Zeitschrift fur Herz Thorax und Gefasschirurgie最新文献

Background: The incidence and mortality of acute cardiovascular arrest have been consistently high for decades.

Objective: How to improve the currently unsatisfactory outcome after resuscitation regarding survival and neurological, especially cerebral, sequelae?

Material and methods: Development of a therapeutic approach to curtail ischemia/reperfusion injury in an animal model. Development of a device system optimized for resuscitation that can be used to implement controlled reperfusion of the whole body outside the hospital.

Results: Establishment of CARL treatment in the clinic and in the treatment of OHCA patients. Transfer of the CARL treatment and system in a clinical observational study. First case reports in which patients survived OHCA without brain damage even after ischemia times up to 2 h.

Conclusion: CARL treatment is potentially suitable to treat patients suffering from cardiovascular arrest refractory to treatment even for prolonged periods.

Since the beginning of 2020, the coronavirus disease 2019 (COVID-19) pandemic had a massive impact on and also changed life worldwide and serious consequences have naturally been observed particularly in the healthcare sector. These affect patients as well as medical personnel of all professional groups, both in the outpatient and inpatient areas. As expected, cardiac surgery as a discipline that is more dependent than any other on available capacity in intensive care units, was severely affected by the impact of the pandemic. This article provides an overview of the consequences for clinical care, research and teaching as well as for continuing education in cardiac surgery.

Background: Since the beginning of the COVID-19 pandemic global health systems are confronted with a large number of unknown problems. Venovenous (vv) extracorporeal membrane oxygenation (ECMO) in cases of therapy refractive ARDS often represents a last resort treatment. To improve the health care it is necessary to identify possible influencing factors.

Objective: This analysis presents the findings of an ECMO centre and aims to identify potential factors with an impact on vv-ECMO therapy in cases of COVID-19.

Material and methods: Between 03/2020 and 01/2022 n = 96 patients were treated with vv-ECMO in cases of a COVID-19 infection in our center. A retrospective analysis of demographic and health-specific data took place. The patients with fatal treatment outcome (L-group, n = 62) were compared to the surviving patients (Ü-group, n = 34).

Results: Overall n = 34 (35%) of the patients survived the hospital stay. The patients with a fatal treatment outcome had an average age of 56.7 ± 9.5 years compared to the average age of the surviving patients of 47.9 ± 12.9 years. There were n = 72 (75%) males and n = 24 (25%) females among the treated patients, n = 51 (82.3%) of the deceased patients were male and n = 11 (17.7%) were female. The prevalence of pre-existing illnesses like COPD, diabetes mellitus, cardiovascular diseases and chronic renal insufficiency had shown no significant difference between both groups. Also, in relation to the presence of arterial hypertension and obesity we could not prove a negative influence on the treatment outcome. A nicotine abuse in the patient history showed a negative tendency. The most common reasons for the death of patients were respiratory failure, neurological injury, multiorgan failure and sepsis.

Conclusion: The use of vv-ECMO in cases of therapy resistant ARDS in COVID-19 still correlates with a high mortality and as such should only be considered as a last resort of intensive care treatment.According to our expectations we could notice better therapy results for younger patients as well as for women in our patient database. In addition, for most comorbidities we could not prove any negative influence on the therapy outcome. This knowledge could help to identify future high-risk patients.

Background: The pandemic caused by SARS-CoV‑2 (severe acute respiratory syndrome coronavirus type 2) has led to hospitalizations and increased mortality worldwide. With potentially high prevalence and severity of COVID-19 in cardiac transplantation, there is a great need to generate data in this at-risk cohort.

Objective: We report here our experience with COVID-19 (coronavirus disease 2019) in heart transplant recipients at a German transplantation center longitudinally over the previous pandemic waves and place it in context to published experiences of other centers.

Material and methods: All adult patients who had received a heart transplant at our center and had confirmed COVID-19 infection (n = 12) were included and retrospectively characterized.

Results: The mean age was 61.5 (49-63) years, and the majority were male (83%). Comorbidities such as diabetes (42%), arterial hypertension (43%), and chronic renal failure (67%) were found. Passive immunization (convalescent plasma/monoclonal antibodies) was performed in 50%. Oxygen administration was required in 33% of patients; only one patient required noninvasive ventilation (8%), and no patient required invasive ventilation or mechanical cardiovascular support (ECMO). No new cardiovascular or thromboembolic events were found.

Conclusion: We could longitudinally not detect severe courses or increased mortality of COVID-19 in heart transplant patients. Prospective studies are needed to make better prognostic estimates of COVID-19 in (heart) transplant patients in the future.