Andre Simon - Academia.edu (original) (raw)

Papers by Andre Simon

Research paper thumbnail of Outcomes after implantation of partial-support left ventricular assist devices in inotropic-dependent patients: Do we still need full-support assist devices?

The Journal of Thoracic and Cardiovascular Surgery, 2014

Objectives: Partial-support left ventricular assist devices (LVADs) represent a novel strategy fo... more Objectives: Partial-support left ventricular assist devices (LVADs) represent a novel strategy for heart failure treatment. The Synergy Pocket Micro-pump (HeartWare Inc, Framingham, Mass), the smallest surgically implanted long-term LVAD, provides partial flow up to 4.25 L/min and was primarily designed for ''less sick'' patients with severe heart failure. This device is implanted minimally invasively without sternotomy or cardiopulmonary bypass. Early implantation in patients with Interagency Registry for Mechanically Assisted Circulatory Support class 4 and higher was shown to be feasible and associated with significantly improved hemodynamics and quality of life. The aim of this study was to present our experience with implementation of long-term partial circulatory support as a bridge to transplantation in patients with more advanced heart failure who were dependent preoperatively on inotropic support or intra-aortic balloon pump.

Research paper thumbnail of Lung transplantation from donors outside standard acceptability criteria - are they really marginal?

Transplant International, 2014

Lung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ s... more Lung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ shortage. However, its influence on results remains unclear. In this study, we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years, and history of smoking > 20 pack-years. Two hundred and forty-eight patients underwent first time LTx in our institution between January 2007 and January 2013. Seventy-nine patients (Group I) received organs from "extended donor criteria" and 169 patients (Group II) from "standard donor criteria." Recipients' and donors' demographics, perioperative variables, and outcome were compared. Donors from Group I were significantly older [median (interquartile range)]: 52.5 (44;58) vs. 42 (28.5;48.5) years (P < 0.001) with lower PaO2/FiO2 ratio: 366 AE 116.1 455 AE 80.5 mmHg (P < 0.001), higher incidence of smoking history: 57.7% vs. 41.8% (P = 0.013), and more extensive smoking history: 24(15;30) vs. 10 (3.75;14) pack-years (P < 0.001). Other parameters were comparable. Recipients' gender, diagnosis, percentage of patients operated on pump and receiving double LTx were also comparable. Recipients from Group I were significantly older: 50 (42;57) vs. 44 (29.5;53.5) years (P = 001). There were no differences observed in recipients' prevalence of primary graft dysfunction (PGD) grade 3 over first three postoperative days, duration of mechanical ventilation, intensive care and hospital length of stay, prevalence of rejection, and bronchiolitis obliterans syndrome (BOS). 90-day, 1-year, and 5-year survival (Group I vs. II) were also similar: 88.6% vs. 91.7%, 83.2% vs. 84.6%, and 59% vs. 68.2% (log rank P = 0.367). Carefully selected donor lungs from outside the standard acceptability criteria may expand existing donor pool with no detrimental effect on LTx outcome.

Research paper thumbnail of CentriMag(R) short-term ventricular assist as a bridge to solution in patients with advanced heart failure: use beyond 30 days

European Journal of Cardio-Thoracic Surgery, 2013

OBJECTIVES: Left ventricular assist devices (LVADs) offer very valuable therapeutic options for p... more OBJECTIVES: Left ventricular assist devices (LVADs) offer very valuable therapeutic options for patients with advanced heart failure. CentriMag® (Thoratec, Pleasanton, CA, USA) is an extracorporeal short-term circulatory assist device Conformité Européenne-marked in Europe for use up to 30 days.

Research paper thumbnail of First Experience With the Synergy Micro-Pump in Patients in INTERMACS Class 1-2 as a Bridge to Transplantation: Pushing the Limits?

Artificial Organs, 2014

The Synergy Micro-pump is the smallest implantable left ventricular assist device (LVAD) and prov... more The Synergy Micro-pump is the smallest implantable left ventricular assist device (LVAD) and provides partial flow support up to 4.25 L/min.

Research paper thumbnail of Left ventricular assist device implantation with concomitant left ventricular reconstruction without patchplasty

Journal of Artificial Organs, 2014

In this case report, we describe a 66-year-old patient with a massive LV aneurism which resulted ... more In this case report, we describe a 66-year-old patient with a massive LV aneurism which resulted after myocardial infarction. Due to severe LV function impairment, it was decided to perform left ventricular reconstruction surgery and, at the same time, left ventricular assist device implantation as a bridge to transplantation. The entire procedure was completed without using any patch material. The patient had an uneventful recovery and was discharged home after 18 days. After 1-year follow-up no adverse events were observed.

