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]

Sutured coronary artery grafting utilizing the heartflo anastomosis device- first clinical experiences.

BACKGROUND: The Heartflo device was developed to facilitate consistency in distal coronary anastomosis quality. The device automates the suturing process during the anastomosis procedure via simultaneous delivery of ten standard 7-0 polypropylene sutures through the graft and the coronary vessel wall.

METHODS: In 30 elective coronary artery bypass patients, one distal anastomosis was intentionally performed with the anastomosis device. Device success was stated if a patent anastomosis with a minimal flow of 50 ml/min resulted, additional stitches were counted if bleeding occurred.

RESULTS: 4 cases of device failure occurred in the first 5 patients. The subsequent patients were operated without any mechanical problems. In 16 patients (53 %), a patent anastomosis with a mean flow of 75 +/- 6 ml/min using 1.7 +/- 0.3 additional stitches was achieved. Anastomoses were completed in 19.0 +/- 0.7 min; postoperative course was uneventful in all patients.

CONCLUSIONS: We have shown that coronary anastomoses are feasible using the Heartflo device, representing a promising step on the way to automated coronary anastomoses. Its application is still limited by the size and tissue quality of the target vessel and difficult suture management during the anastomosis procedure.

Author(s): Martens S, Doss M, Moritz A, Wimmer-Greinecker G.

in: The Thoracic and Cardiovascular Surgeon,Vol. 50, February 2002: 1 – 5

PMID: 11847595 [PubMed - indexed for MEDLINE]

Five year experience with valve sparing surgery for aortic root aneurysms.

BACKGROUND: The aim of this study was to analyze the mid-term results of aortic root reconstruction.

METHODS: Between September 1995 and March 2001, 32 patients (25 males, 7 females, median age 58 +/- 21 years) underwent aortic root reconstruction as described by T. David. Indications for operation were aortic insufficiency with ascending aortic aneurysm in 27 patients, and acute aortic dissection (Stanford type A) in 5 patients. In all patients the native valve was preserved and suspended inside a tubular prosthesis with reimplantation of the coronary arteries. In 10 patients the classic reconstruction technique was modified by shaping a “Neosinus.”

RESULTS: There was one perioperative death due to myocardial infarction. Two patients suffered a stroke. 26 patients were followed up 12 months postoperatively. 22 out of 26 patients were in NYHA functional class I, 2 patients in class II and the remaining 2 in class III. Three patients died in the postoperative period. Six patients had trivial AR, 4 mild and 1 moderate regurgitation. There were no thromboembolic events during follow up. The mean transvalvular gradient was 3.5 +/- 2.2 mmHg. Compared to a normal cohort of patients (n = 20), resuspended aortic valves opened (26.4 +/- 5.8 vs. 61.3 +/- 22.1 cm/sec, p < 0.0001) and closed (22.8+/- 6.9 vs. 57.9 +/- 22.3) at a higher speeds and also showed shorter opening (0.053 +/- 0.12 vs. 0.023 +/- 0.09 sec, p < 0.0001) and closing times (0.051 +/- 0.07 vs. 0.23 +/- 0.07 cm/sec) of the aortic leaflets.

CONCLUSIONS: Aortic valve reimplantation is a reliable technique able to reduce long term complications when compared to conventional composite graft replacement of the aortic root. Altered leaflet opening and closing dynamics do not impair midterm durability.

This paper was presented at the 30th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery in Leipzig, February 17th – 21th 2001

Author(s): Aybek T, Wohleke T, Simon A, Doss M, Moritz A.

in: The Thoracic and Cardiovascular Surgeon,Vol. 50, February 2002: 35 – 40
PMID: 11847602 [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]