Prosthesis Dependant Left Ventricular Mass Regression After Aortic Valve Replacement. A Prospective Randomized Trial.

OBJECTIVES: This study assesses the hemodynamic performance of various aortic valve substitutes, the subsequent regression of left ventricular hypertrophy and the clinical outcomes after aortic valve replacement, in different age groups

METHODS: A total of 120 patients with isolated aortic valve stenosis were included in this prospective randomized trial. In group I (age 75 years), patients received a stentless bioprosthesis (CE Prima Plus n=20) or a stented bioprosthesis (CE Perimount n=20).

RESULTS: At 12 months, in group I, pulmonary autografts had significantly lower mean gradients when compared to mechanical valves ( 2.6 vs 10.9 mmHg, p=0.0005). Left ventricular mass regression however, was comparable in both groups (114±27.2 vs 110±30.2 g/m²). In group II, mean gradients were lower for stentless bioprostheses compared to mechanical valves (7.0 vs 8.9 mmHg, p=0.81), however it did not reach statistical significance. The rate of left ventricular mass regression was comparable(109±29.3 vs 111±27.6 g/m²). In group III, mean gradients did not differ significantly (7.8 vs 6.5 mmHg, p=0.06).Regression of left ventricular mass was comparable in both groups (104±28.5 vs 106±32.5 g/m²).

CONCLUSIONS: The rate and completeness of left ventricular mass regression was uniform for all prostheses and was not influenced by the differences in transvalvular gradients.

Author(s): Mirko Doss, Heinz Deschka, Petar Risteski, Gerhard Wimmer Greinecker, Anton Moritz

Endovascular interventions of the descending thoracic aorta.

Endovascular interventions of the descending thoracic aorta have been established as an alternative to conventional open surgery. Initially, they were limited to elective patients with a high risk profile for open surgery, but soon their use was extended to emergencies as well. In the elective setting, endovascular interventions significantly lowered short-term morbidity and mortality. These excellent perioperative results were reproducible in the emergency setting, thereby leading to superior outcomes for patients treated by endovascular stent grafts when compared to the conventional open surgical approach. However, some questions regarding long-term durability of these devices remain unanswered. Stent-graft failures at mid and long-term follow-up have been reported in the literature. The progressive nature of stent graft-related mid- and long-term complications stresses the need for continued surveillance of these patients.

Author(s): Doss M, Wood JP, Balzer J, Thalhammer A, Martens S, Wimmer-Greinecker G, Vogl T, Moritz A.
in: Herz. 2006 Aug;31(5):429-33
[Article in German] (Endovaskuläre Interventionen der thorakalen Aorta descendens)

PMID: 16944062 [PubMed - indexed for MEDLINE]
Springerlink

Left ventricular remodeling impacts the function of the Quattro stentless mitral valve bioprosthesis (a 4-year experience).

OBJECTIVE: The St Jude Quattro stentless mitral valve prosthesis (QMV) is sutured to the mitral annulus and the papillary muscle heads, thereby preserving the subvalvular apparatus. After mitral valve replacement, remodeling of the left ventricle is often observed, causing a dilated ventricle to shrink in diameter. It was our objective to assess these changes in left ventricular (LV) geometry and evaluate its effects on the function of the QMV.

METHODS: From September 1997 to October 2000, 24 patients received QMV at our institution. The patients were followed up at yearly intervals (mean 4.1 +/- 2.2 years). All pre- and postoperative echocardiograms were evaluated, with attention focused on the subvalvular apparatus, leaflet morphology, and occurrence of late mitral regurgitation. In addition, all clinical outcomes and valve-related complications were recorded.

RESULTS: Forty-one percent of patients (10/24) developed late mitral regurgitation (mild, n = 5; moderate, n = 5). The site of regurgitation was located at the 2 commissures in all cases. In 8 patients, changes in LV diameter had occurred. The point of leaflet coaptation had shifted away from the annulus in 4 patients. The overall mortality was 12.3%, and the postoperative stroke rate was 12.3%.

CONCLUSIONS: Midterm changes in LV geometry seem to affect the competence of the QMV. Predicting these changes and subsequently adapting the sizing procedure remain a challenging task. The high rate of late valve incompetence and poor clinical outcomes has prompted us to discontinue recruitment of patients for this trial.

