Right/surgery , Adult , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/physiopathology , Follow-Up Studies , Humans , Male , Thrombocytopenia/chemically induced , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/physiopathologyABSTRACT
OBJECTIVE: Different surgical approaches have been used to repair complete atrioventricular septal defects (AVSD). Regurgitant atrioventricular valves (AV-valves) are common after surgery. We compared different surgical techniques with respect to long-term postoperative AV-valve regurgitation. METHODS: In 69 patients with complete AVSD, three different surgical techniques were applied: Single-patch, two-patch, and modified techniques. The left-sided AV-valve cleft was surgically closed in all patients. RESULTS: A comparison of the results of the different techniques showed no difference in the degree of AV-valve regurgitation on either the right or the left side. The average degree was mild on both sides. Only one patient needed reoperation for severe left-sided AV-valve regurgitation. CONCLUSION: The different surgical techniques used for the correction of AVSD do not have a major bearing on the degree of AV-valve regurgitation.
Subject(s)
Cardiac Surgical Procedures , Heart Septal Defects/surgery , Mitral Valve Insufficiency/etiology , Postoperative Complications , Tricuspid Valve Insufficiency/etiology , Adolescent , Adult , Cardiac Output, Low , Cardiac Surgical Procedures/methods , Child , Child, Preschool , Down Syndrome/complications , Female , Heart Defects, Congenital , Humans , Infant , Male , Mitral Valve Insufficiency/surgery , Postoperative Complications/surgery , Reoperation , Retrospective Studies , Tricuspid Valve Insufficiency/surgeryABSTRACT
Isolated noncompaction of the left ventricular myocardium is a rare cardiomyopathy typically showing a "spongy" myocardium on ultrasound. We report on the ultrasonic and pathomorphological characteristics of an infant who, at the age of 40 days, was treated by heart transplantation for isolated noncompaction. Noncompaction should be suspected in newborns with otherwise unexplained cardiomyopathy and a "spongy" left ventricle. However, ultrasonic and pathological findings may be much less pronounced at this age than later in life.
Subject(s)
Cardiomyopathy, Hypertrophic/congenital , Cardiomyopathy, Hypertrophic/surgery , Heart Transplantation , Endomyocardial Fibrosis/etiology , Heart Atria/abnormalities , Heart Ventricles/abnormalities , Humans , Infant , Male , Myocytes, Cardiac/pathology , Postoperative Complications/etiologyABSTRACT
OBJECTIVE: We report on our experience with the BerlinHeart Excor system in adults and paediatric patients who underwent placement of the mechanical support device under emergency conditions and demonstrate the exceptional advantages and the considerable versatility of the system. METHODS: Since 2003, 29 consecutive patients (25 adults and 4 infants) with ages ranging from 10 months to 54 years underwent implantation of an Excor system. Main underlying heart diseases in adults were acute myocardial infarction (n = 9), dilative cardiomyopathy (n = 6), acute myocarditis (n = 6), whereas most of the children suffered from dilative cardiomyopathy. Ten patients had undergone implantation of an extracorporeal membrane oxygenation system. RESULTS: In 26 cases, a left ventricular assist device (LVAD) was implanted, while 3 patients had biventricular support. The support interval of all patients surviving the perioperative period lasted from 30 to 412 days, mean period of support until heart transplantation or explantation was 184 +/- 117 days. Severe complications were rare. CONCLUSION: The Excor paracorporeal mechanical support system is an excellent and highly versatile device for the support of patients of all ages and different types of underlying heart disease in the mid-term and long-term. The implant procedure and the perioperative management are simple, and complication rates are low.
Subject(s)
Heart Failure/surgery , Heart-Assist Devices , Prosthesis Implantation , Ventricular Dysfunction, Left/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Heart Transplantation , Humans , Infant , Kaplan-Meier Estimate , Male , Middle Aged , Perioperative Care , Prosthesis Design , Prosthesis Implantation/adverse effects , Prosthesis Implantation/methods , Regression Analysis , Treatment OutcomeABSTRACT
We report on a technical modification in the creation of an apicoaortic conduit which was successfully performed in a 49-year-old patient with porcelain aorta and previous off-pump coronary revascularization.
