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

swissknife spezial 06 12.06.2006 13:40 Uhr Seite 62
35.04
E. Pektok 1 , M. Cikirikcioglu 1 , K.M. Djebaili 2 , J. Sierra 1 , A. Kalangos 1
1 Department of Cardiovascular Surgery, University Hospital of Geneva, 1211 Geneva/CH,
2 Depertment of Cardiovascular Surgery, University Hospital of Geneva, 1211 Geneva/CH
Bridge to recovery or transplantation: pulsatile, pneumatic, extracorporeal ventricular assist
device (EXCOR-Berlin Heart ® ) application
Objective: Two indications for the use of ventricular asist devices(VAD) are; a)Bridge to transplantation
in cronic heart failure patients until a suitable donor is found, b)Bridge to recovery
in cases with acute heart failure due to stunned myocardium. Pulsatile, pneumatic, extracorporeal
VAD (EXCOR-Berlin Heart ® ) has been used in our clinic since 1996. This retrospective
study is designed to evaluate our clinical experiences and results of the last 10 years.
Methods: Between September-1996 and February-2006, 21 patients (16 males) were implanted
EXCOR-Berlin Heart ® . Mean age was 45.7+18.0(5-65)years. Indications for implantation
were cardiogenic shock in 12 cases, left ventricular failure in 7 cases, and right ventricular
failure in 2 cases. Biventricular(BVAD), left ventricular(LVAD), and right ventricular(RVAD)
support was performed in 10, 9 and 2 cases, respectively.
Results: Duration of support was 12.8+16.4 days for BVAD, 24.3+49.9 days for LVAD, and
8.5+10.6 days for RVAD. 3 cases were bridged to heart transplantation, 5 cases were detached
due to recovery. Remaining 13 cases were lost due to sepsis and/or multiorgan failure.
Conclusion: EXCOR-Berlin Heart ® is a safe, effective, and easy-to-use VAD in patients with endstage
chronical heart failure for bridge to transplantation, and in patients with acute heart failure
due to stunned myocardium until the recovery. High mortality is a consequence of the
underlying cause rather than the technique itself. The predictor of survival is the implantation
of VAD before the end-organ failure occurs. With the help of this method, a great proportion of
hopeless patients would be survived.
35.05
E. Gygax
Dhge, Klinik für Herz- und Gefässchirurgie, 3010 Bern/CH
Klinische und perfusionstechnische Erfahrungen nach den ersten 805 MECC ® -Smart Perfusionen
im Jahre 2004/2005
Objective: Ungeachtet der grossen Anzahl an minimalen Kreislaufsystemen für die extrakorporelle
Zirkulation (MECC), werden nur gerade 8% aller Perfusionen mit diesem Setup durchgeführt.
Ursächlich hierfür ist die Problematik der Saugsysteme, der Kardioplegie sowie
Befürchtungen hinsichtlich der Sicherheit. Wir haben retrospektiv alle MECC Perfusionen
(2004-05) bezüglich klinischer und perfusionstechnischer Daten analysiert und mit denjenigen
der konventionell durchgeführten Perfusionen (ECC) verglichen.
Methods: Insgesamt wurden 805 MECC- mit 1095 ECC Perfusionen verglichen. Für die untersuchten
Parameter wurden verschiedene Subgruppen gebildet. Als klinische Parameter
wurde die Inzidenz des Vorhofflimmerns, die postoperativen Troponin-I-Werte (cTnl) und die
postoperative Gewichtszunahme erfasst. Perfusionstechnisch wurde der intraoperative Blutund
Pressorenbedarf sowie die technischen Komplikationen erfasst.
