swissknife spezial 06 12.06.2006 13:40 Uhr Seite 60
swissknife spezial 06 12.06.2006 13:40 Uhr Seite 61 3<strong>4.</strong>08 W. Zhai 1 , I. Inci 2 , M. Cardell 3 , S. Hillinger 4 , F.J. Jung 5 , S. Korom 6 , W. We<strong>der</strong> 4 1 Thoracic Surgical Department, University Hospital Zurich, 8091 Zurich/CH, 2 Department of Thoracic Surgery, University of Zurich, 8091 Zurich/CH, 3 Thoracic Surgical Department, University Hospital Zurich, 8091 Zurich/CH, 4 Department of Thoracic Surgery, University of Zurich, Zurich/CH, 5 Thoracic Surgery, University Hospital, Zurich/CH, 6 Thoracic Surgical Department, University Hospital Zurich, Zurich/CH Simplified rat lung transplantation by using a modified cuff technique Objective: To investigate a simple improved cuff technique in a rat orthotopic left lung transplantation (LT) model. Methods: The warm ischemia time was compared between two groups. Group I: Traditional cuff technique was performed in 50 rat orthotopic left lung transplantations. Group II: A simple improved cuff technique was performed in 18 rat orthotopic left lung transplantations. Cuffs consisted of a cuff body of 1.0 mm and a cuff extention (cuff-tail) of 1.5 mm in length. In group II, we cut off cuff-tails after cuff setting. When did the implantation, we hold cuff body instead of cuff-tail to insert it into equvalent structure of recipient, and did the ligation in a simple manner thus finished the anastomosis without additional microsurgical aneurysm, therefore simplified the anastomosis procedure. Results: In group II, all recipients survived for 2h after transplantation then were sacrificed because these rats were also used for other investigations, no bleeding and air leakage, no twist of vessels or bronchus. The warm ischemia time in group II significantly reduced in comparison with equvalent time cost in group I (II: 11.2 ± 2.1 min vs I: 18.1 ± 3.6 min). Conclusion: This is the first report that the anastomosis can be finished without using cuff-tail and additional microsurgical aneurysm in rat LT. The simple technique leads to less warm ischemia time and avoids potential complications induced by cuff-tail technique. It has been verified to be a safe, simple and reproducible technique which can provide us more precise assessment in rat LT model. 3<strong>4.</strong>09 N. Zeh 1 , U. Stammberger 2 , M. Gugger 3 , A.E. Dutly 4 , R.A. Schmid 5 1 Thoraxchirurgie, DMLL, Inselspital Bern, 3010 Bern/CH, 2 DMLL, Klinik und Poliklinik für Thoraxchirurgie, 3010 Bern/CH, 3 Universität Bern, Institut für Pathologie, 3010 Bern/CH, 4 Thoraxchirurgie, Inselspital Bern, Bern/CH, 5 Klinik Und Poliklinik für Thoraxchirurgie, Inselspital, 3010 Bern/CH Primary myoepithelial carcinoma of the lung – a rare entity Objective: Myoepithelial tumors are generally found to occur in the salivary gland, the parotid gland, and the mammary gland. So far only 9 cases of myoepithelial carcinoma with primary site in the lung have been reported. Methods: We report a case of intrabronchial myoepithelial carcinoma in a 45 year old male smoker presenting with thoracic pain, dyspnea and coughing, who was admitted to our institution after being diagnosed with pneumonia and relapsing pleural effusion. Chest computed tomography showed a nodular lesion located in the postero-basal segment bronchus of the right lung, which was PET-positive. No distant metastases were found upon staging. Bronchoscopically, the lesion was easily found and biopsies were taken which were highly suspicious for bronchogenic carcinoma. No other endobronchial lesions were detected. Results: The patient un<strong>der</strong>went right lower lobe resection with radical hilar and formal mediastinal lymph node dissection. The pathology demonstrated a single lesion with a diameter of 24 mm with clear resections margins (pT1 N0 M0). Histologically, the tumour showed atypical epithelial cells arranged in solid groups with reticular stroma with signs of submucosal infiltration. Immunohistochemistry of these myoepithelial cells was positive for s-100 protein, c-kit and vimentin. Focal atypical and increased mitotic activity was present but no nodular metastases were identified. On ultra sonographic examination the salivary glands and the parotid glands were normal. Conclusion: The patient was discussed in the tumor conference and no adjuvant oncological treatment was suggested. Follow-up CT-scans will