Author(s): Mirko Doss, Tayfun Aybek, Jeffrey Paul Wood, Sven Martens, Gerhard Wimmer-Greinecker, Anton Moritz

in: Am Heart J. 2006 Apr ;151 (4):943.e1-4 16569568

Do pulmonary autografts provide better outcomes than mechanical valves? A prospective randomized trial.

BACKGROUND: The objective of this study was to compare the performance of pulmonary autografts with mechanical aortic valves, in the treatment of aortic valve stenosis.

METHODS: Forty patients with aortic valve stenoses, and below the age of 55 years, were randomly assigned to receive either pulmonary autografts (n = 20) or mechanical valve (Edwards MIRA; Edwards Lifesciences, Irvine, CA) prostheses (n = 20). Clinical outcomes, left ventricular mass regression, effective orifice area, ejection fraction, and mean gradients were evaluated at discharge, 6 months, and one year after surgery. Follow-up was complete for all patients.

RESULTS: Hemodynamic performance was significantly better in the Ross group (mean gradient 2.6 mm Hg vs 10.9 mm Hg, p = 0.0005). Overall, a significant decrease in left ventricular mass was found one year postoperatively. However, there was no significant difference in the rate and extent of regression between the groups. There was one stroke in the Ross group and one major bleeding complication in the mechanical valve group. Both patients recovered fully.

CONCLUSIONS: In our randomized cohort of young patients with aortic valve stenoses, the Ross procedure was superior to the mechanical prostheses with regard to hemodynamic performance. However, this did not result in an accelerated left ventricular mass regression. Clinical advantages like reduced valve-related complications and lesser myocardial strain will have to be proven in the long term.

Author(s): Mirko Doss, MD , Jeffrey P. Wood, MD, Sven Martens, MD, Gerhard Wimmer-Greinecker, MD, Anton Moritz, MD

in: Ann Thorac Surg. 2005 Dec;80(6):2194-8

PMID: 16305870 [PubMed - indexed for MEDLINE]

Pericardial patch augmentation for reconstruction of incompetent bicuspid aortic valves.

PURPOSE: Reoperation rates after repair of bicuspid aortic valves are higher than for mitral valve reconstruction. Secondary changes and small coaptation surface render repair unreliable. Satisfactory results have been reported for patch augmentation for tricuspid aortic valves. We have applied this technique for the repair of bicuspid aortic valves.

DESCRIPTION: Our technique retains the bicuspid morphology of the incompetent aortic valve. A strip of glutaraldehyde-fixed pericardium is sutured to the free edge of the fused leaflet. A large coaptation surface is created, and competence of the bicuspid valve is achieved.

EVALUATION: Sixteen patients underwent reconstruction of their bicuspid aortic valves by pericardial patch augmentation. There were no intraoperative or postoperative deaths. The degree of aortic regurgitation was none to trivial for all patients at a mean follow-up of 3.1 +/- 3.4 months. Planimetric effective orifice areas ranged above 2 cm2. Mean aortic gradients were 8.2 +/- 4.8 mm Hg, and the mean height of coaptation surface was 14.7 +/- 2.1 mm.

CONCLUSIONS: The pericardial patch augmentation technique increases coaptation surface, and thus provides reliable early competence of reconstructed bicuspid aortic valves.

Author(s): Doss M, Moidl R, Wood JP, Miskovic A, Martens S, Moritz A

in: The Annals of Thoracic Surgery, 2005 Jul;80(1):304-7.

PMID: 15975387 [PubMed - indexed for MEDLINE]

Emergency endovascular interventions for acute thoracic aortic rupture: 4 year follow up.

OBJECTIVE: High mortality and paraplegia rates associated with the surgical management of acute thoracic aortic ruptures limit its success. It was our objective to evaluate whether emergency endovascular interventions would improve the outcomes of these patients.

METHODS: Sixty patients aged 28 to 83 years were admitted to our institution with an acute rupture of the thoracic aorta (27 ruptured aneurysms, 15 perforated type B dissections, 18 traumatic ruptures). Twenty-eight patients were treated surgically with cardiopulmonary bypass, and 32 patients were acutely treated with an endovascular stent graft. Medical records were reviewed for prehospital and emergency department data, operative findings, and outcomes. Patients were followed up at yearly intervals with high-resolution multidetector computed tomographic angiography.

