Michael Gorlitzer - Academia.edu (original) (raw)

Papers by Michael Gorlitzer

Research paper thumbnail of Abstract 13882: Final Results of the World Largest Prospective Randomized Multicenter Trial Regarding Prevention of Sternal Wound Complications After Open Heart Surgery

Circulation, Nov 22, 2011

Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a s... more Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a specifically designed vest (Posthorax support vest) to prevent sternal wound infections after cardiac...

Research paper thumbnail of Redo surgery for carotid artery stenosis: when and how?

Cardiovascular Surgery, Aug 1, 2000

Purpose: We analyzed operations performed at our institution retrospectively for recurrent caroti... more Purpose: We analyzed operations performed at our institution retrospectively for recurrent carotid artery stenosis to assess the indication for surgery. We also assessed the techniques used for these operations. Patients and methods: From January 1992 to December 1998 1210 carotid endarterectomies were performed. Forty two (3.4%) of these were for recurrent stenosis. A new vein patch was implanted in 27 cases, PTFE patches were used in nine cases. In six cases an interposition with the great saphenous vein was performed. Results: The mean interval between primary and secondary procedure was 60.2 months (3 months to 23 yr). Twenty five of our 41 patients had had ipsilateral neurologic symptoms before redo surgery, the remainder were free of symptoms. The grade of stenosis was over 90% in 22 cases, between 75 and 90% in 11 cases and below 75% in nine cases, two cases had aneurysmatic lesions. None of the patients died in the 30 day observation period. One patient had a stroke with a permanent neurological deficit. In two cases postoperative bleeding occurred requiring reexploration. Two patients developed hypoglossal neurapraxia and in four patients the recurrent laryngeal nerve was injured. One patient had an apnoic episode in the recovery room. Conclusion: The reported incidence of recurrent carotid artery stenosis surgery ranges from 3 to 36% and our incidence is at the lower end of this range. The surgical results of reoperating are acceptable with a low incidence of complications.

Research paper thumbnail of Is the urgent carotid endarterectomy in patients with acute neurological symptoms a safe procedure?

Interactive Cardiovascular and Thoracic Surgery, Feb 23, 2009

The aim of the present case-control study was to assess patients with acute neurological symptoms... more The aim of the present case-control study was to assess patients with acute neurological symptoms requiring urgent carotid endarterectomy (CEA) and compare the outcome of the procedure in this group with that achieved in stable patients. Twenty-eight CEAs were performed in patients with an acute neurological deficit and 302 in stable patients from December 2006 to April 2008. Those selected for urgent surgery fulfilled the following criteria: acute onset of hemispheric neurological symptoms or crescendo TIAs, significant carotid pathology, the absence of cerebral hemorrhage, uncompromised vigilance, and stable cardiopulmonary conditions. Perioperative mortality in the stable patients' cohort was 0.33%. One patient died during the hospital stay because of myocardial infarction. Perioperative neurological events were observed in 2.2%: one ipsilateral stroke in stage II A, one contralateral stroke in stage I A, and a prolonged neurological deficit with complete restitution at the time of discharge in five patients. No mortality or neurological morbidity was encountered in those who underwent urgent CEA. Compared to stable patients with stage I, II or IV disease, neither mortality nor morbidity was increased in those who underwent urgent CEA. Urgent CEA after non-disabling stroke or crescendo TIAs is a safe procedure with a favorable outcome.

Research paper thumbnail of Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial†

Interactive Cardiovascular and Thoracic Surgery, Jun 11, 2013

OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a... more OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a vest (Posthorax support vest®) to prevent sternal wound infection after cardiac surgery, and to identify risk factors. METHODS: From September 2007 to March 2010, 2539 patients undergoing cardiac surgery via median sternotomy were prospectively randomized into those who received a Posthorax® vest and those who did not. Patients were instructed to wear the vest postoperatively for 24 h a day for at least 6 weeks; the duration of follow-up was 90 days. Patients who did not use the vest within a period of 72 h postoperatively were regarded as study dropouts. Statistical calculations were based on an intention-to-treat (ITT) analysis. Further evaluations comprised all subgroups of patients. RESULTS: Complete data were available for 2539 patients (age 67 ± 11years, 45% female). Of these, 1351 were randomized to receive a vest, while 1188 received no vest. No significant differences were observed between groups regarding age, gender, diabetes, body mass index, chronic obstructive pulmonary disease (COPD), renal failure, the logistic EuroSCORE and the indication for surgery. The frequency of deep wound complications (dWC: mediastinitis and sternal dehiscence) was significantly lower in vest (n = 14; 1.04%) vs non-vest (n = 27; 2.27%) patients (ITT, P < 0.01), but superficial complications did not differ between groups. Subanalysis of vest patients revealed that only 933 (Group A) wore the vest according to the protocol, while 202 (Group BR) refused to wear the vest (non-compliance) and 216 (Group BN) did not use the vest for other reasons. All dWC occurred in Groups BR (n = 7) and BN (n = 7), although these groups had the same preoperative risk profile as Group A. Postoperatively, Group BN had a prolonged intubation time, a longer stay in the intensive care unit, greater use of intra-aortic balloon pump, higher frequency of COPD and a larger percentage of patients who required prolonged surgery. CONCLUSIONS: Consistent use of the Posthorax® vest prevented deep sternal wounds. The anticipated risk factors for wound complications did not prove to be relevant, whereas intra-and postoperative complications appear to be very significant.

