Background and aim of the study: A prospective randomized study was performed to compare conventi... more Background and aim of the study: A prospective randomized study was performed to compare conventional with minimally invasive aortic valve replacement (AVR). Methods: Forty consecutive patients scheduled for elective aortic valve surgery were prospectively randomized either to the conventional group (group A, complete median sternotomy) or minimally invasive group (group B, partial upper sternotomy). Intraoperative and postoperative clinical data, and markers of myocardial and cerebral protection were determined. Neuropsychological tests were carried out to quantify psychological disorders. Results: Operative time and cardiopulmonary bypass time were slightly longer in group B, but not significantly so. No significant inter-group differences were found for postoperative pain scores and respiratory function. Chest tube drainage was significantly less in group B (495 +/- 165 versus 240 +/- 69 ml, p = 0.008). Creatine kinase (CK), CK-MB and troponin T levels were similar in both groups. Neither S-100B protein nor neuron-specific enolase levels differed significantly between groups at all sampling times. There were no strokes in the entire cohort. None of the neuropsychological tests yielded significant inter-group differences between conventional and minimally invasive surgery. Conclusion: The safety and reliability of AVR via a partial upper sternotomy is reported. Minimally invasive AVR can be performed with only slightly longer operative times, good cosmetic results and significantly less blood loss. A limited surgical access affected neither the patients' neurological outcome nor the efficacy of myocardial protection.
Background: Despite excellent data on lowering long-term stroke and all-cause mortality rates, cu... more Background: Despite excellent data on lowering long-term stroke and all-cause mortality rates, currently, only 25–40% of atrial fibrillation (AF) patients undergo simultaneous surgical ablation therapy (SA) during cardiac surgery. Surgeon’s fear exposing their patients to an additional, unjustified, and disproportionate risk when performing SA in AF patients presenting with sinus rhythm (SR) before surgery. To clarify the influence of preoperative SR before SA for AF, we conducted a subgroup analysis of the German Cardiosurgical Atrial Fibrillation (CASE-AF) register. Methods: Between September 2016 and August 2020, 964 AF patients with an underlying cardiac disease were scheduled for surgery with SA and enrolled in the CASE-AF register. Data prospectively were collected and analyzed retrospectively. We divided the entire cohort into an SR-group (38.2%, N = 368) and an AF-group (61.8%, N = 596), based on preoperative heart rhythm. Results: Over half of the patients were moderately a...
International Journal of Artificial Organs, Jun 16, 2022
Left Ventricular Assist Device (LVAD) is currently implanted not only as a bridge to transplant o... more Left Ventricular Assist Device (LVAD) is currently implanted not only as a bridge to transplant or recovery but also as destination therapy. One factor, affecting the device performance and treatment adequacy negatively is the development of aortic valve insufficiency (AI) after the implantation. Herein, we introduce a minimally invasive partial sternotomy aortic valve replacement with an expandable bio-prosthesis in a 74-year-old LVAD patient with severe AI.
Background and aim of the study: A prospective randomized study was performed to compare conventi... more Background and aim of the study: A prospective randomized study was performed to compare conventional with minimally invasive aortic valve replacement (AVR). Methods: Forty consecutive patients scheduled for elective aortic valve surgery were prospectively randomized either to the conventional group (group A, complete median sternotomy) or minimally invasive group (group B, partial upper sternotomy). Intraoperative and postoperative clinical data, and markers of myocardial and cerebral protection were determined. Neuropsychological tests were carried out to quantify psychological disorders. Results: Operative time and cardiopulmonary bypass time were slightly longer in group B, but not significantly so. No significant inter-group differences were found for postoperative pain scores and respiratory function. Chest tube drainage was significantly less in group B (495 +/- 165 versus 240 +/- 69 ml, p = 0.008). Creatine kinase (CK), CK-MB and troponin T levels were similar in both groups. Neither S-100B protein nor neuron-specific enolase levels differed significantly between groups at all sampling times. There were no strokes in the entire cohort. None of the neuropsychological tests yielded significant inter-group differences between conventional and minimally invasive surgery. Conclusion: The safety and reliability of AVR via a partial upper sternotomy is reported. Minimally invasive AVR can be performed with only slightly longer operative times, good cosmetic results and significantly less blood loss. A limited surgical access affected neither the patients' neurological outcome nor the efficacy of myocardial protection.
Background: Despite excellent data on lowering long-term stroke and all-cause mortality rates, cu... more Background: Despite excellent data on lowering long-term stroke and all-cause mortality rates, currently, only 25–40% of atrial fibrillation (AF) patients undergo simultaneous surgical ablation therapy (SA) during cardiac surgery. Surgeon’s fear exposing their patients to an additional, unjustified, and disproportionate risk when performing SA in AF patients presenting with sinus rhythm (SR) before surgery. To clarify the influence of preoperative SR before SA for AF, we conducted a subgroup analysis of the German Cardiosurgical Atrial Fibrillation (CASE-AF) register. Methods: Between September 2016 and August 2020, 964 AF patients with an underlying cardiac disease were scheduled for surgery with SA and enrolled in the CASE-AF register. Data prospectively were collected and analyzed retrospectively. We divided the entire cohort into an SR-group (38.2%, N = 368) and an AF-group (61.8%, N = 596), based on preoperative heart rhythm. Results: Over half of the patients were moderately a...
International Journal of Artificial Organs, Jun 16, 2022
Left Ventricular Assist Device (LVAD) is currently implanted not only as a bridge to transplant o... more Left Ventricular Assist Device (LVAD) is currently implanted not only as a bridge to transplant or recovery but also as destination therapy. One factor, affecting the device performance and treatment adequacy negatively is the development of aortic valve insufficiency (AI) after the implantation. Herein, we introduce a minimally invasive partial sternotomy aortic valve replacement with an expandable bio-prosthesis in a 74-year-old LVAD patient with severe AI.
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Papers by Mirko Doss