RESULTS: Perioperatively, there were 1 death (3.1%) among the 32 patients in the endovascular group and 5 deaths (17.8%) among the 28 patients in the surgical group. There were 4 late deaths in the endovascular group and 1 in the surgical group. There were 2 access failures in the endovascular group. There were 1 stroke in the endovascular group and 1 case of paraplegia in the surgical group. Three patients in the endovascular group had endovascular leaks develop that required reintervention. Two patients in the endovascular group had late thrombosis of the left subclavian artery.

CONCLUSION: Despite encouraging early outcomes, midterm results suggest a trend toward increased reintervention and late complication rates in the endovascular group. Therefore continued surveillance of patients treated with stent grafts is necessary.

Author(s): Doss M, Wood JP, Balzer J, Martens S, Wimmer-Greinecker G, Moritz A.
in: Journal of Thoracic and Cardiovascular Surgery, 2005 Mar;129(3):645-51.

Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23-26, 2004.

PMID: 15746750 [PubMed - indexed for MEDLINE]

Aortic leaflet replacement with the new 3F stentless aortic bioprosthesis.

PURPOSE: Clinical trials with the new 3F stentless aortic bioprosthesis began October 2001, and as one of the first centers to implant this prosthesis in humans, we would like to present our experiences with this new device.

DESCRIPTION: The 3F aortic bioprosthesis is a stentless biological heart valve fabricated from three equal leaflets of equine pericardium, assembled in a tubular shape, and implanted in the native aortic root to replace the patient’s diseased aortic leaflets. Between January 2002 and August 2002, 24 3F aortic bioprostheses were implanted at our institution. Effective orifice area, mean gradients, and ejection fraction were evaluated by echocardiography at discharge and at 12-month follow-ups after surgery.

EVALUATION: At 12-month follow-ups, the 3F bioprosthesis showed a good hemodynamic performance with a significant drop of mean gradients to 10.3 mm Hg, a mean effective orifice area of 1.7 cm2, and a mean ejection fraction of 61.5%.

CONCLUSIONS: The clinical performance of the new 3F aortic bioprosthesis is comparable with regular stentless aortic valves. However its unique design facilitates implantation.

Author(s): Doss M, Martens S, Wood JP, Miskovic A, Christodoulou T, Wimmer-Greinecker G,
in: The Annals of Thoracic Surgery, 2005 Feb;79(2):682-5; discussion 685

PMID: 15680860 [PubMed - indexed for MEDLINE]

Five-year follow-up after long plaque-bridging coronary arteriotomy for diffuse coronary artery disease.

Long arteriotomy bridging a stenotic plaque or segment may improve runoff in diffuse coronary artery disease. However, patency might be impaired due to vascular wall pathology.

OBJECTIVE: To determine the patency rates of plaque-bridging arteriotomy compared to conventional coronary artery bypass grafting. METHODS: Between May 1995 and December 1998, 104 patients with a mean age of 65 +/- 7 years received a long arteriotomy extending over a heavily plaqued area in an effort to treat their diffuse coronary artery disease. The length of the arteriotomy ranged from 14 mm to 40 mm. We retrospectively analyzed the intra-individual bypass graft patency rates by multidetector-computed tomography or coronary angiography.

RESULTS: The mean follow-up was 5 years. There were 5 (4.8 %) early and 10 (9.6 %) late deaths, three non-cardiovascular. Graft patency for internal thoracic artery (ITA) to left anterior descending artery (LAD) (plaque-bridging) was 94.8 %, for saphenous vein graft (SVG) to circumflex artery (CX) (plaque-bridging) 67 %, and SVG to right coronary artery (RCA) (plaque-bridging) 79.5 %. Graft patency for ITA to LAD (conventional) was 94.9 %, for SVG to CX (conventional) 72.4 %, and SVG to RCA (conventional) 75 %. Freedom from angina was 82.8 % (n = 58/70), freedom from myocardial infarction was 95.7 % (n = 67/70), freedom from reintervention was 91.4 % (n = 64/70) and freedom from reoperation was 100 % (n = 70/70).

CONCLUSION: Diffuse coronary artery disease can be treated by extending the arteriotomy over the plaques, with graft patency rates comparable to bypass grafts onto less diseased segments.

Author(s): Doss M, Martens S, Wood P, Tsoukalas I, Moritz A.

in: Thorac Cardiovasc Surg. 2003 Dec;51(6):318-21.