Research paper thumbnail of A prospective randomized multicenter trial shows improvement of sternum related complications in cardiac surgery with the Posthorax® support vest☆

Interactive Cardiovascular and Thoracic Surgery, May 1, 2010

Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in ... more Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in cardiac surgery. The aim of this analysis is to determine the effect of a Posthorax support vest (Epple Inc, Vienna, Austria) after median sternotomy. One thousand five hundred and ᮋ sixty cases were included in a prospective randomized multicenter trial. Patients were randomized as follows: 905 received a flexible dressing postoperatively (group A) and 655 patients were given a Posthorax support vest (group B). Patients in groups A and B were well ᮋ matched. Their mean age was 68 years (range: 34-87 years). The patient characteristics and operative data were equally distributed in both groups. The mean total hospital stay was significantly shorter in group B than in group A (A: 17.33"17.5; B: 14.76"7.7; Ps0.04). Sternal wound complications necessitating reoperation during the 90 days follow-up period were observed in 4.5%. Reoperation rates were as follows: 3.9% in group A and 0.6% in group B (P-0.05). The use of the Posthorax sternum support vest is a valuable adjunct to prevent ᮋ sternum-related complications after cardiac surgery. In the 90 days follow-up period, additional surgical procedures were significantly reduced by the use of the support vest.

Research paper thumbnail of Enhanced Endothelial Cell Retention on Shear-Stressed Synthetic Vascular Grafts Precoated with RGD-Cross-Linked Fibrin

Tissue Engineering, May 1, 2005

Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular... more Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular grafts. The shear stress resistance of the cultured autologous endothelium represents a crucial cornerstone of the concept. We investigated whether an enrichment of the precoating matrix with adhesion sites can augment endothelial cell attachment. Adult human saphenous vein endothelial cells (AHSVECs) were seeded confluently ([58 ؎ 11] ؋ 10 3 AHSVECs/cm 2) onto 10-cm-long ePTFE (expanded polytetrafluorethylene) vascular grafts (n ‫؍‬ 24) precoated with commercial clinically approved fibrin gel (Tisseal) containing various concentrations of cross-linked RGD peptide (0.0, 4.0, 8.0, or 16.0 mg of RGD per milliliter of Tisseal fibrinogen component). Endothelialized grafts were postcultivated for 9 days before they were exposed to a pulsatile circulation model mimicking peak physiological shear stress conditions of the femoral artery (12 dyn/cm 2 ; min/max, ؊60/؉28 dyn/cm 2). Cell loss after 24 h was quantitatively determined by image analysis of vital stains. Initial 24-h cell loss was 27.2 ؎ 1.7% in grafts precoated with the non-RGD-enriched fibrin matrix. In contrast, cell loss was significantly less on fibrin containing 4.0 mg of RGD peptide per milliliter of Tisseal fibrinogen component (13.3 ؎ 7.9%; p Ͻ 0.05). Cell loss on fibrin containing 8 and 16 mg of RGD per milliliter of Tisseal fibrinogen component was 41.0 ؎ 27.4 and 43.0 ؎ 23.2% (p Ͼ 0.05), respectively. We conclude that low concentrations of RGD peptide cross-linked into commercial fibrin matrices used for clinical in vitro lining of vascular grafts led to significantly increased endothelial cell retention. The failure of higher RGD concentrations to enhance endothelial cell attachment may be explained by competitive binding of endothelial cells to non-cross-linked RGD.

Research paper thumbnail of Treatment of chronic aortic type A dissection with a new designed hybridprosthesis

European Journal of Cardio-Thoracic Surgery, Feb 1, 2007

This report describes the use of a new combined surgical and endovascular treatment for chronic t... more This report describes the use of a new combined surgical and endovascular treatment for chronic type A aortic dissection after Cabrol operation. Intraoperative antegrade stenting of the descending aorta combined with distal ascending aorta and aortic arch repair was performed using the E-vita open endoluminal stentgraft. The stentgraft was deployed under direct vision into the true lumen. Postperative CT scan revealed a partially thrombosed false lumen. This report shows that a combined surgical and endovascular approach of chronic type A aortic dissection in a single stage procedure is a feasible option and extends aortic repair without increase of risk.

Research paper thumbnail of Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm

Interactive Cardiovascular and Thoracic Surgery, Oct 1, 2008

Research paper thumbnail of Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international registry☆

European Journal of Cardio-Thoracic Surgery, 2011

Objectives: Arch replacement combined with antegrade stent grafting of the descending aorta repre... more Objectives: Arch replacement combined with antegrade stent grafting of the descending aorta represents a hybrid surgical approach for extensive thoracic aortic disease. This multicentre study evaluates the early results of this method in complex aortic dissection (AD). Methods: Retrospective data acquisition was achieved by institution of an international registry. A hybrid stent graft with integrated vascular prosthesis for arch replacement (E-vita open W) was used. From January 2005 to March 2009, 106 patients (mean age 57; 77% male) with complex AD (55 acute, 51 chronic) were studied. Results: As many as 49/106 (46%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (95 total, 11 subtotal) were performed under hypothermic circulatory arrest (HCA (8 AE 6 min) and selective antegrade cerebral perfusion (SACP) (74 AE 23 min). Stent-graft placement into the true lumen was successful in all but one case (99%). Ascending aortic replacement was performed in 91/106 (86%), aortic valve repair/replacement in 49/106 (46%), coronary artery bypass grafting (CABG) in 17/106 (16%) and mitral valve repair in 2/106 (2%). Cardiopulmonary bypass (CPB) and cardiac arrest times were 242 AE 64 and 144 AE 44 min, respectively. Inhospital mortality was 12% (13/106; six acute, seven chronic AD) and new strokes observed in 5/106 (5%). The false lumen (FL) was evaluated in 96/106 (91%) patients postoperatively. At first follow-up computed tomography (CT)-examination, thoracic FL thrombosis was 93% (76 complete, 13 partial) and 58% (31 complete, 25 partial) in the thoraco-abdominal aorta. Conclusions: By combining arch replacement with downstream stent grafting, one-stage repair of complex aortic dissection with almost unanimous thoracic FL thrombosis can be achieved at acceptable perioperative risk.