Research paper thumbnail of Outcomes and predictors of early mortality after continuous flow left ventricular assist device implantation as a bridge to transplantation

ASAIO Journal, 2014

Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with adva... more Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014-1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01-1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation. ASAIO Journal 2014; 60:162-169.

Research paper thumbnail of Impact of Duration of “Agonal Time” during the Controlled Donation after Circulatory Death (DCD) on Early and Mid-Term Results of Lung Transplantation (LTx)

The Journal of Heart and Lung Transplantation, 2013

ABSTRACT Lung transplantation from DCD donors is by now a well established procedure. However, th... more ABSTRACT Lung transplantation from DCD donors is by now a well established procedure. However, there is little evidence about impact of the time between withdrawal of treatment and circulatory arrest - agonal time (AT) on lung function after LTx. Having previously analyzed the correlation of differently defined warm ischemic time in controlled DCD with LTx outcome, we now evaluated the impact of the length of AT on LTx patients outcome.Methods and MaterialsBetween 01.2007 and 08.2012 44 patients underwent LTx with organs from DCD in our institution. Recipients were divided into 2 groups: I: AT≤15 min. (N=25) and II: AT&gt;15min. (N=19). Donor and recipients demographics, pre- and post-operative data were compared: PaO2/FiO2 ratio on arrival to intensive care unit (ICU), 24, 48 and 72 hours after, duration of postoperative mechanical ventilation (MV), ICU and hospital length of stay (LOS), acute rejection (AR), survival and freedom from BOS.ResultsDonors were comparable with regards to: age, gender, cause of death, PaO2/FiO2 ratio, percentage of extended donor criteria donors and total ischemic time. AT in group I was significantly shorter vs. group II: 10.6±3.52 vs. 25.8±9.57 (p&lt;0.01). There were no significant differences in: duration of MV, ICU and hospital LOS, and frequency of AR. The survival (log rank=1.0) and freedom from BOS (log rank=0.57) were also comparable. Difference in PaO2/FiO2 [mmHg] ratio reached statistical significance 72 hours after transplant: I vs. II: on arrival – 308±166 vs. 268±95 (p=0.38), 24 hours - 343±108 vs. 307±99 (p=0.25), 48 hours - 379±192 vs. 335±99 (p=0.19), 72 hours 401±152 vs. 316±79 (p=0.04).ConclusionsAT ≤ 1 hour is safe and does not influence midterm survival after LTx. However, longer AT (within 1 hour range) already has a negative impact on early graft function, suggesting that a significant extension of AT may have more pronounced effects. No data is available as of yet pertaining to long term graft function and survival.

Research paper thumbnail of HeartWare miniaturized intrapericardial ventricular assist device: advantages and adverse events in comparison to contemporary devices

Expert Review of Medical Devices, 2013

Research paper thumbnail of Do We Really Need to Rush? Early and Mid Term Results of Lung Transplantation (Ltx) of Organs With Total Ischemic Time (TIT) Over 8 Hours - A Propensity Score Matched, Single-Center Analysis

The Journal of Heart and Lung Transplantation, 2015

Research paper thumbnail of Influence of Intraoperative Hemodynamic Factors on the Development of Acute Kidney Injury in Lung Transplantation

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Minimally invasive left ventricular assist device implantation: at the crossroads

Journal of thoracic disease, 2015

Research paper thumbnail of Perfusion-Decellularization of Porcine Lung and Trachea for Respiratory Bioengineering

Artificial organs, Jan 20, 2015

Decellularization of native organs may provide an acellular tissue platform for organ regeneratio... more Decellularization of native organs may provide an acellular tissue platform for organ regeneration. However, decellularization involves a trade-off between removal of immunogenic cellular elements and preservation of biomechanical integrity. We sought to develop a bioartificial scaffold for respiratory tissue engineering by decellularization of porcine lungs and trachea while preserving organ architecture and vasculature. Lung-trachea preparations from 25 German Landrace pigs were perfused in a modified Langendorff circuit and decellularized by an SDC (sodium deoxycholate)-based perfusion protocol. Decellularization was evaluated by histology and fluorescence microscopy, and residual DNA quantified spectrophotometrically and compared with controls. Airway compliance was evaluated by endotracheal intubation and mechanical ventilation to simulate physiological breathing-induced stretch. Structural integrity was evaluated by bronchoscopy and biomechanical stress/strain analysis by meas...