PMID: 14669127 [PubMed - indexed for MEDLINE]

Surgical versus endovascular treatment of acute thoracic aortic rupture: a single-center experience.

BACKGROUND: Surgical management of acute thoracic aortic ruptures is controversial, especially in patients with preexisting comorbidities; associated mortality and paraplegia rates remain high. It was our objective to evaluate whether treating these patients acutely with endovascular stent grafts would improve their outcome.

METHODS: From November 1999 to February 2002 a total of 54 patients, age 28 to 83 years, were admitted to our institution with an acute rupture of the thoracic aorta (24 ruptured aneurysms, 14 perforated type B dissections, 16 traumatic ruptures). Twenty-eight patients were managed surgically using cardiopulmonary bypass (group 1), and 26 patients were treated acutely with an endovascular stent graft (group 2). The resuscitation protocol and interval from onset of symptoms to treatment was comparable in both groups. Medical records were reviewed for prehospitalization and emergency department data, operative findings, and outcomes.

RESULTS: There were 5 of 28 deaths (17.8%) in the surgical group and 1 of 26 deaths (3.8%) in the endovascular group. In the surgical group 1 of 28 patients (3.6%) exhibited paraplegia; there were no cases of paraplegia in the endovascular group. There were 4 of 28 cases (14.3%) of renal failure in group 1 and 1 of 26 (3.8%) in group 2. In group 1, 8 patients (28.6%) required mechanical ventilation for more than 48 hours; there were 2 of 26 patients (7.7%) in group 2 with this ventilatory requirement. Three patients required a repeat thoracotomy for hemorrhage in the surgical group. There were two access failures in the endovascular group.

CONCLUSIONS: In the treatment of acute ruptures of the thoracic aorta, the immediate outcome of patients treated with endovascular stent grafts appears to be better than with management by conventional surgical repair.

Author(s): Doss M, Balzer J, Martens S, Wood JP, Wimmer-Greinecker G, Fieguth HG, Moritz A.
in: Ann Thorac Surg. 2003 Nov;76(5):1465-9; discussion 1469-70.

PMID: 14602268 [PubMed - indexed for MEDLINE]

The clamshell approach for the treatment of extensive thoracic aortic disease.

OBJECTIVE: Management of extensive thoracic aortic disease may present an immense technical challenge. The choice of surgical access and subsequent exposure determines whether a single-stage or a 2-stage approach can be adopted.

METHODS: Fifteen patients with extensive thoracic aortic disease underwent resection of the ascending aorta, the aortic arch, and varying segments of the descending aorta. Four patients had concomitant coronary artery bypass grafting and 3 patients had aortic valve reconstruction. All patients were treated with a single-stage approach via a bilateral anterior thoracosternotomy (clamshell incision).

RESULTS: There was 1 hospital death (6.6%). Two patients required reoperation for bleeding (13.3%). Two patients needed mechanical ventilation for more than 48 hours. Three patients suffered a stroke (20%). Two patients (13.3%) had transient neurologic dysfunction. None of the patients had renal failure. There were no wound infections in this group.

CONCLUSION: The single-stage approach, via a clamshell incision, is a safe and effective procedure for patients who require treatment of extensive thoracic aortic disease and concomitant cardiac lesions.

Author(s): Doss M, Woehleke T, Wood JP, Martens S, Greinecker GW, Moritz A.

in: J Thorac Cardiovasc Surg. 2003 Sep;126(3):814-7.

PMID: 14502158 [PubMed - indexed for MEDLINE]

Emergent endovascular stent grafting for perforated acute type B dissections and ruptured thoracic aortic aneurysms.

BACKGROUND: The purpose of our study was to demonstrate the effectiveness of endovascular stent grafts in the treatment of acutely ruptured thoracic aortic aneurysms and type B dissections as an alternative to the conventional surgical approach in an emergency setting.

METHODS: From January 2001 to October 2001, we deployed 11 emergent endovascular stent grafts into the thoracic aorta. We treated seven ruptured aortic aneurysms and four acutely perforated type B dissections. Aortic rupture was confirmed preoperatively by spiral computed tomography. In all cases, hemothorax was present. The average interval from onset of symptoms to treatment was 28.5 hours. We used nine Talent and two Excluder stent grafts.