Research paper thumbnail of FJVIS 9. New Biomaterials in Vascular Surgery

Journal of Vascular Surgery, 2019

0.3 6 0.9). In addition, overall quality of life, as measured by the Vascular Quality of Life que... more 0.3 6 0.9). In addition, overall quality of life, as measured by the Vascular Quality of Life questionnaire total score, improved significantly from baseline to 2 years in all RC groups. A late-breaking update on the 3-year OA outcomes will be presented. Conclusions: LIBERTY investigated real-world PAD patients with rigorous study guidelines and independent oversight of outcomes. This LIBERTY subanalysis demonstrated that PVI involving OA treatment resulted in low rates of major amputation and improvement in wound healing and quality of life.

Research paper thumbnail of FJVIS 14. Update of the European Society for Vascular Surgery Guidelines for Aortoabdominal and Iliac Aneurysms: What Is New and How Does It Differ From the Society for Vascular Surgery and National Institute for Health and Care Excellence Guidelines in Preparation?

Journal of Vascular Surgery, 2019

Research paper thumbnail of Abstract 13882: Final Results of the World Largest Prospective Randomized Multicenter Trial Regarding Prevention of Sternal Wound Complications After Open Heart Surgery

Circulation, Nov 22, 2011

Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a s... more Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a specifically designed vest (Posthorax support vest) to prevent sternal wound infections after cardiac...

Research paper thumbnail of Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm

Interactive cardiovascular and thoracic surgery, 2008

The modality of treatment and the appropriate time point to treat type II endoleaks after endovas... more The modality of treatment and the appropriate time point to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms (EVAR) remain controversial issues. The purpose of the present study was to assess the efficacy of translumbar embolization of type II endoleaks after endovascular repair of aortic aneurysm repair. Eighty-four consecutive patients after EVAR were analyzed for the onset of type II endoleaks. Of these, five patients had experienced translumbar embolization after ineffective intraartrial approach to exclude the endoleak. A combination of several liquid embolic agents was used as sealant. Post-procedural contrast-enhanced ultrasound (CEUS) was used to document the outcome of the embolization. Translumbar embolization was successful in four patients. Complete sealing of the nidus was seen on CEUS 24 h after the procedure. In one patient with a duplication of the inferior vena cava, the procedure was aborted because an additional type Ib endoleak was ...

Research paper thumbnail of Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch, 2011

Research paper thumbnail of Glutaraldehyde detoxification of aortic wall tissue: a promising perspective for emerging bioprosthetic valve concepts

The Journal of heart valve disease, 1997

Due to its superb crosslinking activity, glutaraldehyde (GA) is still the most widely used fixati... more Due to its superb crosslinking activity, glutaraldehyde (GA) is still the most widely used fixative for bioprosthetic heart valves. At the same time, however, GA is also believed to be partly responsible for tissue calcification and the lack of surface re-endothelialization, both of which may contribute to valve degeneration. Although excess GA has previously been extracted from thin leaflet tissue, this treatment proved insufficient for the detoxification of thick aortic wall tissue of stentless valves or root prostheses. In order to establish a detoxification procedure which thoroughly extracts biologically active GA from aortic wall tissue, we used a highly sensitive bioassay where endothelial cells were seeded onto glutaraldehyde-fixed aortic wall discs following various detoxification procedures. Absolute cell numbers and morphologic shape were correlated with shrinkage temperature and shrinkage extent of the tissue to determine the potential of the treatments to reverse crossl...

Research paper thumbnail of A prospective randomized multicenter trial shows improvement of sternum related complications in cardiac surgery with the Posthorax® support vest☆

Interactive CardioVascular and Thoracic Surgery, 2010

Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in ... more Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in cardiac surgery. The aim of this analysis is to determine the effect of a Posthorax support vest (Epple Inc, Vienna, Austria) after median sternotomy. One thousand five hundred and ᮋ sixty cases were included in a prospective randomized multicenter trial. Patients were randomized as follows: 905 received a flexible dressing postoperatively (group A) and 655 patients were given a Posthorax support vest (group B). Patients in groups A and B were well ᮋ matched. Their mean age was 68 years (range: 34-87 years). The patient characteristics and operative data were equally distributed in both groups. The mean total hospital stay was significantly shorter in group B than in group A (A: 17.33"17.5; B: 14.76"7.7; Ps0.04). Sternal wound complications necessitating reoperation during the 90 days follow-up period were observed in 4.5%. Reoperation rates were as follows: 3.9% in group A and 0.6% in group B (P-0.05). The use of the Posthorax sternum support vest is a valuable adjunct to prevent ᮋ sternum-related complications after cardiac surgery. In the 90 days follow-up period, additional surgical procedures were significantly reduced by the use of the support vest.

Research paper thumbnail of Is the transpulmonary pressure gradient a predictor for mortality after orthotopic cardiac transplantation?

