@article{RadakovicPenovHamoudaetal.2022, author = {Radakovic, Dejan and Penov, Kiril and Hamouda, Khaled and Madrahimov, Nodir and Radakovic, Darko and Bening, Constanze and Leyh, Rainer G. and Aleksic, Ivan}, title = {Benefits of intra-aortic balloon pump support in patients with postcardiotomy shock requiring venoarterial extracorporeal membrane oxygenation}, series = {Life}, volume = {12}, journal = {Life}, number = {8}, issn = {2075-1729}, doi = {10.3390/life12081195}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-286241}, year = {2022}, abstract = {Background: The benefit of the combined use of an intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy shock remains unclear. We aimed to analyse the potential benefits and safety of combining these two devices. Methods: We enrolled 200 patients treated with either VA-ECMO only or in combination with IABP (ECMO-I group) between January 2012 and January 2021. To adjust the patients' backgrounds, we used propensity score matching for additional analyses, resulting in 57 pairs. The primary endpoint was 30-day survival. Secondary endpoints included successful weaning and complication rates. We also analysed hemodynamic parameters in both groups. Results: After propensity score matching, 30-day survival was better in the ECMO-I group (log-rank p = 0.004). The ECMO-I and ECMO-only groups differed regarding the secondary endpoints, including successful weaning (50.9\% and 26.3\%, respectively; p = 0.012) and the need for continuous renal replacement therapy (28.1\% and 50.9\%, p = 0.021). Complication rates were not statistically different between the two groups. Conclusion: Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is beneficial regarding 30-day survival in selected patients with postcardiotomy shock; successful ECMO weaning and freedom from renal replacement therapy is more common in patients supported with VA-ECMO plus IABP.}, language = {en} } @article{BeningSalesAlhussinietal.2021, author = {Bening, Constanze and Sales, Virna L. and Alhussini, Khaled and Radakovic, Dejan and Cris Benitez, R. and Madrahimov, Nodir and Keller, Daria M. and Leyh, Rainer}, title = {Clinically inapparent right heart dysfunction is associated with reduced myofilament force development in coronary artery disease}, series = {BMC Cardiovascular Disorders}, volume = {21}, journal = {BMC Cardiovascular Disorders}, number = {1}, doi = {10.1186/s12872-021-01926-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259213}, pages = {125}, year = {2021}, abstract = {Background Right ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We aimed to identify clinical and experimental predictors for preoperative inapparent right ventricular dysfunction and therefore hypothesized that reduced myofilament force development as well as altered levels of biomarkers might predict inapparent right ventricular dysfunction. Methods From 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥ 20 mm, n = 178; TAPSE < 20 mm, n = 40). Baseline serum samples for biomarkers (Galectin, TGFß1, N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements. Results Patients with TAPSE < 20 mm had a higher incidence of DM (55 vs. 34\%, p = 0.018), preoperative AFib (43 vs. 16\%, p < 0.001), reduced GFR (67 ± 18 vs. 77 ± 24 ml/min/1.73 m\(^2\), p = 0.013), larger LA area (22 ± 6 vs. 20 ± 5 cm\(^2\), p = 0.005) and reduced LVEF (50 vs. 55\%, p = 0.008). Furthermore, higher serum ADMA (0.70 ± 0.13 vs. 0.65 ± 0.15 µmol/l, p = 0.046) and higher serum Pentraxin-3 levels (3371 ± 1068 vs. 2681 ± 1353 pg/dl, p = 0.004) were observed in these patients. Skinned fiber force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5, p < 0.01 and pCa 5.75-6.0, p < 0.05). Multivariable analysis revealed DM (OR 2.53, CI 1.12-5.73, Euro Score II (OR 1.34, CI 1.02-1.78), preoperative AF (OR 4.86, CI 2.06-11.47), GFR (OR 7.72, CI 1.87-31.96), albumin (OR 1.56, CI 0.52-2.60), Pentraxin-3 (OR 19.68, CI 14.13-25.24), depressed LVEF (OR 8.61, CI 6.37-10.86), lower force values: (pCa 5.4; OR 2.34, CI 0.40-4.29 and pCa 5.2; OR 2.00, CI 0.39-3.60) as predictors for clinical inapparent right heart dysfunction. Conclusions These preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.