RESULTS: Deployment of the stent grafts was successful in nine cases. There were two cases of access failure due to small caliber of iliac arteries, and 1 of these patients died shortly after the procedure was abandoned, At 12 months of follow-up, there were no cases of paraplegia, stent migration, or endoleaks. There was, however, one temporary renal failure, and 2 patients required mechanical ventilation for more than 48 hours.

CONCLUSIONS: Our experiences with emergency endovascular stent grafting show that the procedure is technically feasible, with less morbidity and mortality than conventional open surgery, in high-risk patients.

Author(s): Doss M, Balzer J, Martens S, Wood JP, Wimmer-Greinecker G, Moritz A, Fieguth HG.

in: Ann Thorac Surg. 2003 Aug;76(2):493-8; discussion 497-8.

PMID: 12902092 [PubMed - indexed for MEDLINE]

Effects of geometric left ventricular remodelling on the function of stentless quadrileaflet mitral valve bioprostheses. A four year experience.

OBJECTIVES: The stentless quadrileaflet mitral valve prosthesis (QMV) is sutured to the mitral annulus and the papillary muscle heads, thereby preserving the subvalvular apparatus. After mitral valve replacement, remodeling of the left ventricle is often observed, causing a dilated ventricle to shrink in diameter. Thus, the distance between annulus and papillary heads, which in the QMV is fixed at the time of surgery by the papillary flaps, also changes with time and might cause late mitral valve incompetence.

METHODS: From September 1997 to October 2000, 24 patients received QMV at our institution. The patients were followed up at yearly intervals (mean 4.04 years /range 2-5). All pre- and postoperative echocardiograms were evaluated, with attention focused on the subvalvular apparatus, leaflet morphology and occurrence of late mitral regurgitation.
RESULTS: 41% patients (10/24) developed late mitral regurgitation ( mild n=5, moderate n=5).The site of regurgitation was located at the two commisures in all cases. In eight patients changes in left ventricular diameter had occurred. The point of leaflet coaptation had shifted away from the annulus in four patients.

CONCLUSIONS: Midterm changes in left ventricular geometry seem to affect the competence of the QMV. As late regurgitation always occurred at the commissures, we have to consider that rotational remodeling of the left ventricle also took place. Predicting these changes and subsequently adapting the sizing procedure remains a challenging task.

Author(s): Doss M, Aybek T, Wood JP, Martens S, Wimmer-Greinecker G, Moritz A.
in: 2003, Society for Heart Valve Disease 2nd Biennial Meeting, Paris / France

Emergent endovascular interventions for contained rupture of thoracic aortic aneurysms.

BACKGROUND: The purpose of our study was to assess in an emergency setting the feasibility of endovascular stent graft treatment of contained ruptures of thoracic aortic aneurysms.

METHODS: Seven patients with contained ruptures of thoracic aortic aneurysms from a series of 54 endovascular interventions were treated by the deployment of an aortic stent graft. In all cases, hemothorax was present. Acute deployment was performed with the patient under general anesthesia, and access was gained via the common femoral or iliac arteries. After a follow-up o f 12 months, the patients were evaluated by computed tomography.

RESULTS: One patient died perioperatively. The procedure was technically successful in 5 patients. Perioperatively and at follow-up, there were no cases of paraplegia, stent graft migration, or endoleaks. There were, however, 2 cases of access failure, 1 case of temporary renal failure, and 2 patients who required prolonged mechanical ventilation.

CONCLUSION: The acute treatment of contained ruptures of thoracic aortic aneurysms is feasible. This form of treatment seems to be a promising option in the treatment of these high-risk patients.

Author(s): Doss M, Balzer J, Martens S, Fieguth HG, Vogl T, Moritz A, Wimmer-Greinecker G.

in: Heart Surg Forum. 2003;6(6):E133-7.

PMID: 14721999 [PubMed - indexed for MEDLINE]

Performance of stentless versus stented aortic valve bioprostheses in the elderly patient: a prospective randomized trial.

OBJECTIVES: Although stentless aortic bioprostheses are believed to offer improved outcomes, benefits remain unsubstantiated. The aim of our study was to compare stentless with stented bioprostheses, with regard to postoperative changes in left ventricular mass and hemodynamic performance, in the elderly patient.

METHODS: Forty patients with aortic stenoses, over the age of 75 years, were randomized to receive either the stented Perimount (n=20) or the stentless Prima Plus (n=20) bioprosthesis. Left ventricular mass regression, effective orifice area, ejection fraction and mean gradients were evaluated at discharge, 6 months and 1 year after surgery.