Transplant international : official journal of the European Society for Organ Transplantation, 2005

Elevated pulmonary vascular resistance (PVR) is a well-known risk factor for right ventricular fa... more Elevated pulmonary vascular resistance (PVR) is a well-known risk factor for right ventricular failure after orthotopic cardiac transplantation. The influence of preoperative transpulmonary pressure gradient (TPG) and PVR on post-transplant 30 days mortality was evaluated. To analyze the response of PVR and TPG to cardiac transplantation, we analyzed 718 adult patients undergoing primary cardiac transplantation. Indications for operation were: 35.2% ischemic cardiomyopathy (ICM), 61.2% idiopathic dilated cardiomyopathy (DCM), and 3.3% other diagnosis (e.g. hypertrophic cardiomyopathy). The mean age (51.9) and the mean ischemic time (169.7 min) were comparable between 30 days survivors and nonsurvivors. Student's t-tests and chi-square analysis were used to compare data from 30-day survivors and nonsurvivors. Statistical significance was defined as P < 0.05. Fisher's exact test and multiple logistic regression analysis was performed to evaluate the relationship between hem...

Research paper thumbnail of Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial†

Interactive CardioVascular and Thoracic Surgery, 2013

OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a... more OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a vest (Posthorax support vest®) to prevent sternal wound infection after cardiac surgery, and to identify risk factors. METHODS: From September 2007 to March 2010, 2539 patients undergoing cardiac surgery via median sternotomy were prospectively randomized into those who received a Posthorax® vest and those who did not. Patients were instructed to wear the vest postoperatively for 24 h a day for at least 6 weeks; the duration of follow-up was 90 days. Patients who did not use the vest within a period of 72 h postoperatively were regarded as study dropouts. Statistical calculations were based on an intention-to-treat (ITT) analysis. Further evaluations comprised all subgroups of patients. RESULTS: Complete data were available for 2539 patients (age 67 ± 11years, 45% female). Of these, 1351 were randomized to receive a vest, while 1188 received no vest. No significant differences were observed between groups regarding age, gender, diabetes, body mass index, chronic obstructive pulmonary disease (COPD), renal failure, the logistic EuroSCORE and the indication for surgery. The frequency of deep wound complications (dWC: mediastinitis and sternal dehiscence) was significantly lower in vest (n = 14; 1.04%) vs non-vest (n = 27; 2.27%) patients (ITT, P < 0.01), but superficial complications did not differ between groups. Subanalysis of vest patients revealed that only 933 (Group A) wore the vest according to the protocol, while 202 (Group BR) refused to wear the vest (non-compliance) and 216 (Group BN) did not use the vest for other reasons. All dWC occurred in Groups BR (n = 7) and BN (n = 7), although these groups had the same preoperative risk profile as Group A. Postoperatively, Group BN had a prolonged intubation time, a longer stay in the intensive care unit, greater use of intra-aortic balloon pump, higher frequency of COPD and a larger percentage of patients who required prolonged surgery. CONCLUSIONS: Consistent use of the Posthorax® vest prevented deep sternal wounds. The anticipated risk factors for wound complications did not prove to be relevant, whereas intra-and postoperative complications appear to be very significant.

Research paper thumbnail of 28.6 Transplantation of autologous endothelial cells

Cardiovascular Surgery, 1997

Objective: PTFE prostheses have a thromboembolic potential, which is a limiting factor especially... more Objective: PTFE prostheses have a thromboembolic potential, which is a limiting factor especially for small diameter grafts. Patency rates between 40 and 55% after 5 years of implantation are documented for femoro-popliteal reconstructions in the international literature. This method aims at the reduction of this thromboembolic risk by covering the PTFE surface with autologous endothelial cells.

Research paper thumbnail of Enhanced Endothelial Cell Retention on Shear-Stressed Synthetic Vascular Grafts Precoated with RGD-Cross-Linked Fibrin

Tissue Engineering, 2005

Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular... more Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular grafts. The shear stress resistance of the cultured autologous endothelium represents a crucial cornerstone of the concept. We investigated whether an enrichment of the precoating matrix with adhesion sites can augment endothelial cell attachment. Adult human saphenous vein endothelial cells (AHSVECs) were seeded confluently ([58 ؎ 11] ؋ 10 3 AHSVECs/cm 2) onto 10-cm-long ePTFE (expanded polytetrafluorethylene) vascular grafts (n ‫؍‬ 24) precoated with commercial clinically approved fibrin gel (Tisseal) containing various concentrations of cross-linked RGD peptide (0.0, 4.0, 8.0, or 16.0 mg of RGD per milliliter of Tisseal fibrinogen component). Endothelialized grafts were postcultivated for 9 days before they were exposed to a pulsatile circulation model mimicking peak physiological shear stress conditions of the femoral artery (12 dyn/cm 2 ; min/max, ؊60/؉28 dyn/cm 2). Cell loss after 24 h was quantitatively determined by image analysis of vital stains. Initial 24-h cell loss was 27.2 ؎ 1.7% in grafts precoated with the non-RGD-enriched fibrin matrix. In contrast, cell loss was significantly less on fibrin containing 4.0 mg of RGD peptide per milliliter of Tisseal fibrinogen component (13.3 ؎ 7.9%; p Ͻ 0.05). Cell loss on fibrin containing 8 and 16 mg of RGD per milliliter of Tisseal fibrinogen component was 41.0 ؎ 27.4 and 43.0 ؎ 23.2% (p Ͼ 0.05), respectively. We conclude that low concentrations of RGD peptide cross-linked into commercial fibrin matrices used for clinical in vitro lining of vascular grafts led to significantly increased endothelial cell retention. The failure of higher RGD concentrations to enhance endothelial cell attachment may be explained by competitive binding of endothelial cells to non-cross-linked RGD.

Research paper thumbnail of Abstract 13882: Final Results of the World Largest Prospective Randomized Multicenter Trial Regarding Prevention of Sternal Wound Complications After Open Heart Surgery

Circulation, Nov 22, 2011

Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a s... more Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a specifically designed vest (Posthorax support vest) to prevent sternal wound infections after cardiac...