Research paper thumbnail of Continuous-flow left ventricular assist device exchange: Clinical outcomes

ABSTRACT A percentage of patients with a left ventricular assist device (LVAD) require device exc... more ABSTRACT A percentage of patients with a left ventricular assist device (LVAD) require device exchange. Although this is an important clinical entity, there are only a handful of relevant studies on this topic in the literature. From 2004 to 2012, 30 device exchanges (HeartMate II to HeartMate II) were performed. Since June 2011, we have employed the subcostal approach for device exchange if indicated. Sixteen patients underwent device exchange through a subcostal approach (S group), whereas 14 patients had devices exchanged through a full sternotomy (F group). Pre- and post-operative data were retrospectively reviewed. There was no difference in baseline patient characteristics between the two groups. Overall, mean duration between primary surgery and device exchange was 425 ± 407 days. Surgical indications included device thrombus/hemolysis (N = 19), device malfunction (N = 9) and infection (N = 2). Cardiopulmonary bypass time was significantly shorter in the S group (S: 40 ± 23 minutes, F: 105 ± 84 minutes; p &lt; 0.05), and post-operative bleeding within 24 hours after surgery was less in the S group (S: 362 ± 367 ml, F: 1,286 ± 971 ml; p &lt; 0.05). Length of ICU stay was significantly shorter in the S group (S: 4.6 ± 1.8 days, F: 8.2 ± 4.9 days; p &lt; 0.05). There was no difference in post-operative complications, except for prolonged intubation (F: N = 6 [43%], S: N = 1 [6.3%]; p &lt; 0.05). There were 3 deaths in the F group and 0 in the S group, with no statistical difference (p = 0.09). Also, there was no significant difference in other outcomes, including transplantation, device explantation and ongoing LVAD support. A subcostal approach may be preferred for HeartMate II device exchange if indicated.

Research paper thumbnail of Bilateral lung transplantation in a patient with Vascular Ehlers-Danlos syndrome

The Annals of thoracic surgery, 2014

We describe the case of a 29-year-old woman with end-stage chronic obstructive pulmonary disease ... more We describe the case of a 29-year-old woman with end-stage chronic obstructive pulmonary disease secondary to vascular Ehlers-Danlos syndrome. Because of critical deterioration, respiratory arrest, and complete lung failure, she required urgent implantation of a venovenous extracorporeal membrane oxygenator as a bridge to lung transplantation. After 6 days of extracorporeal life support, a successful bilateral sequential lung transplantation was performed. This is the first case of lung transplantation in a patient with a diagnosis of chronic obstructive pulmonary disease secondary to Ehlers-Danlos syndrome.

Research paper thumbnail of Use of Foley catheter for insertion of ventricular assist device inflow cannula

Asian cardiovascular & thoracic annals, 2014

Ventricular assist devices are fast becoming an accepted alternative to treat end-stage heart fai... more Ventricular assist devices are fast becoming an accepted alternative to treat end-stage heart failure, and are being implemented as a bridge to myocardial recovery, a bridge to heart transplantation, or as destination therapy. Positioning of the inflow cannula into the apex of the ventricle is a crucial step due to the risk of sucking in air. We describe an improved method of preparing the insertion site for the ventricular assist device inflow cannula, to minimize the chances of air embolism and blood spillage, which we applied in a 34-year-old man, as a bridge to transplantation.

Research paper thumbnail of Utilization of a Novel Rib Spreader for Minimally Invasive Lung Transplantation

Surgical innovation, Jan 7, 2014

Rack-and-pinion-type stainless steel rib spreader was innovated by Truffier in 1914, which was mo... more Rack-and-pinion-type stainless steel rib spreader was innovated by Truffier in 1914, which was modified by Finochietto to have fenestrated blades and a hand-cranked lever to both separate the arms in a staged fashion and lock them in place at each stop. Its Burford-Finochietto variants with replaceable blades are ubiquitous in open thoracic surgery. Fehling Surgical Instrument, Inc (Acworth, GA) introduced a modified rib spreader-an assembly of movable and adjustable blades, a mobile bridge and spreader arms, which owing to its adaptation of thoracotomy incision provides an optimum exposure without injuring the ribs. The spreader is indispensible in lung transplantation surgery performed especially through minimally invasive (bilateral limited anterolateral thoracotomies with intact sternum) approach.