}, language = {en} } @article{MadrahimovMutsenkoNatanovetal.2023, author = {Madrahimov, Nodir and Mutsenko, Vitalii and Natanov, Ruslan and Radaković, Dejan and Klapproth, Andr{\´e} and Hassan, Mohamed and Rosenfeldt, Mathias and Kleefeldt, Florian and Aleksic, Ivan and Erg{\"u}n, S{\"u}leyman and Otto, Christoph and Leyh, Rainer G. and Bening, Constanze}, title = {Multiorgan recovery in a cadaver body using mild hypothermic ECMO treatment in a murine model}, series = {Intensive Care Medicine Experimental}, volume = {11}, journal = {Intensive Care Medicine Experimental}, doi = {10.1186/s40635-023-00534-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357381}, year = {2023}, abstract = {Background Transplant candidates on the waiting list are increasingly challenged by the lack of organs. Most of the organs can only be kept viable within very limited timeframes (e.g., mere 4-6 h for heart and lungs exposed to refrigeration temperatures ex vivo). Donation after circulatory death (DCD) using extracorporeal membrane oxygenation (ECMO) can significantly enlarge the donor pool, organ yield per donor, and shelf life. Nevertheless, clinical attempts to recover organs for transplantation after uncontrolled DCD are extremely complex and hardly reproducible. Therefore, as a preliminary strategy to fulfill this task, experimental protocols using feasible animal models are highly warranted. The primary aim of the study was to develop a model of ECMO-based cadaver organ recovery in mice. Our model mimics uncontrolled organ donation after an "out-of-hospital" sudden unexpected death with subsequent "in-hospital" cadaver management post-mortem. The secondary aim was to assess blood gas parameters, cardiac activity as well as overall organ state. The study protocol included post-mortem heparin-streptokinase administration 10 min after confirmed death induced by cervical dislocation under full anesthesia. After cannulation, veno-arterial ECMO (V-A ECMO) was started 1 h after death and continued for 2 h under mild hypothermic conditions followed by organ harvest. Pressure- and flow-controlled oxygenated blood-based reperfusion of a cadaver body was accompanied by blood gas analysis (BGA), electrocardiography, and histological evaluation of ischemia-reperfusion injury. For the first time, we designed and implemented, a not yet reported, miniaturized murine hemodialysis circuit for the treatment of severe hyperkalemia and metabolic acidosis post-mortem. Results BGA parameters confirmed profound ischemia typical for cadavers and incompatible with normal physiology, including extremely low blood pH, profound negative base excess, and enormously high levels of lactate. Two hours after ECMO implantation, blood pH values of a cadaver body restored from < 6.5 to 7.3 ± 0.05, pCO2 was lowered from > 130 to 41.7 ± 10.5 mmHg, sO2, base excess, and HCO3 were all elevated from below detection thresholds to 99.5 ± 0.6\%, - 4 ± 6.2 and 22.0 ± 6.0 mmol/L, respectively (Student T test, p < 0.05). A substantial decrease in hyperlactatemia (from > 20 to 10.5 ± 1.7 mmol/L) and hyperkalemia (from > 9 to 6.9 ± 1.0 mmol/L) was observed when hemodialysis was implemented. On balance, the first signs of regained heart activity appeared on average 10 min after ECMO initiation without cardioplegia or any inotropic and vasopressor support. This was followed by restoration of myocardial contractility with a heart rate of up to 200 beats per minute (bpm) as detected by an electrocardiogram (ECG). Histological examinations revealed no evidence of heart injury 3 h post-mortem, whereas shock-specific morphological changes relevant to acute death and consequent cardiac/circulatory arrest were observed in the lungs, liver, and kidney of both control and ECMO-treated cadaver mice. Conclusions Thus, our model represents a promising approach to facilitate studying perspectives of cadaveric multiorgan recovery for transplantation. Moreover, it opens new possibilities for cadaver organ treatment to extend and potentiate donation and, hence, contribute to solving the organ shortage dilemma.