Research paper thumbnail of Redo surgery for carotid artery stenosis: when and how?

Cardiovascular Surgery, Aug 1, 2000

Purpose: We analyzed operations performed at our institution retrospectively for recurrent caroti... more Purpose: We analyzed operations performed at our institution retrospectively for recurrent carotid artery stenosis to assess the indication for surgery. We also assessed the techniques used for these operations. Patients and methods: From January 1992 to December 1998 1210 carotid endarterectomies were performed. Forty two (3.4%) of these were for recurrent stenosis. A new vein patch was implanted in 27 cases, PTFE patches were used in nine cases. In six cases an interposition with the great saphenous vein was performed. Results: The mean interval between primary and secondary procedure was 60.2 months (3 months to 23 yr). Twenty five of our 41 patients had had ipsilateral neurologic symptoms before redo surgery, the remainder were free of symptoms. The grade of stenosis was over 90% in 22 cases, between 75 and 90% in 11 cases and below 75% in nine cases, two cases had aneurysmatic lesions. None of the patients died in the 30 day observation period. One patient had a stroke with a permanent neurological deficit. In two cases postoperative bleeding occurred requiring reexploration. Two patients developed hypoglossal neurapraxia and in four patients the recurrent laryngeal nerve was injured. One patient had an apnoic episode in the recovery room. Conclusion: The reported incidence of recurrent carotid artery stenosis surgery ranges from 3 to 36% and our incidence is at the lower end of this range. The surgical results of reoperating are acceptable with a low incidence of complications.

Research paper thumbnail of Is the urgent carotid endarterectomy in patients with acute neurological symptoms a safe procedure?

Interactive Cardiovascular and Thoracic Surgery, Feb 23, 2009

The aim of the present case-control study was to assess patients with acute neurological symptoms... more The aim of the present case-control study was to assess patients with acute neurological symptoms requiring urgent carotid endarterectomy (CEA) and compare the outcome of the procedure in this group with that achieved in stable patients. Twenty-eight CEAs were performed in patients with an acute neurological deficit and 302 in stable patients from December 2006 to April 2008. Those selected for urgent surgery fulfilled the following criteria: acute onset of hemispheric neurological symptoms or crescendo TIAs, significant carotid pathology, the absence of cerebral hemorrhage, uncompromised vigilance, and stable cardiopulmonary conditions. Perioperative mortality in the stable patients' cohort was 0.33%. One patient died during the hospital stay because of myocardial infarction. Perioperative neurological events were observed in 2.2%: one ipsilateral stroke in stage II A, one contralateral stroke in stage I A, and a prolonged neurological deficit with complete restitution at the time of discharge in five patients. No mortality or neurological morbidity was encountered in those who underwent urgent CEA. Compared to stable patients with stage I, II or IV disease, neither mortality nor morbidity was increased in those who underwent urgent CEA. Urgent CEA after non-disabling stroke or crescendo TIAs is a safe procedure with a favorable outcome.

Research paper thumbnail of Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial†

Interactive Cardiovascular and Thoracic Surgery, Jun 11, 2013

OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a... more OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a vest (Posthorax support vest®) to prevent sternal wound infection after cardiac surgery, and to identify risk factors. METHODS: From September 2007 to March 2010, 2539 patients undergoing cardiac surgery via median sternotomy were prospectively randomized into those who received a Posthorax® vest and those who did not. Patients were instructed to wear the vest postoperatively for 24 h a day for at least 6 weeks; the duration of follow-up was 90 days. Patients who did not use the vest within a period of 72 h postoperatively were regarded as study dropouts. Statistical calculations were based on an intention-to-treat (ITT) analysis. Further evaluations comprised all subgroups of patients. RESULTS: Complete data were available for 2539 patients (age 67 ± 11years, 45% female). Of these, 1351 were randomized to receive a vest, while 1188 received no vest. No significant differences were observed between groups regarding age, gender, diabetes, body mass index, chronic obstructive pulmonary disease (COPD), renal failure, the logistic EuroSCORE and the indication for surgery. The frequency of deep wound complications (dWC: mediastinitis and sternal dehiscence) was significantly lower in vest (n = 14; 1.04%) vs non-vest (n = 27; 2.27%) patients (ITT, P < 0.01), but superficial complications did not differ between groups. Subanalysis of vest patients revealed that only 933 (Group A) wore the vest according to the protocol, while 202 (Group BR) refused to wear the vest (non-compliance) and 216 (Group BN) did not use the vest for other reasons. All dWC occurred in Groups BR (n = 7) and BN (n = 7), although these groups had the same preoperative risk profile as Group A. Postoperatively, Group BN had a prolonged intubation time, a longer stay in the intensive care unit, greater use of intra-aortic balloon pump, higher frequency of COPD and a larger percentage of patients who required prolonged surgery. CONCLUSIONS: Consistent use of the Posthorax® vest prevented deep sternal wounds. The anticipated risk factors for wound complications did not prove to be relevant, whereas intra-and postoperative complications appear to be very significant.