Research paper thumbnail of Modified extracorporeal life support: The Harefield technique

Asian cardiovascular & thoracic annals, Jan 19, 2014

Research paper thumbnail of The influence of bilateral internal mammary arteries on short- and long-term outcomes: a propensity score matching in accordance with current recommendations

The Journal of thoracic and cardiovascular surgery, 2014

We undertook a single-center, 12 years outcomes analysis of the influence of bilateral internal m... more We undertook a single-center, 12 years outcomes analysis of the influence of bilateral internal mammary arteries (BIMA) over single internal mammary artery (SIMA) on short-term outcomes and long-term outcomes by means of propensity score matching technique in accordance to current recommendations. A propensity score was generated for each patient from a multivariable logistic regression model based on 20 pretreatment covariates. The study population consisted of 4195 patients undergoing coronary artery bypass graft procedure using SIMA (n = 3445; 78.3%) or BIMA (n = 750; 21.7%). A total of 750 matching sets were derived. The BIMA group was associated with an increased rate of superficial sternal wound infection (5.6% vs 1.7%; P = .0001) but the incidence of deep sternal wound infection was comparable between the 2 groups, at 2.1% and 1.5% in BIMA and SIMA groups, respectively (P = .43). With regard to other postoperative complications the 2 groups were comparable. Operative mortalit...

Research paper thumbnail of Extracorporeal Life Support in Patients with Refractory Cardiogenic Shock: Keep Them Awake

The Thoracic and Cardiovascular Surgeon, 2015

OBJECTIVE: Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanic... more OBJECTIVE: Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanically ventilated and therefore prone to complications related to immobility and ventilation. We adopted this 'Awake ECLS' strategy for the patients with refractory cardiogenic shock (RCS) as a bridge to decision.

Research paper thumbnail of Ex vivo lung perfusion to evaluate donor lungs after high-pressure pulmonoplegia

The Journal of thoracic and cardiovascular surgery, 2014

Research paper thumbnail of Outcomes after implantation of partial-support left ventricular assist devices in inotropic-dependent patients: Do we still need full-support assist devices?

The Journal of Thoracic and Cardiovascular Surgery, 2014

Objectives: Partial-support left ventricular assist devices (LVADs) represent a novel strategy fo... more Objectives: Partial-support left ventricular assist devices (LVADs) represent a novel strategy for heart failure treatment. The Synergy Pocket Micro-pump (HeartWare Inc, Framingham, Mass), the smallest surgically implanted long-term LVAD, provides partial flow up to 4.25 L/min and was primarily designed for ''less sick'' patients with severe heart failure. This device is implanted minimally invasively without sternotomy or cardiopulmonary bypass. Early implantation in patients with Interagency Registry for Mechanically Assisted Circulatory Support class 4 and higher was shown to be feasible and associated with significantly improved hemodynamics and quality of life. The aim of this study was to present our experience with implementation of long-term partial circulatory support as a bridge to transplantation in patients with more advanced heart failure who were dependent preoperatively on inotropic support or intra-aortic balloon pump.

Research paper thumbnail of Lung transplantation from donors outside standard acceptability criteria - are they really marginal?

Transplant International, 2014

Lung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ s... more Lung transplantation (LTx) from "extended donor criteria" donors may reduce significantly organ shortage. However, its influence on results remains unclear. In this study, we evaluate retrospectively the results of LTx from donors outside standard criteria: PaO2/FiO2 ratio < 300 mmHg, age over 55 years, and history of smoking > 20 pack-years. Two hundred and forty-eight patients underwent first time LTx in our institution between January 2007 and January 2013. Seventy-nine patients (Group I) received organs from "extended donor criteria" and 169 patients (Group II) from "standard donor criteria." Recipients' and donors' demographics, perioperative variables, and outcome were compared. Donors from Group I were significantly older [median (interquartile range)]: 52.5 (44;58) vs. 42 (28.5;48.5) years (P < 0.001) with lower PaO2/FiO2 ratio: 366 AE 116.1 455 AE 80.5 mmHg (P < 0.001), higher incidence of smoking history: 57.7% vs. 41.8% (P = 0.013), and more extensive smoking history: 24(15;30) vs. 10 (3.75;14) pack-years (P < 0.001). Other parameters were comparable. Recipients' gender, diagnosis, percentage of patients operated on pump and receiving double LTx were also comparable. Recipients from Group I were significantly older: 50 (42;57) vs. 44 (29.5;53.5) years (P = 001). There were no differences observed in recipients' prevalence of primary graft dysfunction (PGD) grade 3 over first three postoperative days, duration of mechanical ventilation, intensive care and hospital length of stay, prevalence of rejection, and bronchiolitis obliterans syndrome (BOS). 90-day, 1-year, and 5-year survival (Group I vs. II) were also similar: 88.6% vs. 91.7%, 83.2% vs. 84.6%, and 59% vs. 68.2% (log rank P = 0.367). Carefully selected donor lungs from outside the standard acceptability criteria may expand existing donor pool with no detrimental effect on LTx outcome.