be performed every 3 months for the first year. Currently, 2 months after surgery the patient is doing well. 35.01 H. Jenni Herz-Gefässchirurgie, Inselspital, 3010 Bern/CH 35 Analyse des myocardialen Metabolismus mittels Khuri Myocardial pH Monitoring System am Schweinemodell. Vergleichenden Studie: Offenes versus geschlossenes System mit zwei Kardioplegieverfahren (Erste Resultate). Objective: Hintergrund: Isolierte ACB-Operationen werden an unserer Klinik routinemässig mit dem MECC-Smart ® -System perfundiert. Die Kardioplegie besteht aus einem Single-Shot (100 ml) einer hauseigenen Kardioplegielösung (Cardioplex) auf Procainbasis. In <strong>der</strong> Klinik erreichen wir damit ausgezeichnete Resultate und wollen diese auch im Tierversuch reproduzieren. Für konventionelle Perfusionen (offene Systeme) verwenden wir die Blutkardioplegie nach Buckberg. Des weiteren soll aufgezeigt werden ob und wie sich das geschlossene Perfusionsverfahren und die verschiedenen Kardioplegieformen auf den myokardialen Metabolismus auswirken. Methods: Methoden: 15 Schweine wurden in Gruppen zu 5 Tieren eingeteilt. Gruppe I: konventio-nelle Herz-Lungen-Maschine HL 20 (Maquet; Hirrlingen, Deutschland), offenes System. Gruppe II: MECC-Smart ® (Maquet, Hirrlingen, D). Gruppe III: ECC.O (Dideco, Mirandola, Italien) beides geschlossene Syteme. Der Perfusionsablauf war in allen Gruppen identisch: Vorperfundieren über 5 Minuten. Aortenabklemmung und anschliessende Kardioplegiegabe. Nach 60 Minuten Perfusion, Aortenklemmenöffnung und 20 Minuten Reperfusion. In <strong>der</strong> Gruppe I wurde initial ein Single-Shot Cardioplex und während 5 Minuten eine kalte Blutkardioplegie nach Buckberg verabreicht. Die Buckbergkardioplegie wurde jeweils nach 20 Minuten über 2 Minuten kalt repetiert. Vor Öffnung <strong>der</strong> Aortenklemme wurde ein Hotshot über eine Minute verabreicht. In den Grupen II und III wurde jeweils nur ein Single-Shot Cardioplex gegeben. Neben verschiedenen an<strong>der</strong>en Untersuchungen wurde <strong>der</strong> myokardiale Metabolismus kontinuierlich (anterior und posterior) mit dem Khuri Myocardial pH Monitoring System gemessen. Ausgewertet wurde die Zeit zwischen dem Öffnen <strong>der</strong> Aortenklemme bis zum Erreichen des Ausgangs-pH-Wertes (Baseline). Es wurden nun in je<strong>der</strong> Gruppe die prozentualen Anteile <strong>der</strong> Messungen ermittelt, welche innerhalb von 20 Minuten die Baseline erreicht haben. Results: Ergebnisse: Anhand dieser Versuchsanordnung konnten total 630 Einzelmessungen (210 für jede Gruppe) ausgewertet werden und für jedes Tier die prozentuale Annäherung berechnet werden. Resultate: Gruppe I: posterior: 0 %; anterior: 33 %. Gruppe II: posterior: 75 %; anterior: 100 %. Gruppe III: posterior: 60 %; anterior: 60 %. Conclusion: Schlussfolgerung: Aufgrund dieser Ergebnisse lässt sich sagen, dass die verwendete Cardioplex-Kardioplegie in Bezug auf den myokardialen Metabolismus <strong>der</strong> konventionellen Buckberg-Kardioplegie in diesen Voruntersuchungen überlegen ist. Aussagen über den Einfluss normovolämer (geschlossener) o<strong>der</strong> volumenextrahieren<strong>der</strong> (halboffener) Perfusionen konnten im Rahmen dieser Vorversuche nicht gemacht werden. Diese Hinweise sollen in weiteren Studien untersucht werden. 35.02 P. Tozzi 1 , J. Horisberger 2 , P. Ruchat 2 , E. Ferrari 3 , C. Hubert 2 , G. Siniscalchi 4 , L.K. von Segesser 5 1 Chirurgie Cardiovasculaire, CHUV, 1011 Lausanne/CH, 2 Cardiovascular Surgery, CHUV, Lausanne/CH, 3 Cardiovascular Surgery, CHUV, LAusanne/CH, 4 Chirurgie Cardiovasculaire, CHUV, 1011 Lausanne/CH, 5 Chirurgie Cardiovasculaire, CHUV, 1011 Lausanne/CH Bridge to heart transplantation with the Thoratec ventricular assist device: long term results in Lausanne Objective: The use of ventricular assist devices (VAD) as bridge to heart transplantation is a well-established treatment when no donor heart is available for transplant candidates who are rapidly deteriorating despite maximum medical treatment. Several devices have been developed with different designs. The Thoratec VAD is the first electrically driven implantable VAD and herein we report our long-term experience. Methods: The medical records of all patients who received Thoratec VAD at our institution were reviewed. Results: From January 2000 through December 2005, 4 patients received a