Research paper thumbnail of A prospective randomized multicenter trial shows improvement of sternum related complications in cardiac surgery with the Posthorax® support vest☆

Interactive Cardiovascular and Thoracic Surgery, May 1, 2010

Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in ... more Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in cardiac surgery. The aim of this analysis is to determine the effect of a Posthorax support vest (Epple Inc, Vienna, Austria) after median sternotomy. One thousand five hundred and ᮋ sixty cases were included in a prospective randomized multicenter trial. Patients were randomized as follows: 905 received a flexible dressing postoperatively (group A) and 655 patients were given a Posthorax support vest (group B). Patients in groups A and B were well ᮋ matched. Their mean age was 68 years (range: 34-87 years). The patient characteristics and operative data were equally distributed in both groups. The mean total hospital stay was significantly shorter in group B than in group A (A: 17.33"17.5; B: 14.76"7.7; Ps0.04). Sternal wound complications necessitating reoperation during the 90 days follow-up period were observed in 4.5%. Reoperation rates were as follows: 3.9% in group A and 0.6% in group B (P-0.05). The use of the Posthorax sternum support vest is a valuable adjunct to prevent ᮋ sternum-related complications after cardiac surgery. In the 90 days follow-up period, additional surgical procedures were significantly reduced by the use of the support vest.

Research paper thumbnail of Enhanced Endothelial Cell Retention on Shear-Stressed Synthetic Vascular Grafts Precoated with RGD-Cross-Linked Fibrin

Tissue Engineering, May 1, 2005

Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular... more Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular grafts. The shear stress resistance of the cultured autologous endothelium represents a crucial cornerstone of the concept. We investigated whether an enrichment of the precoating matrix with adhesion sites can augment endothelial cell attachment. Adult human saphenous vein endothelial cells (AHSVECs) were seeded confluently ([58 ؎ 11] ؋ 10 3 AHSVECs/cm 2) onto 10-cm-long ePTFE (expanded polytetrafluorethylene) vascular grafts (n ‫؍‬ 24) precoated with commercial clinically approved fibrin gel (Tisseal) containing various concentrations of cross-linked RGD peptide (0.0, 4.0, 8.0, or 16.0 mg of RGD per milliliter of Tisseal fibrinogen component). Endothelialized grafts were postcultivated for 9 days before they were exposed to a pulsatile circulation model mimicking peak physiological shear stress conditions of the femoral artery (12 dyn/cm 2 ; min/max, ؊60/؉28 dyn/cm 2). Cell loss after 24 h was quantitatively determined by image analysis of vital stains. Initial 24-h cell loss was 27.2 ؎ 1.7% in grafts precoated with the non-RGD-enriched fibrin matrix. In contrast, cell loss was significantly less on fibrin containing 4.0 mg of RGD peptide per milliliter of Tisseal fibrinogen component (13.3 ؎ 7.9%; p Ͻ 0.05). Cell loss on fibrin containing 8 and 16 mg of RGD per milliliter of Tisseal fibrinogen component was 41.0 ؎ 27.4 and 43.0 ؎ 23.2% (p Ͼ 0.05), respectively. We conclude that low concentrations of RGD peptide cross-linked into commercial fibrin matrices used for clinical in vitro lining of vascular grafts led to significantly increased endothelial cell retention. The failure of higher RGD concentrations to enhance endothelial cell attachment may be explained by competitive binding of endothelial cells to non-cross-linked RGD.

Research paper thumbnail of Treatment of chronic aortic type A dissection with a new designed hybridprosthesis

European Journal of Cardio-Thoracic Surgery, Feb 1, 2007

This report describes the use of a new combined surgical and endovascular treatment for chronic t... more This report describes the use of a new combined surgical and endovascular treatment for chronic type A aortic dissection after Cabrol operation. Intraoperative antegrade stenting of the descending aorta combined with distal ascending aorta and aortic arch repair was performed using the E-vita open endoluminal stentgraft. The stentgraft was deployed under direct vision into the true lumen. Postperative CT scan revealed a partially thrombosed false lumen. This report shows that a combined surgical and endovascular approach of chronic type A aortic dissection in a single stage procedure is a feasible option and extends aortic repair without increase of risk.

Research paper thumbnail of Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm

Interactive Cardiovascular and Thoracic Surgery, Oct 1, 2008

Research paper thumbnail of Arch replacement and downstream stent grafting in complex aortic dissection: first results of an international registry☆

European Journal of Cardio-Thoracic Surgery, 2011

Objectives: Arch replacement combined with antegrade stent grafting of the descending aorta repre... more Objectives: Arch replacement combined with antegrade stent grafting of the descending aorta represents a hybrid surgical approach for extensive thoracic aortic disease. This multicentre study evaluates the early results of this method in complex aortic dissection (AD). Methods: Retrospective data acquisition was achieved by institution of an international registry. A hybrid stent graft with integrated vascular prosthesis for arch replacement (E-vita open W) was used. From January 2005 to March 2009, 106 patients (mean age 57; 77% male) with complex AD (55 acute, 51 chronic) were studied. Results: As many as 49/106 (46%) patients underwent emergency surgery. Stent-graft deployment and arch replacement (95 total, 11 subtotal) were performed under hypothermic circulatory arrest (HCA (8 AE 6 min) and selective antegrade cerebral perfusion (SACP) (74 AE 23 min). Stent-graft placement into the true lumen was successful in all but one case (99%). Ascending aortic replacement was performed in 91/106 (86%), aortic valve repair/replacement in 49/106 (46%), coronary artery bypass grafting (CABG) in 17/106 (16%) and mitral valve repair in 2/106 (2%). Cardiopulmonary bypass (CPB) and cardiac arrest times were 242 AE 64 and 144 AE 44 min, respectively. Inhospital mortality was 12% (13/106; six acute, seven chronic AD) and new strokes observed in 5/106 (5%). The false lumen (FL) was evaluated in 96/106 (91%) patients postoperatively. At first follow-up computed tomography (CT)-examination, thoracic FL thrombosis was 93% (76 complete, 13 partial) and 58% (31 complete, 25 partial) in the thoraco-abdominal aorta. Conclusions: By combining arch replacement with downstream stent grafting, one-stage repair of complex aortic dissection with almost unanimous thoracic FL thrombosis can be achieved at acceptable perioperative risk.