Research paper thumbnail of CentriMag(R) short-term ventricular assist as a bridge to solution in patients with advanced heart failure: use beyond 30 days

European Journal of Cardio-Thoracic Surgery, 2013

OBJECTIVES: Left ventricular assist devices (LVADs) offer very valuable therapeutic options for p... more OBJECTIVES: Left ventricular assist devices (LVADs) offer very valuable therapeutic options for patients with advanced heart failure. CentriMag® (Thoratec, Pleasanton, CA, USA) is an extracorporeal short-term circulatory assist device Conformité Européenne-marked in Europe for use up to 30 days.

Research paper thumbnail of First Experience With the Synergy Micro-Pump in Patients in INTERMACS Class 1-2 as a Bridge to Transplantation: Pushing the Limits?

Artificial Organs, 2014

The Synergy Micro-pump is the smallest implantable left ventricular assist device (LVAD) and prov... more The Synergy Micro-pump is the smallest implantable left ventricular assist device (LVAD) and provides partial flow support up to 4.25 L/min.

Research paper thumbnail of Left ventricular assist device implantation with concomitant left ventricular reconstruction without patchplasty

Journal of Artificial Organs, 2014

In this case report, we describe a 66-year-old patient with a massive LV aneurism which resulted ... more In this case report, we describe a 66-year-old patient with a massive LV aneurism which resulted after myocardial infarction. Due to severe LV function impairment, it was decided to perform left ventricular reconstruction surgery and, at the same time, left ventricular assist device implantation as a bridge to transplantation. The entire procedure was completed without using any patch material. The patient had an uneventful recovery and was discharged home after 18 days. After 1-year follow-up no adverse events were observed.

Research paper thumbnail of Outcomes and predictors of early mortality after continuous flow left ventricular assist device implantation as a bridge to transplantation

ASAIO Journal, 2014

Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with adva... more Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014-1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01-1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation. ASAIO Journal 2014; 60:162-169.

Research paper thumbnail of Impact of Duration of “Agonal Time” during the Controlled Donation after Circulatory Death (DCD) on Early and Mid-Term Results of Lung Transplantation (LTx)

The Journal of Heart and Lung Transplantation, 2013

ABSTRACT Lung transplantation from DCD donors is by now a well established procedure. However, th... more ABSTRACT Lung transplantation from DCD donors is by now a well established procedure. However, there is little evidence about impact of the time between withdrawal of treatment and circulatory arrest - agonal time (AT) on lung function after LTx. Having previously analyzed the correlation of differently defined warm ischemic time in controlled DCD with LTx outcome, we now evaluated the impact of the length of AT on LTx patients outcome.Methods and MaterialsBetween 01.2007 and 08.2012 44 patients underwent LTx with organs from DCD in our institution. Recipients were divided into 2 groups: I: AT≤15 min. (N=25) and II: AT&gt;15min. (N=19). Donor and recipients demographics, pre- and post-operative data were compared: PaO2/FiO2 ratio on arrival to intensive care unit (ICU), 24, 48 and 72 hours after, duration of postoperative mechanical ventilation (MV), ICU and hospital length of stay (LOS), acute rejection (AR), survival and freedom from BOS.ResultsDonors were comparable with regards to: age, gender, cause of death, PaO2/FiO2 ratio, percentage of extended donor criteria donors and total ischemic time. AT in group I was significantly shorter vs. group II: 10.6±3.52 vs. 25.8±9.57 (p&lt;0.01). There were no significant differences in: duration of MV, ICU and hospital LOS, and frequency of AR. The survival (log rank=1.0) and freedom from BOS (log rank=0.57) were also comparable. Difference in PaO2/FiO2 [mmHg] ratio reached statistical significance 72 hours after transplant: I vs. II: on arrival – 308±166 vs. 268±95 (p=0.38), 24 hours - 343±108 vs. 307±99 (p=0.25), 48 hours - 379±192 vs. 335±99 (p=0.19), 72 hours 401±152 vs. 316±79 (p=0.04).ConclusionsAT ≤ 1 hour is safe and does not influence midterm survival after LTx. However, longer AT (within 1 hour range) already has a negative impact on early graft function, suggesting that a significant extension of AT may have more pronounced effects. No data is available as of yet pertaining to long term graft function and survival.