Subject(s)
Aortic Diseases/surgery , Aortic Valve Stenosis/surgery , Blood Vessel Prosthesis Implantation/methods , Calcinosis/surgery , Anastomosis, Surgical , Aortic Diseases/complications , Aortic Valve Stenosis/complications , Calcinosis/complications , Cardiopulmonary Bypass , Humans , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: Aminoterminal B-type pro-natriuretic peptide (NT-proBNP) is a reliable indicator of heart failure severity. Levels of NT-proBNP are markedly increased in patients with coronary artery disease (CAD) and severely impaired left ventricular (LV) function. The aim of our study was to assess the impact of NT-proBNP levels after high-risk coronary artery bypass grafting (CABG) with regard to recovery potential. METHODS: Between 1998 and 2004, 121 patients with CAD and severely impaired LV function, who were undergoing CABG, were investigated. Their mean age was 64 +/- 11 years. All patients were in New York Heart Association (NYHA) Class III/IV status; LV ejection fraction (EF) was 20 +/- 6%. All survivors underwent follow-up (59 +/- 34 months) spiroergometric, electrocardiographic (ECG) and echocardiographic assessment and were tested for routine blood controls and NT-proBNP levels (Roche, Mannheim, Germany). RESULTS: The survival rate after 8 years was 70%. All survivors received follow-up assessment. Among survivors the median NT-proBNP level at follow-up was 896 (521 to 1,687) pg/ml. The maximum oxygen uptake was 14.6 +/- 4.9 ml/min/kg, and EF increased to 42% at follow-up among all survivors. On dichotomizing survivors into two groups with NT-proBNP levels above and below the median, the post-operative body mass index was significantly higher in the high NT-proBNP group (p = 0.036). EF (p = 0.028) and NYHA classification (p < 0.05) improved significantly in both groups, with a tendency toward higher EF in the low NT-proBNP group. CONCLUSIONS: Patients undergoing a high-risk CABG procedure have a survival rate comparable to heart transplantation patients and show a potential for clinical and myocardial recovery. NT-proBNP use a useful marker for recovery after a high-risk CABG procedure, with significant correlation with clinical parameters.
Subject(s)
Biomarkers/blood , Coronary Artery Bypass , Myocardial Ischemia/surgery , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Ventricular Dysfunction, Left/blood , Ventricular Dysfunction, Left/surgery , Aged , Comorbidity , Coronary Artery Bypass/mortality , Exercise Test , Female , Humans , Male , Middle Aged , Multivariate Analysis , Myocardial Ischemia/blood , Myocardial Ischemia/epidemiology , Postoperative Period , Recovery of Function , Spirometry , Survival Analysis , Ventricular Dysfunction, Left/epidemiologyABSTRACT
We present a young female patient with three caval drainages after complete Fontan's procedure and with bilateral bidirectional cavopulmonary connections who underwent orthotopic heart transplantation. Instead of reconstructing the hypoplastic innominate vein the persistent left superior caval vein was reanastomosed via the recipient's coronary sinus into the right atrium.
Subject(s)
Fontan Procedure , Heart Bypass, Right , Heart Transplantation , Adult , Coronary Vessels/surgery , Female , Heart Atria/abnormalities , Heart Atria/surgery , Heart Defects, Congenital/surgery , Heart Failure/etiology , Heart Failure/surgery , Humans , Hypertension, Pulmonary/surgery , Postoperative Complications/etiology , Postoperative Complications/surgery , Pulmonary Artery/surgery , Reoperation , Vena Cava, Superior/abnormalities , Vena Cava, Superior/surgeryABSTRACT
A few weeks after orthotopic heart transplantation, a male adolescent developed atrial arrhythmias of the donor heart due to an atypical recipient atrial flutter with a recipient-to-donor transatrial conduction resulting in an absolute arrhythmia. Under medication with propafenone, the atrial flutter of the donor heart could be terminated with cardioversion.
