@article{SchusterWessigSchimmeretal.2012, author = {Schuster, Frank and Wessig, Carsten and Schimmer, Christoph and Johannsen, Stephan and Lazarus, Marc and Aleksic, Ivan and Leyh, Rainer and Roewer, Norbert}, title = {In vitro contracture test results and anaesthetic management of a patient with emery-dreifuss muscular dystrophy for cardiac transplantation}, series = {Case Reports in Anesthesiology}, volume = {2012}, journal = {Case Reports in Anesthesiology}, number = {349046}, doi = {10.1155/2012/349046}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-123413}, year = {2012}, abstract = {Emery-Dreifuss muscular dystrophy (EDMD) is a hereditary neuromuscular disorder characterized by slowly progressive muscle weakness, early contractures, and dilated cardiomyopathy. We reported an uneventful general anaesthesia using total intravenous anaesthesia (TIVA) for cardiac transplantation in a 19-year-old woman suffering from EDMD. In vitro contracture test results of two pectoralis major muscle bundles of the patient suggest that exposition to triggering agents does not induce a pathological sarcoplasmic calcium release in the lamin A/C phenotype. However, due to the lack of evidence in the literature, we would recommend TIVA for patients with EDMD if general anaesthesia is required.}, language = {en} } @article{OezkurGorskiPeltzetal.2014, author = {Oezkur, Mehmet and Gorski, Armin and Peltz, Jennifer and Wagner, Martin and Lazariotou, Maria and Schimmer, Christoph and Heuschmann, Peter U. and Leyh, Rainer G.}, title = {Preoperative serum h-FABP concentration is associated with postoperative incidence of acute kidney injury in patients undergoing cardiac surgery}, doi = {10.1186/1471-2261-14-117}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-110480}, year = {2014}, abstract = {Background Fatty acid binding protein (FABP) is an intracellular transport protein associated with myocardial damage size in patients undergoing cardiac surgery. Furthermore, elevated FABP serum concentrations are related to a number of common comorbidities, such as heart failure, chronic kidney disease, diabetes mellitus, and metabolic syndrome, which represent important risk factors for postoperative acute kidney injury (AKI). Data are lacking on the association between preoperative FABP serum level and postoperative incidence of AKI. Methods This prospective cohort study investigated the association between preoperative h-FABP serum concentrations and postoperative incidence of AKI, hospitalization time and length of ICU treatment. Blood samples were collected according to a predefined schedule. The AKI Network definition of AKI was used as primary endpoint. All associations were analysed using descriptive and univariate analyses. Results Between 05/2009 and 09/2009, 70 patients undergoing cardiac surgery were investigated. AKI was observed in 45 patients (64\%). Preoperative median (IQR) h-FABP differed between the AKI group (2.9 [1.7-4.1] ng/ml) and patients without AKI (1.7 [1.1-3.3] ng/ml; p = 0.04), respectively. Patients with AKI were significantly older. No statistically significant differences were found for gender, type of surgery, operation duration, CPB-, or X-Clamp time, preoperative cardiac enzymes, HbA1c, or CRP between the two groups. Preoperative h-FABP was also correlated with the length of ICU stay (rs = 0.32, p = 0.007). Conclusions We found a correlation between preoperative serum h-FABP and the postoperative incidence of AKI. Our results suggest a potential role for h-FABP as a biomarker for AKI in cardiac surgery.}, language = {en} } @article{OezkurWagnerWeismannetal.2015, author = {Oezkur, Mehmet and Wagner, Martin and Weismann, Dirk and Krannich, Jens Holger and Schimmer, Christoph and Riegler, Christoph and R{\"u}cker, Victoria and Leyh, Rainer and Heuschmann, Peter U.}, title = {Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery - a cohort study}, series = {BMC Cardiovascular Disorders}, volume = {15}, journal = {BMC Cardiovascular Disorders}, number = {41}, doi = {10.1186/s12872-015-0028-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-125224}, year = {2015}, abstract = {Background Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM). Methods This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0 \%. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling. Results Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2 \%. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI. Conclusions Our results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0 \% was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes.}, language = {en} } @article{HamoudaOezkurSinhaetal.2015, author = {Hamouda, Khaled and Oezkur, Mehmet and Sinha, Bhanu and Hain, Johannes and Menkel, Hannah and Leistner, Marcus and Leyh, Rainer and Schimmer, Christoph}, title = {Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery: an observational study}, series = {Journal of Cardiothoracic Surgery}, volume = {10}, journal = {Journal of Cardiothoracic Surgery}, number = {25}, doi = {10.1186/s13019-015-0225-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-124977}, year = {2015}, abstract = {Background All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients' characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate. Results 615/1096 patients (56,1\%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4\%), 5/283 (1,7\%), and 1/283 (0,3\%) in group I versus 6/332 (1,8\%), 9/332 (2,7\%), and 3/332 (0,9\%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all ≤ 0,05). Subgroup analyses of these high-risk patients did not show any differences between the two regimes (all ≥ 0,05). Conclusions Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs.}, language = {en} } @article{BeningHamoudaOezkuretal.2017, author = {Bening, Constanze and Hamouda, Khaled and Oezkur, Mehmet and Schimmer, Christoph and Schade, Ina and Gorski, Armin and Aleksic, Ivan and Leyh, Rainer}, title = {Rapid deployment valve system shortens operative times for aortic valve replacement through right anterior minithoracotomy}, series = {Journal of Cardiothoracic Surgery}, volume = {12}, journal = {Journal of Cardiothoracic Surgery}, number = {27}, doi = {10.1186/s13019-017-0598-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-159439}, year = {2017}, abstract = {Background: There is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome. However, increased cross clamp time is the strongest argument for surgeons not performing RAT-AVR. Rapid deployment aortic valve systems have the potential to decrease cross-clamp time and ease this procedure. We assessed clinical outcome of rapid deployment and conventional valves through RAT. Methods: Sixty-eight patients (mean age 76 ± 6 years, 32\% females) underwent RAT-AVR between 9/2013 and 7/2015. According to the valve type implanted the patients were divided into two groups. In 43 patients (R-group; mean age 74.1 ± 6.6 years) a rapid deployment valve system (Edwards Intuity, Edwards Lifesciences Corp; Irvine, Calif) and in 25 patients (C-group; mean age 74.2 ± 6.6 years) a conventional stented biological aortic valve was implanted. Results: Aortic cross-clamp (42.1 ± 12 min vs. 68.3 ± 20.3 min; p < 0.001) and bypass time (80.4 ± 39.3 min vs. 106.6 ± 23.2 min; p = 0.001) were shorter in the rapid deployment group (R-group). We observed no differences in clinical outcome. Postoperative gradients (R-group: max gradient, 14.3 ± 8 mmHg vs. 15.5 ± 5 mmHg (C-group), mean gradient, 9.2 ± 1.7 mmHg (R-group) vs. 9.1 ± 2.3 mmHg (C-group) revealed no differences. However, larger prostheses were implanted in C-group (25 mm; IQR 23-27 mm vs. 23 mm; IQR 21-25; p = 0.009). Conclusions: Our data suggest that the rapid deployment aortic valve system reduced cross clamp and bypass time in patients undergoing RAT-AVR with similar hemodynamics as with larger size stented prosthesis. However, larger studies and long-term follow-up are mandatory to confirm our findings.}, language = {en} } @article{SayedSchimmerShadeetal.2017, author = {Sayed, Sameh and Schimmer, Christoph and Shade, Ina and Leyh, Rainer and Aleksic, Ivan}, title = {Combined pulmonary and left ventricular support with veno-pulmonary ECMO and impella 5.0 for cardiogenic shock after coronary surgery}, series = {Journal of Cardiothoracic Surgery}, volume = {12}, journal = {Journal of Cardiothoracic Surgery}, number = {38}, doi = {10.1186/s13019-017-0594-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157598}, year = {2017}, abstract = {Background: Mechanical circulatory support is a common practice nowadays in the management of patients after cardiogenic shock due to myocardial infarction. The single or combined use of one or more devices for mechanical support depends not only on the advantage or disadvantage of these devices but also on the timing of use of these devices before the development of multi organ failure. In our case we used more than one tool for mechanical circulatory support during the prolonged and complicated course of our patient with postcardiotomy cardiogenic shock after coronary artery bypass surgery. Case Presentation: We describe the combined use of Impella 5.0 and veno- pulmonary extra corporeal membrane oxygenation (VP-ECMO) for biventricular failure in a 52 years—old man. He presented with cardiogenic shock after inferior wall ST-elevation myocardial infarction. After emergency coronary artery bypass surgery and failure to wean from extracorporeal circulation we employed V-P ECMO and consecutively Impella 5.0 to manage the primarily failing right and secondarily failing left ventricles. He remained hemodynamically stable on both Impella 5.0 and VP-ECMO until Heart Mate II left ventricular assist device implantation on the 14th postoperative day. Right sided support was weaned on 66th postoperative day. The patient remained in the intensive care unit for 77 days. During his prolonged stay, he underwent renal replacement therapy and tracheostomy with complete recovery. Six months later, he was successfully heart transplanted and has completed three and half years of unremarkable follow up. Conclusions: The combined use of VP ECMO and Impella 5.0 is effective in the management of postcardiotomy biventricular failure as a bridge for further mechanical support or heart transplantation.}, language = {en} } @article{SuratBernsenSchimmer2021, author = {Surat, G{\"u}zin and Bernsen, Dominik and Schimmer, Christoph}, title = {Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections}, series = {Journal of Cardiothoracic Surgery}, volume = {16}, journal = {Journal of Cardiothoracic Surgery}, doi = {10.1186/s13019-021-01693-7}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265533}, year = {2021}, abstract = {Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital's antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6\%) of the cases, 20 (3.4\%) in cefuroxime patients and 17 (3.8\%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.}, language = {en} }