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: 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.

Cardiac cell therapy covers more than two decades of tumultuous history. In this period of time, the perception of the heart as an organ consisting of a fixed number of terminally differentiated cardiomyocytes fundamentally changed. Suddenly, the myocardium was (or is) considered to be regenerative by intrinsic progenitor cells, inducible proliferation, and in particular by exogenic transplanted cells. While the clinical translation of real cardiomyocytes obtained by cellular reprogramming has progressed only slowly, a multitude of clinical studies were carried out with cell products of somatic origin. This was mostly based on assumptions and experimentally acquired data with respect to the plasticity of adult precursor cells that, in retrospect, lacked validity. Accordingly, on closer inspection the results of the clinical studies were not convincing but they were nevertheless often presented and viewed in a very optimistic light. Today, cardiac cell therapy with cells of a somatic origin is considered to have failed. Recapitulating the stages of this era can help recognize and avoid such undesirable developments in the future.