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, 2<strong>4.</strong>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 un<strong>der</strong>lying 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 <strong>der</strong> 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 <strong>der</strong> Saugsysteme, <strong>der</strong> Kardioplegie sowie Befürchtungen hinsichtlich <strong>der</strong> Sicherheit. Wir haben retrospektiv alle MECC Perfusionen (2004-05) bezüglich klinischer und perfusionstechnischer Daten analysiert und mit denjenigen <strong>der</strong> 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 <strong>der</strong> intraoperative Blutund Pressorenbedarf sowie die technischen Komplikationen erfasst. Results: Nur gerade 1% <strong>der</strong> MECC Patienten mussten beim Abgehen von <strong>der</strong> Perfusion defibrilliert werden, gegenüber 88% in <strong>der</strong> ECC Gruppe (p< 0.05). Dies mag Folge einer besseren perioperativen Myokardprotektion sein, waren doch die maximalen postoperativen cTnl- Werte in <strong>der</strong> MECC Gruppe tiefer als in <strong>der</strong> ECC Gruppe (11.8 ± 11.6 vs. 2<strong>4.</strong>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 <strong>der</strong> MECC Gruppe sein, wo die durchschnittliche maximale Gewichtszunahme 2.8% gegenüber <strong>4.</strong>4% in <strong>der</strong> ECC Gruppe betrug (p< 0.05). Der durchschnittliche Blutverbrauch in <strong>der</strong> MECC Gruppe betrug 0,058 E/Eingriff gegenüber 1,46 E/Eingriff in <strong>der</strong> ECC Gruppe (p< 0.05). Eine Vasoplegie konnte in <strong>der</strong> MECC Gruppe nicht beobachtet werden, gegenüber einer Inzidenz von 14% in <strong>der</strong> ECC Gruppe (p< 0.05). In <strong>der</strong> ECC Gruppe wurde ein technischer Zwischenfall registriert. In <strong>der</strong> MECC Gruppe kam es zu einer Dislokation <strong>der</strong> 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 un<strong>der</strong>standing 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
swissknife spezial 06 12.06.2006 13:40 Uhr Seite 63