}, 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{RadakovicPenovLazarusetal.2023, author = {Radakovic, Dejan and Penov, Kiril and Lazarus, Marc and Madrahimov, Nodir and Hamouda, Khaled and Schimmer, Christoph and Leyh, Rainer G. and Bening, Constanze}, title = {The completeness of the left atrial appendage amputation during routine cardiac surgery}, series = {BMC Cardiovascular Disorders}, volume = {23}, journal = {BMC Cardiovascular Disorders}, doi = {10.1186/s12872-023-03330-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357376}, year = {2023}, abstract = {Background Left atrial appendage (LAA) is the origin of most heart thrombi which can lead to stroke or other cerebrovascular event in patients with non-valvular atrial fibrillation (AF). This study aimed to prove safety and low complication rate of surgical LAA amputation using cut and sew technique with control of its effectiveness. Methods 303 patients who have undergone selective LAA amputation were enrolled in the study in a period from 10/17 to 08/20. The LAA amputation was performed concomitant to routine cardiac surgery on cardiopulmonary bypass with cardiac arrest with or without previous history of AF. The operative and clinical data were evaluated. Extent of LAA amputation was examined intraoperatively by transoesophageal echocardiography (TEE). Six months in follow up, the patients were controlled regarding clinical status and episodes of strokes. Results Average age of study population was 69.9 ± 19.2 and 81.9\% of patients were male. In only three patients was residual stump after LAA amputation larger than 1 cm with average stump size 0.28 ± 0.34 cm. 3 patients (1\%) developed postoperative bleeding. Postoperatively 77 (25.4\%) patients developed postoperative AF (POAF), of which 29 (9.6\%) still had AF at discharge. On 6 months follow up only 5 patients had NYHA class III and 1 NYHA class IV. Seven patients reported with leg oedema and no patient experienced any cerebrovascular event in early postoperative follow up. Conclusion LAA amputation can be performed safely and completely leaving minimal to no LAA residual stump.}, language = {en} } @article{OezkurMagyarThomasetal.2017, author = {Oezkur, Mehmet and Magyar, Attila and Thomas, Phillip and Stork, Tabea and Schneider, Reinhard and Bening, Constanze and St{\"o}rk, Stefan and Heuschmann, Peter U. and Leyh, Rainer G. and Wagner, Martin}, title = {TIMP-2*IGFBP7 (Nephrocheck®) Measurements at Intensive Care Unit Admission After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48 Hours}, series = {Kidney \& Blood Pressure Research}, volume = {42}, journal = {Kidney \& Blood Pressure Research}, doi = {10.1159/000479298}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157988}, pages = {456-467}, year = {2017}, abstract = {Background/Aims: Acute kidney injury (AKI) is a postoperative complication after cardiac surgery with a high impact on mortality and morbidity. Nephrocheck® [TIMP-2*IGFBP7] determines markers of tubular stress, which occurs prior to tubular damage. It is unknown at which time-point [TIMP-2*IGFBP7] measurement should be performed to ideally predict AKI. We investigated the association of [TIMP-2*IGFBP7] at various time-points with the incidence of AKI in patients undergoing elective cardiac surgery including cardio-pulmonary bypass. Methods: In a prospective cohort study, serial blood and urine samples were collected from 150 patients: pre-operative, at ICU-admission, 24h and 48h post-surgery. AKI was defined as Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7] was measured at pre-operative, ICU-admission and 24h post-surgery; medical staff was kept blinded to these results. Results: A total of 35 patients (23.5\%) experienced AKI, with a higher incidence in those with high [TIMP-2*IGFBP7] values at ICU admission (57.1\% vs. 10.1\%, p<0.001). In logistic regression [TIMP-2*IGFBP7] at ICU admission was independently associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001, C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time. Conclusions: Early detection of elevated [TIMP-2*IGFBP7] at ICU admission was strongly predictive for postoperative AKI and appeared to be more precise as compared to subsequent measurements.}, language = {en} }