biventricular Thoratec assistance. In 3 out of 4 patients, artificial ventricles were implanted in the abdomen, in the preperitoneal space, in one patient, the ventricles were external, with two 45F cables piercing the skin. All patients were anticoagulated with coumadin keeping INR between 2 and 3. Overall period of VAD assistance was 605 days. All patients were discharged from the hospital to their homes and were periodically readmitted for routine controls or for the treatment of complications. None died during the treatment. Three out of 4 were transplanted, one is still assisted. Major complications were bleeding requiring blood transfusions and infection at the surgical site in 2 patients. Infections occurred few months after the implantation and were both sustained by Staphylococcus epi<strong>der</strong>midis. Both required surgical drainage of the subcutaneous pouch containing the right and left VADs and were treated with antibiotics and continuous suction system (VAC). None of the patient developed a sepsis. No technical failure occurred. Conclusion: The Thoratec is a reliable and efficient tool for patients rapidly deteriorating while waiting heart transplantation reducing number of death due to lack of donors. Patients quickly learn how to handle the system and may safely go back home. Costs and pouch infection seem to be the only drawbacks of this procedure. 35.03 M. Wilhelm 1 , M. Lachat 2 , R. Prêtre 2 , G. Zünd 2 , S. Salzberg 2 , E. Schmid 3 , F. Ruschitzka 2 , G. Noll 4 , M. Genoni 2 1 Department of Cardiovascular Surgery, University Hospital Zurich, 8091 Zurich/CH, 2 Department of Cardiovascular Surgery, University Hospital Zurich, Zurich/CH, 3 Institute of Anesthesiology, University of Zurich, Zurich/CH, 4 Clinic for Cardiology, University Hospital Zurich, Zurich/CH Management of decompensated severe heart failure: the axial-flow pump Berlin Heart INCOR for mechanical circulatory support Objective: In patients with terminal heart failure, mechanical circulatory support is the ultimate treatment option. The Berlin Heart INCOR is one of the most advanced mechanical support devices consisting of an intracorporeal axial-flow pump with a magnetically suspended impeller. Here, we report our experience with ten patients supported by this device for bridging to transplantation. Methods: From November 2004 to February 2006, ten transplant candidates were supported with the Berlin Heart INCOR (male/female: 9/1; age: 54±7 years; ischemic/dilative cardiomyopathy: 4/4, combination of both: 2). All patients were in severe low output despite inotropic support. Three patients were supported by the intraaortic ballon pump (IABP), one patient was on additional extracorporeal membrane oxygenation (ECMO). Four patients exhibited renal failure, four patients hepatic failure, three patients were intubated. Two patients had previous cardiac surgery (coronary artery bypass, composite graft). One patient required concomitant aortic valve replacement for severe aortic insufficiency. In two patients, perioperative ECMO was required for right heart failure which was discontinued within few days after surgery. Results: Cumulative support is 1011 days (mean: 101±52). Five patients were transplanted, one patient died 13 days after implantation due to untreatable parenchymal lung bleeding. Four patients are currently on support (50-150 days). Three patients were treated as outpatients, two patients went back to work while being on support. Resternotomy for pericardial tamponade was required in one patient following removal of temporary pacemaker wires un<strong>der</strong> anticoagulation. Drive line infection occurred in one patient which was managed by open-wound-treatment followed by skin transplantation after device removal and heart transplantation. Two patients experienced neurological events (TIA, minor stroke) with subsequent complete recovery. There was no pump thrombosis, mechanical failure or hemolysis. Quality of life was excellent. Conclusion: Our experience indicates that the Berlin Heart INCOR may contribute to the increasing success of mechanical circulatory support devices in treatment of patients with severe heart failure. It is associated with a low frequency of adverse events and offers the patients the chance to return to a nearly normal life. swiss knife 2006; special edition 61
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