Results: Nur gerade 1% der MECC Patienten mussten beim Abgehen von der Perfusion defibrilliert
werden, gegenüber 88% in der ECC Gruppe (p< 0.05). Dies mag Folge einer besseren
perioperativen Myokardprotektion sein, waren doch die maximalen postoperativen cTnl-
Werte in der MECC Gruppe tiefer als in der ECC Gruppe (11.8 ± 11.6 vs. 24.2 ± 26.0 ug/l; p<
0.05). Im postoperativen Verlauf fiel auf, dass weniger Patienten ein Vorhofflimmern entwikkeln
nach MECC als nach ECC Perfusion (11% vs. 39% p< 0.05). Ursächlich hierfür könnte ein
weniger ausgeprägter Volumen Shift in der MECC Gruppe sein, wo die durchschnittliche
maximale Gewichtszunahme 2.8% gegenüber 4.4% in der ECC Gruppe betrug (p< 0.05). Der
durchschnittliche Blutverbrauch in der MECC Gruppe betrug 0,058 E/Eingriff gegenüber 1,46
E/Eingriff in der ECC Gruppe (p< 0.05). Eine Vasoplegie konnte in der MECC Gruppe nicht
beobachtet werden, gegenüber einer Inzidenz von 14% in der ECC Gruppe (p< 0.05). In der
ECC Gruppe wurde ein technischer Zwischenfall registriert. In der MECC Gruppe kam es zu
einer Dislokation der venösen Kanüle. Die Frühmortalität betrug nach MECC 0.7% und nach
ECC 2.7%.
Conclusion: Die MECC ist eine sichere Perfusionstechnik für koronarchirurgischen Eingriffe.
Die aufgezeigten Vorteile haben dazu geführt, dass alle Koronareingriffe aktuell mit dem
MECC System durchgeführt werden.
35.06
K. Graves 1 , R. Behr 2 , S. Costabile 2 , O. Reuthebuch 3 , X.M. Mueller 4 , M. Genoni 4
1 Herzchirurgie, Stadtspital Triemli Zürich, 8063 Zürich/CH, 2 Herzchirurgie, Stadtspital Triemli
Zürich, Zürich/CH, 3 Herzchirurgie, Stadtspital Triemli, 8063 Zürich/CH, 4 Herz Chirurgie, Stadtspital
Triemli, 8063 Zürich/CH
Quality control through online perfusion data storage in cardiac surgery
Objective: Objective: Current online database systems allow for automatic central storage of
all important data relating to pre-, intra-, and post-operative surgical procedures, eliminating
ommissions. The Stockert Data Management System (DMS) integrated with a Microsoft
Access/SQL server database was used in off pump coronary bypass surgery and procedures
requiring cardiopulmonary bypass support to assess its use in the reconstruction of
events leading up to unwanted incidents.
Methods: Methods: All data from external devices, such as blood gas analyzers, patient monitors,
as well as direct data from the heart lung maschine, were recorded at one minute intervals.
Manually entered data is also stored as time related and included venous saturation,
administered drugs, solutions, and blood products, volumes given and extracted, and perfusionist
comments. Data transfer in Excel format was made for evaluation.
Results: Results: Reconstruction of several cases using data analysis allowed for retrospective
evaluation of events that led to changes in procedure protocol, to improved understanding
of unwanted operative events, and how mistakes are made. The cases will be presented in
detail.
Conclusion: Conclusion: Automatic data recording during cardiac operations enables valuable
reconstruction of events in the operative theatre before, during and after surgery, as well as
their relation to intra-operative events and manuevers on the heart lung maschine. Retrospective
analysis of this data enhanced learning from mistakes, led to improvement in operative
protocols and supplemented the critical incident reporting system (CIRS), M & M presentations,
and continuing education.
62 swiss knife 2006; special edition
35.07
D. Jegger 1 , C. Huber 2 , G. Murphy 2 , I. Seigneul 2 , L.K. von Segesser 3
1 Cardiovascular Surgery, CHUV, 1011 Lausanne/CH, 2 Ccv, CHUV, Lausanne/CH, 3 Chirurgie
Cardiovasculaire, CHUV, 1011 Lausanne/CH
The Smartcanula ® : as efficient as assisted venous drainage for peripheral access cardiac
surgical applications.
Objective: Little progress has been made concerning the design of venous cannula.
Therefore, peripheral cannulation for cardiopulmonary bypass (CPB) has always been a challenge
for the surgeon. A novel cannula was designed to overcome this limitation, the
Smartcanula ® (SC) and we tested its performance in an experimental setup using vacuum
assisted venous drainage (VAVD).
Methods: A porcine model was used with jugular and carotid cannulation. A control percutaneous
cannula (CTRL, 19Fr) was compared to the SC. After heparinisation, the pigs were placed
on CPB and baseline flows (Q) were observed followed by VAVD in CTRL. Biochemical
and arterial-venous blood samples were recorded, to obviate any signs of hemolysis or hypoperfusion,
at baseline (BL) and every hour for a 6 hour period (6hr) and compared using the
Student t-test with *p