Research paper thumbnail of HeartWare miniaturized intrapericardial ventricular assist device: advantages and adverse events in comparison to contemporary devices

Expert Review of Medical Devices, 2013

Research paper thumbnail of Do We Really Need to Rush? Early and Mid Term Results of Lung Transplantation (Ltx) of Organs With Total Ischemic Time (TIT) Over 8 Hours - A Propensity Score Matched, Single-Center Analysis

The Journal of Heart and Lung Transplantation, 2015

Research paper thumbnail of Influence of Intraoperative Hemodynamic Factors on the Development of Acute Kidney Injury in Lung Transplantation

The Journal of Heart and Lung Transplantation, 2014

Research paper thumbnail of Minimally invasive left ventricular assist device implantation: at the crossroads

Journal of thoracic disease, 2015

Research paper thumbnail of Perfusion-Decellularization of Porcine Lung and Trachea for Respiratory Bioengineering

Artificial organs, Jan 20, 2015

Decellularization of native organs may provide an acellular tissue platform for organ regeneratio... more Decellularization of native organs may provide an acellular tissue platform for organ regeneration. However, decellularization involves a trade-off between removal of immunogenic cellular elements and preservation of biomechanical integrity. We sought to develop a bioartificial scaffold for respiratory tissue engineering by decellularization of porcine lungs and trachea while preserving organ architecture and vasculature. Lung-trachea preparations from 25 German Landrace pigs were perfused in a modified Langendorff circuit and decellularized by an SDC (sodium deoxycholate)-based perfusion protocol. Decellularization was evaluated by histology and fluorescence microscopy, and residual DNA quantified spectrophotometrically and compared with controls. Airway compliance was evaluated by endotracheal intubation and mechanical ventilation to simulate physiological breathing-induced stretch. Structural integrity was evaluated by bronchoscopy and biomechanical stress/strain analysis by meas...

Research paper thumbnail of Continuous-flow left ventricular assist device exchange: Clinical outcomes

ABSTRACT A percentage of patients with a left ventricular assist device (LVAD) require device exc... more ABSTRACT A percentage of patients with a left ventricular assist device (LVAD) require device exchange. Although this is an important clinical entity, there are only a handful of relevant studies on this topic in the literature. From 2004 to 2012, 30 device exchanges (HeartMate II to HeartMate II) were performed. Since June 2011, we have employed the subcostal approach for device exchange if indicated. Sixteen patients underwent device exchange through a subcostal approach (S group), whereas 14 patients had devices exchanged through a full sternotomy (F group). Pre- and post-operative data were retrospectively reviewed. There was no difference in baseline patient characteristics between the two groups. Overall, mean duration between primary surgery and device exchange was 425 ± 407 days. Surgical indications included device thrombus/hemolysis (N = 19), device malfunction (N = 9) and infection (N = 2). Cardiopulmonary bypass time was significantly shorter in the S group (S: 40 ± 23 minutes, F: 105 ± 84 minutes; p &lt; 0.05), and post-operative bleeding within 24 hours after surgery was less in the S group (S: 362 ± 367 ml, F: 1,286 ± 971 ml; p &lt; 0.05). Length of ICU stay was significantly shorter in the S group (S: 4.6 ± 1.8 days, F: 8.2 ± 4.9 days; p &lt; 0.05). There was no difference in post-operative complications, except for prolonged intubation (F: N = 6 [43%], S: N = 1 [6.3%]; p &lt; 0.05). There were 3 deaths in the F group and 0 in the S group, with no statistical difference (p = 0.09). Also, there was no significant difference in other outcomes, including transplantation, device explantation and ongoing LVAD support. A subcostal approach may be preferred for HeartMate II device exchange if indicated.