RESULTS: Overall a significant decrease in left ventricular mass was found 1 year postoperatively. However, there was no significant difference in the rate of left ventricular mass regression between the groups. Furthermore, 1 year postoperatively, the hemodynamic performance of the valves and the change in the ejection fraction did not differ between the groups.

CONCLUSIONS: Our study shows that in a randomized cohort of elderly patients with aortic stenosis, we were not able to detect significant differences, with regard to hemodynamic performance and regression of left ventricular mass, between the stentless and stented valve groups. To our surprise, previously reported findings of non-randomized trials that showed faster and more complete regression of left ventricular mass and hemodynamic benefits of stentless valves were not reproducible.

Author(s): Doss M, Martens S, Wood JP, Aybek T, Kleine P, Wimmer Greinecker G, Moritz A.
in: Eur J Cardiothorac Surg. 2003 Mar;23(3):299-304.

PMID: 12614797 [PubMed - indexed for MEDLINE]

Vacuum Assisted Suction Drainage Versus Conventional Treatment in the Management of Poststernotomy Osteomyelitis. Management of Poststernotomy Osteomyelitis.

OBJECTIVE: The purpose of our study was to compare vacuum-assisted suction drainage (VASD) to conventional wound management, in the treatment of poststernotomy osteomyelitis (SOM).

METHODS: We included a total of 42 patients that developed poststernotomy osteomyelitis and required open wound management, between 1998 and 2000, in this study. Twenty of these patients were treated by VASD and the other 22 by conventional wound management. The patients were well comparable with regards to age, presenting postoperative day, infecting organism and risk factors for osteomyelitis. This was a retrospective study.

RESULTS: The patients treated by VASD had a significantly reduced treatment duration (mean 17.2+/-5.8 vs. 22.9+/-10.8 days, P=0.009) and total hospital stay (mean 27.2+/-6.5 vs. 33.0+/-11.0 days, P=0.03). Perioperative mortality was similar, with one early death in each group.

CONCLUSION: We conclude from our experience in the treatment of 42 patients with poststernotomy osteomyelitis that VASD shortened wound healing and hospital stay and thus proved to be an excellent alternative to conventional open management of these wounds.

Author(s): Doss M, Martens S, Wood JP, Wolff JD, Baier C, Moritz A.

in: Eur J Cardiothorac Surg. 2002 Dec;22(6):934-8.

PMID: 12467816 [PubMed - indexed for MEDLINE]

Emergency endovascular interventions for ruptured thoracic and abdominal aortic aneurysms.

BACKGROUND: The purpose of our study was to show the effectiveness of endovascular stent grafts in the treatment of acutely ruptured abdominal and thoracic aortic aneurysms as an alternative to the conventional surgical approach in an emergency setting.

METHODS: From October 1996 to October 1998 we deployed 9 emergent endovascular stent grafts–6 in the abdominal aorta and 3 in the thoracic aorta. Aortic rupture was confirmed before surgery with spiral-computed tomographic scan. The average interval from onset of symptoms to treatment was 4.5 hours. We used commercially manufactured stent grafts: 4 Corvita (Corvita Inc/Schneider Corp/Boston Scientific Corp, Natick, Mass), 3 Talent (World Medical Inc, Surise, Fla/Medtronic, Sunnyvale, Calif), and 2 Vanguard (Boston Scientific Corp, Natick, Mass).

RESULTS: Deployment of the stent grafts was successful in all cases. Two patients died in the follow-up period (120 months) from myocardial infarction. No cases were seen of paraplegia or stent migration. However, 2 endoleaks, 1 in-stent stenosis, 1 temporary renal failure, and 1 brief episode of myocardial ischemia occurred.

CONCLUSION: Our experiences with emergency endovascular stent grafting show that the procedure is technically feasible, with less morbidity and mortality than conventional open surgery, in selected patients.

Author(s): Doss M, Martens S, Hemmer W.

in: Am Heart J. 2002 Sep;144(3):544-8.

PMID: 12228794 [PubMed - indexed for MEDLINE]

Fate of bypass grafts onto totally occluded coronary arteries.