Research paper thumbnail of FJVIS 9. New Biomaterials in Vascular Surgery

Journal of Vascular Surgery, 2019

0.3 6 0.9). In addition, overall quality of life, as measured by the Vascular Quality of Life que... more 0.3 6 0.9). In addition, overall quality of life, as measured by the Vascular Quality of Life questionnaire total score, improved significantly from baseline to 2 years in all RC groups. A late-breaking update on the 3-year OA outcomes will be presented. Conclusions: LIBERTY investigated real-world PAD patients with rigorous study guidelines and independent oversight of outcomes. This LIBERTY subanalysis demonstrated that PVI involving OA treatment resulted in low rates of major amputation and improvement in wound healing and quality of life.

Research paper thumbnail of FJVIS 14. Update of the European Society for Vascular Surgery Guidelines for Aortoabdominal and Iliac Aneurysms: What Is New and How Does It Differ From the Society for Vascular Surgery and National Institute for Health and Care Excellence Guidelines in Preparation?

Journal of Vascular Surgery, 2019

Research paper thumbnail of Abstract 13882: Final Results of the World Largest Prospective Randomized Multicenter Trial Regarding Prevention of Sternal Wound Complications After Open Heart Surgery

Circulation, Nov 22, 2011

Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a s... more Objective: A prospective randomized mulitcenter trial was performed for analyzing efficacy of a specifically designed vest (Posthorax support vest) to prevent sternal wound infections after cardiac...

Research paper thumbnail of Translumbar treatment of type II endoleaks after endovascular repair of abdominal aortic aneurysm

Interactive cardiovascular and thoracic surgery, 2008

The modality of treatment and the appropriate time point to treat type II endoleaks after endovas... more The modality of treatment and the appropriate time point to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms (EVAR) remain controversial issues. The purpose of the present study was to assess the efficacy of translumbar embolization of type II endoleaks after endovascular repair of aortic aneurysm repair. Eighty-four consecutive patients after EVAR were analyzed for the onset of type II endoleaks. Of these, five patients had experienced translumbar embolization after ineffective intraartrial approach to exclude the endoleak. A combination of several liquid embolic agents was used as sealant. Post-procedural contrast-enhanced ultrasound (CEUS) was used to document the outcome of the embolization. Translumbar embolization was successful in four patients. Complete sealing of the nidus was seen on CEUS 24 h after the procedure. In one patient with a duplication of the inferior vena cava, the procedure was aborted because an additional type Ib endoleak was ...

Research paper thumbnail of Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch, 2011

Research paper thumbnail of Glutaraldehyde detoxification of aortic wall tissue: a promising perspective for emerging bioprosthetic valve concepts

The Journal of heart valve disease, 1997

Due to its superb crosslinking activity, glutaraldehyde (GA) is still the most widely used fixati... more Due to its superb crosslinking activity, glutaraldehyde (GA) is still the most widely used fixative for bioprosthetic heart valves. At the same time, however, GA is also believed to be partly responsible for tissue calcification and the lack of surface re-endothelialization, both of which may contribute to valve degeneration. Although excess GA has previously been extracted from thin leaflet tissue, this treatment proved insufficient for the detoxification of thick aortic wall tissue of stentless valves or root prostheses. In order to establish a detoxification procedure which thoroughly extracts biologically active GA from aortic wall tissue, we used a highly sensitive bioassay where endothelial cells were seeded onto glutaraldehyde-fixed aortic wall discs following various detoxification procedures. Absolute cell numbers and morphologic shape were correlated with shrinkage temperature and shrinkage extent of the tissue to determine the potential of the treatments to reverse crossl...

Research paper thumbnail of A prospective randomized multicenter trial shows improvement of sternum related complications in cardiac surgery with the Posthorax® support vest☆

Interactive CardioVascular and Thoracic Surgery, 2010

Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in ... more Sternal instability, dehiscence and mediastinitis are major causes of morbidity and mortality in cardiac surgery. The aim of this analysis is to determine the effect of a Posthorax support vest (Epple Inc, Vienna, Austria) after median sternotomy. One thousand five hundred and ᮋ sixty cases were included in a prospective randomized multicenter trial. Patients were randomized as follows: 905 received a flexible dressing postoperatively (group A) and 655 patients were given a Posthorax support vest (group B). Patients in groups A and B were well ᮋ matched. Their mean age was 68 years (range: 34-87 years). The patient characteristics and operative data were equally distributed in both groups. The mean total hospital stay was significantly shorter in group B than in group A (A: 17.33"17.5; B: 14.76"7.7; Ps0.04). Sternal wound complications necessitating reoperation during the 90 days follow-up period were observed in 4.5%. Reoperation rates were as follows: 3.9% in group A and 0.6% in group B (P-0.05). The use of the Posthorax sternum support vest is a valuable adjunct to prevent ᮋ sternum-related complications after cardiac surgery. In the 90 days follow-up period, additional surgical procedures were significantly reduced by the use of the support vest.

Research paper thumbnail of Is the transpulmonary pressure gradient a predictor for mortality after orthotopic cardiac transplantation?