Research paper thumbnail of Bilateral lung transplantation in a patient with Vascular Ehlers-Danlos syndrome

The Annals of thoracic surgery, 2014

We describe the case of a 29-year-old woman with end-stage chronic obstructive pulmonary disease ... more We describe the case of a 29-year-old woman with end-stage chronic obstructive pulmonary disease secondary to vascular Ehlers-Danlos syndrome. Because of critical deterioration, respiratory arrest, and complete lung failure, she required urgent implantation of a venovenous extracorporeal membrane oxygenator as a bridge to lung transplantation. After 6 days of extracorporeal life support, a successful bilateral sequential lung transplantation was performed. This is the first case of lung transplantation in a patient with a diagnosis of chronic obstructive pulmonary disease secondary to Ehlers-Danlos syndrome.

Research paper thumbnail of Use of Foley catheter for insertion of ventricular assist device inflow cannula

Asian cardiovascular & thoracic annals, 2014

Ventricular assist devices are fast becoming an accepted alternative to treat end-stage heart fai... more Ventricular assist devices are fast becoming an accepted alternative to treat end-stage heart failure, and are being implemented as a bridge to myocardial recovery, a bridge to heart transplantation, or as destination therapy. Positioning of the inflow cannula into the apex of the ventricle is a crucial step due to the risk of sucking in air. We describe an improved method of preparing the insertion site for the ventricular assist device inflow cannula, to minimize the chances of air embolism and blood spillage, which we applied in a 34-year-old man, as a bridge to transplantation.

Research paper thumbnail of Utilization of a Novel Rib Spreader for Minimally Invasive Lung Transplantation

Surgical innovation, Jan 7, 2014

Rack-and-pinion-type stainless steel rib spreader was innovated by Truffier in 1914, which was mo... more Rack-and-pinion-type stainless steel rib spreader was innovated by Truffier in 1914, which was modified by Finochietto to have fenestrated blades and a hand-cranked lever to both separate the arms in a staged fashion and lock them in place at each stop. Its Burford-Finochietto variants with replaceable blades are ubiquitous in open thoracic surgery. Fehling Surgical Instrument, Inc (Acworth, GA) introduced a modified rib spreader-an assembly of movable and adjustable blades, a mobile bridge and spreader arms, which owing to its adaptation of thoracotomy incision provides an optimum exposure without injuring the ribs. The spreader is indispensible in lung transplantation surgery performed especially through minimally invasive (bilateral limited anterolateral thoracotomies with intact sternum) approach.

Research paper thumbnail of Modified extracorporeal life support: The Harefield technique

Asian cardiovascular & thoracic annals, Jan 19, 2014

Research paper thumbnail of The influence of bilateral internal mammary arteries on short- and long-term outcomes: a propensity score matching in accordance with current recommendations

The Journal of thoracic and cardiovascular surgery, 2014

We undertook a single-center, 12 years outcomes analysis of the influence of bilateral internal m... more We undertook a single-center, 12 years outcomes analysis of the influence of bilateral internal mammary arteries (BIMA) over single internal mammary artery (SIMA) on short-term outcomes and long-term outcomes by means of propensity score matching technique in accordance to current recommendations. A propensity score was generated for each patient from a multivariable logistic regression model based on 20 pretreatment covariates. The study population consisted of 4195 patients undergoing coronary artery bypass graft procedure using SIMA (n = 3445; 78.3%) or BIMA (n = 750; 21.7%). A total of 750 matching sets were derived. The BIMA group was associated with an increased rate of superficial sternal wound infection (5.6% vs 1.7%; P = .0001) but the incidence of deep sternal wound infection was comparable between the 2 groups, at 2.1% and 1.5% in BIMA and SIMA groups, respectively (P = .43). With regard to other postoperative complications the 2 groups were comparable. Operative mortalit...

Research paper thumbnail of Extracorporeal Life Support in Patients with Refractory Cardiogenic Shock: Keep Them Awake

The Thoracic and Cardiovascular Surgeon, 2015

OBJECTIVE: Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanic... more OBJECTIVE: Traditionally, patients on extracorporeal life support (ECLS) are sedated and mechanically ventilated and therefore prone to complications related to immobility and ventilation. We adopted this 'Awake ECLS' strategy for the patients with refractory cardiogenic shock (RCS) as a bridge to decision.

Research paper thumbnail of Ex vivo lung perfusion to evaluate donor lungs after high-pressure pulmonoplegia

The Journal of thoracic and cardiovascular surgery, 2014