Abstracts 4. Gemeinsamer Jahreskongress der ... - SWISS KNIFE

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34.08
W. Zhai 1 , I. Inci 2 , M. Cardell 3 , S. Hillinger 4 , F.J. Jung 5 , S. Korom 6 , W. Weder 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.
34.09
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 underwent 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 der 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 der
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 der Aortenklemme wurde ein Hotshot über eine
Minute verabreicht. In den Grupen II und III wurde jeweils nur ein Single-Shot Cardioplex gegeben.
Neben verschiedenen anderen Untersuchungen wurde der myokardiale Metabolismus
kontinuierlich (anterior und posterior) mit dem Khuri Myocardial pH Monitoring System
gemessen. Ausgewertet wurde die Zeit zwischen dem Öffnen der Aortenklemme bis zum
Erreichen des Ausgangs-pH-Wertes (Baseline). Es wurden nun in jeder Gruppe die prozentualen
Anteile der 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 der konventionellen
Buckberg-Kardioplegie in diesen Voruntersuchungen überlegen ist. Aussagen über
den Einfluss normovolämer (geschlossener) oder volumenextrahierender (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 epidermidis. 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
under 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