Transplant international : official journal of the European Society for Organ Transplantation, 2005

Elevated pulmonary vascular resistance (PVR) is a well-known risk factor for right ventricular fa... more Elevated pulmonary vascular resistance (PVR) is a well-known risk factor for right ventricular failure after orthotopic cardiac transplantation. The influence of preoperative transpulmonary pressure gradient (TPG) and PVR on post-transplant 30 days mortality was evaluated. To analyze the response of PVR and TPG to cardiac transplantation, we analyzed 718 adult patients undergoing primary cardiac transplantation. Indications for operation were: 35.2% ischemic cardiomyopathy (ICM), 61.2% idiopathic dilated cardiomyopathy (DCM), and 3.3% other diagnosis (e.g. hypertrophic cardiomyopathy). The mean age (51.9) and the mean ischemic time (169.7 min) were comparable between 30 days survivors and nonsurvivors. Student's t-tests and chi-square analysis were used to compare data from 30-day survivors and nonsurvivors. Statistical significance was defined as P < 0.05. Fisher's exact test and multiple logistic regression analysis was performed to evaluate the relationship between hem...

Research paper thumbnail of Prevention of sternal wound complications after sternotomy: results of a large prospective randomized multicentre trial†

Interactive CardioVascular and Thoracic Surgery, 2013

OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a... more OBJECTIVES: A prospective randomized multicentre trial was performed to analyse the efficacy of a vest (Posthorax support vest®) to prevent sternal wound infection after cardiac surgery, and to identify risk factors. METHODS: From September 2007 to March 2010, 2539 patients undergoing cardiac surgery via median sternotomy were prospectively randomized into those who received a Posthorax® vest and those who did not. Patients were instructed to wear the vest postoperatively for 24 h a day for at least 6 weeks; the duration of follow-up was 90 days. Patients who did not use the vest within a period of 72 h postoperatively were regarded as study dropouts. Statistical calculations were based on an intention-to-treat (ITT) analysis. Further evaluations comprised all subgroups of patients. RESULTS: Complete data were available for 2539 patients (age 67 ± 11years, 45% female). Of these, 1351 were randomized to receive a vest, while 1188 received no vest. No significant differences were observed between groups regarding age, gender, diabetes, body mass index, chronic obstructive pulmonary disease (COPD), renal failure, the logistic EuroSCORE and the indication for surgery. The frequency of deep wound complications (dWC: mediastinitis and sternal dehiscence) was significantly lower in vest (n = 14; 1.04%) vs non-vest (n = 27; 2.27%) patients (ITT, P < 0.01), but superficial complications did not differ between groups. Subanalysis of vest patients revealed that only 933 (Group A) wore the vest according to the protocol, while 202 (Group BR) refused to wear the vest (non-compliance) and 216 (Group BN) did not use the vest for other reasons. All dWC occurred in Groups BR (n = 7) and BN (n = 7), although these groups had the same preoperative risk profile as Group A. Postoperatively, Group BN had a prolonged intubation time, a longer stay in the intensive care unit, greater use of intra-aortic balloon pump, higher frequency of COPD and a larger percentage of patients who required prolonged surgery. CONCLUSIONS: Consistent use of the Posthorax® vest prevented deep sternal wounds. The anticipated risk factors for wound complications did not prove to be relevant, whereas intra-and postoperative complications appear to be very significant.

Research paper thumbnail of 28.6 Transplantation of autologous endothelial cells

Cardiovascular Surgery, 1997

Objective: PTFE prostheses have a thromboembolic potential, which is a limiting factor especially... more Objective: PTFE prostheses have a thromboembolic potential, which is a limiting factor especially for small diameter grafts. Patency rates between 40 and 55% after 5 years of implantation are documented for femoro-popliteal reconstructions in the international literature. This method aims at the reduction of this thromboembolic risk by covering the PTFE surface with autologous endothelial cells.

Research paper thumbnail of Enhanced Endothelial Cell Retention on Shear-Stressed Synthetic Vascular Grafts Precoated with RGD-Cross-Linked Fibrin

Tissue Engineering, 2005

Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular... more Clinical in vitro endothelialization has been shown to increase the patency of synthetic vascular grafts. The shear stress resistance of the cultured autologous endothelium represents a crucial cornerstone of the concept. We investigated whether an enrichment of the precoating matrix with adhesion sites can augment endothelial cell attachment. Adult human saphenous vein endothelial cells (AHSVECs) were seeded confluently ([58 ؎ 11] ؋ 10 3 AHSVECs/cm 2) onto 10-cm-long ePTFE (expanded polytetrafluorethylene) vascular grafts (n ‫؍‬ 24) precoated with commercial clinically approved fibrin gel (Tisseal) containing various concentrations of cross-linked RGD peptide (0.0, 4.0, 8.0, or 16.0 mg of RGD per milliliter of Tisseal fibrinogen component). Endothelialized grafts were postcultivated for 9 days before they were exposed to a pulsatile circulation model mimicking peak physiological shear stress conditions of the femoral artery (12 dyn/cm 2 ; min/max, ؊60/؉28 dyn/cm 2). Cell loss after 24 h was quantitatively determined by image analysis of vital stains. Initial 24-h cell loss was 27.2 ؎ 1.7% in grafts precoated with the non-RGD-enriched fibrin matrix. In contrast, cell loss was significantly less on fibrin containing 4.0 mg of RGD peptide per milliliter of Tisseal fibrinogen component (13.3 ؎ 7.9%; p Ͻ 0.05). Cell loss on fibrin containing 8 and 16 mg of RGD per milliliter of Tisseal fibrinogen component was 41.0 ؎ 27.4 and 43.0 ؎ 23.2% (p Ͼ 0.05), respectively. We conclude that low concentrations of RGD peptide cross-linked into commercial fibrin matrices used for clinical in vitro lining of vascular grafts led to significantly increased endothelial cell retention. The failure of higher RGD concentrations to enhance endothelial cell attachment may be explained by competitive binding of endothelial cells to non-cross-linked RGD.