Subject(s)
Atrial Flutter/diagnosis , Atrial Flutter/etiology , Electrocardiography/methods , Heart Atria/physiopathology , Heart Conduction System/physiopathology , Heart Transplantation/adverse effects , Adolescent , Anti-Arrhythmia Agents/administration & dosage , Atrial Flutter/prevention & control , Combined Modality Therapy , Electric Countershock/methods , Graft Rejection/diagnosis , Graft Rejection/etiology , Humans , Male , Propafenone/administration & dosageSubject(s)
Heart Neoplasms/surgery , Heart Transplantation , Magnetic Resonance Imaging/methods , Sarcoma/surgery , Child , Fluorodeoxyglucose F18 , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/pathology , Humans , Male , Positron-Emission Tomography , Radiopharmaceuticals , Sarcoma/diagnostic imaging , Sarcoma/pathologyABSTRACT
Hypoplastic left heart syndrome (HLHS) is a challenge for the pediatric cardiologist and the surgeon. It is generally assumed that the postoperative outcome after surgery for congenital heart disease is influenced by the institutional size. We present the results of 43 patients with true HLHS (situs solitus and atrioventricular and ventriculoarterial concordance) referred for operation between 1992 and 2002 in our center. Two children had atrioseptostomy: one died soon after the operation, and the other one was transplanted successfully but died at the age of 6 months following acute rejection. The remaining 41 underwent Norwood I palliation, 21 stage II palliation, and 10 stage III palliation. Early mortality was 29% after stage I operation, 4.7% after stage II palliation, and 0% after stage III operation. Overall mortality was 39% after stage I, 9.5% after stage II, and 10% after stage III operation. Low birth weight was associated with a higher mortality (p < 0.05). Mortality declined with increasing experience, comparable to the results of very large cardiosurgical centers with many more patients. The quality of surgery and perioperative management in smaller pediatric cardiosurgical centers can reach the level of very large centers.
Subject(s)
Hypoplastic Left Heart Syndrome/surgery , Palliative Care , Germany , Hospitals, Pediatric , Hospitals, Teaching , Humans , Hypoplastic Left Heart Syndrome/mortality , Infant , Infant, Newborn , Surgicenters , Time FactorsABSTRACT
OBJECTIVE: We sought to examine our management and the outcomes of cardiothoracic procedures after heart and heart lung transplantation. METHODS: We performed a retrospective review of cardiothoracic surgical procedures carried out between 1990 and 2004 in patients who had previously undergone heart or heart-lung transplantation at our institution. RESULTS: Twenty-one out of 340 patients (6.2 %) were identified. Cardiothoracic surgery was performed 44.4 +/- 33 months (range 1 - 115 months) after transplantation. Predominant types of surgery were coronary artery bypass grafting due to allograft vasculopathy (n = 5), aortic surgery due to acute dissection (n = 3), biventricular assist device implantation due to acute rejection (n = 1), tricuspid valve repair (n = 1), multiple cardiac surgical procedures including coronary artery bypass grafting, retransplantation, and tricuspid valve replacement (n = 2), explantation of a functionless heterotopic transplanted heart (n = 1). Lung surgery was performed in six patients due to pneumonia (n = 2), primary lung carcinoma (n = 3), lung torsion following heart-lung transplantation (n = 1). All patients underwent either lobectomy or segmental lung resection. Single lung retransplantation (n = 2) after prior heart-lung transplantation due to bronchiolitis obliterans was performed. In one patient a pneumonectomy (n = 1) due to severe chronic rejection of the contralateral lung was performed. Six subsequent deaths after cardiothoracic procedures were recorded after 1, 4, 78, 163, 205, and 730 days, respectively. Causes of death were advanced carcinoma (n = 1), multi-organ failure due to sepsis (n = 2), sudden heart death (n = 2), and advanced heart failure (n = 1). Fifteen out of 21 patients having undergone cardiothoracic procedures (71.4 %) survived the observation period of 56.6 +/- 34 months (range 1 - 114). CONCLUSIONS: Reasons for cardiothoracic procedures after prior heart or heart-lung transplantation were allograft vasculopathy, aortic dissections years after transplantation, chronic rejection, and either lung infections or malignancies. Surgical repair can be performed with an acceptable operative risk and good long-term survival rates.
Subject(s)
Coronary Artery Bypass , Heart Transplantation , Heart-Lung Transplantation , Lung Diseases/surgery , Pneumonectomy , Vascular Diseases/surgery , Cardiac Surgical Procedures , Female , Humans , Male , Middle Aged , Postoperative Complications/surgery , Retrospective Studies , Survival Rate , Thoracic Surgical Procedures , Time Factors , Tomography, X-Ray ComputedABSTRACT
Heart transplantation is not a unique event, neither from the medical point of view nor from the standpoint of psychosocial care. It is a process which begins during the evaluation for transplantation and continues up to re-integration of the patient into everyday life. It is obvious that during the entire time both the child suffering from heart disease and the family of the affected child have to deal with heavy emotional stresses and adjustments. For this reason transplantation centers are obliged by law to provide psychological care.