BACKGROUND: Chronically occluded coronary arteries often develop good collateralisation, that leads to retrograde perfusion of these vessels, as regularly seen in coronary angiograms. Retrograde perfusion constitutes a form of competitive flow, which in turn is associated with an increased risk for early bypass graft failure. The aim of our study is to investigate the patency rate of bypass grafts onto totally occluded coronary arteries, in the presence of retrograde flow.

METHODS: Two groups of patients were followed up by cardiac catheterisation. One month after undergoing coronary artery bypass grafting. Group 1 (n=33) had coronary three vessel disease, with one totally occluded coronary artery and evidence of retrograde flow in the preoperative coronary angiogram. Group 2 (n=30) was the control group, with coronary three vessel disease and without totally occluded coronaries. We used internal mammary arteries and saphenous vein grafts as conduits.

RESULTS: Thirty-six point thirty-six per cent of bypass grafts onto totally occluded coronaries were occluded one month postoperatively (n=12). Graft failure in the control group was 13.3%. Significance p=0.03.

CONCLUSIONS: In view of our findings we conclude, that there is a significantly increased incidence of early graft failure, when totally occluded coronary arteries are revascularised, that show retrograde flow in the preoperative coronary angiogram.

Author(s): Doss M, Hemmer W.
in: Journal of Cardiovascular Surgery 2001 Dec;42(6):719-21.

PMID: 11698935 [PubMed - indexed for MEDLINE]

Long term follow up of left ventricular function after repair of left ventricular aneurysm. A comparison of linear closure versus patch plasty.

OBJECTIVE: Suboptimal early and unsatisfactory late results after linear closure of left ventricular aneurysms, have focused attention on more physiologic concepts of aneurysmectomy, like endoventricular patch plasty. The aim of our study was to compare clinical results of linear closure and patch plasty 8 years after surgery.

METHODS: From a total of 102 patients with postinfarctional left ventricular aneurysms, clinical outcomes and echocardiographic measurements of left ventricular function in 32 patients who underwent linear closure were compared to those of 20 patients who had endoventricular patch plasty.

RESULTS: The two groups were matched with respect to age, gender, comorbid risk factors, functional class, urgency of the operation and concomitant procedures. In the patch plasty group, ejection fraction increased from 33.1+/-12.2% to 34.4+/-9.7%. In the linear closure group, ejection fraction decreased from 44.3+/-10.9% to 40.1+/-7.9%. Perioperative mortality and complications, long term survival and functional class were similar in both groups with a total perioperative mortality of 1.9%, an 8-year survival rate of 85.6%, and a mean NYHA functional class of 2.51.

CONCLUSION: Long-term follow up showed a decline in ejection fraction in the direct closure group and a slight increase in the patch plasty group. We suggest that linear closure should be limited to small ventricular aneurysms and that large ventricular aneurysms extending into the septum should be treated by patch plasty.

Author(s): Doss M, Martens S, Sayour S, Hemmer W.
in: European Journal of Cardio-Thoracic-Surgery, Vol.20, No. 4 October 2001: 783 – 786

PMID: 11574225 [PubMed – indexed for MEDLINE

Unusually high uptake of Fluoro-2-Deoxy-D-Glucose on Pet scanning of a benign paravertebral Mass.

Positron emisson tomography (PET) is a noninvasive and highly accurate method for identifying malignant tumors. In our practice we have chosen a Standard Uptake Value (SUV) of 3.5 to distinguish between benign and malignant lesions. We describe a patient with a paravertebral mass which on PET scanning showed a SUV of 7, thereby clearly being identified as a malignant tumor. Subsequent open biopsy of the lesion, however, revealed benign connective tissue.

Author(s): Doss M.
in: The Thoracic and Cardiovascular Surgeon, Vol. 45, December 1997: 310 – 311

PMID: 9477465 [PubMed - indexed for MEDLINE]

Bilateral internal mammary artery atherosclerosis: a late complication of delayed repair of coarctation of the aorta.

A 58-year old patient who had undergone repair of aortic coarctation at 19 years of age, subsequently developed coronary artery disease requiring coronary artery bypass surgery. At operation both internal mammary arteries were found to be totally occluded with calcific atherosclerosis. We therefore advise that the internal mammary arteries should be assessed carefully in patients with similar past histories.

Author(s): Doss M, Barrett A, Anderson D.
in: European Journal of Cardio-Thoracic -Surgery, Vol. 11 No. 4, April 1997: 788 – 789

PMID: 9151057 [PubMed - indexed for MEDLINE]