1. health and fitness
2. disease

Program and abstracts
25th Annual Meeting
12 - 14 February 2015
Geilo, Norway
www.ssrcts.org
1
SSRCTS 2015
Table of contents
Welcome! .............................................................................................................. 3
Committee ............................................................................................................. 4
Program at a glance ............................................................................................... 5
Scientific program .................................................................................................. 6
Thursday, 12 February ...................................................................................... 6
Friday, 13 February ........................................................................................... 9
Saturday, 14 February ..................................................................................... 11
Abstracts - Oral presentations ............................................................................. 13
Abstracts - Poster presentations ......................................................................... 44
Authors’ index...................................................................................................... 55
2
SSRCTS 2015
Welcome!
Dear Colleagues and Friends,
th
We welcome you to the 25 Annual Scientific Meeting
of SSRCTS! This is a jubilee meeting showing that “the
little rebellion” has proven its independency and
become a true and proud offspring of the Scandinavian
Association of Thoracic Surgery, hosting around 60
participants every year.
The last year’s meeting proved that the new location
at Bardøla Høyfjellshotell was a success. We also hope
to continue the success of the meeting this year with
interesting abstracts from both inside and outside of
Scandinavia. Our aim is to give a “voice” to every
participating scientist, so there will be mainly oral
presentations. We hope to succeed in our work to
combine basic and clinical research within the field of
cardiothoracic surgery and give our young scientists a
thorough overview of ongoing research in Scandinavia.
th
The invited guests for the 25 anniversary meeting in 2015 are renowned international
scientists and surgeons: Professor Johan Pillgram-Larsen from Oslo will lecture on
cardiothoracic trauma, Professor RJ Cusimano from Toronto will add on with a talk on
training of cardiothoracic surgeons in Canada. He will also lecture on the treatment of
cardiac tumors. Professor Pascal Dohmen from Berlin will guide us through the latest in
tissue engineering and heart surgery in his Main Basic Topic lecture: The decellularized
homograft. In the same symposium the mechanisms of valvular calcifications will be
clarified by Dr. Arkady Rutkovskiy from Oslo. The Clinical Main Topic lecture will focus on
heart- and lung-transplantation and Dr. Göran Dellgren from Gothenburg will give this
State-of-the-Art lecture. There will also be some surprises and for sure, “pompous”
speeches at the Anniversary Dinner on Saturday.
I hope your days in Geilo will be memorable ones.
Sincerely,
Tómas Guðbjartsson
President of SSRCTS
n
3
SSRCTS 2015
Committee
President SSRCTS
Program Director SSRCTS
Professor Tómas Guðbjartsson, MD, PhD
Department of Cardiothoracic Surgery
Landspitali - University Hospital
IS-101 Reykjavik, Iceland
Mobile: +354 825 5016
[email protected]
www.ssrcts.org
Mari-Liis Kaljusto, MD, PhD
Department of Cardiothoracic Surgery
Oslo University Hospital, Ullevål
0407 Oslo, Norway
Tel: +47 99727991
[email protected]
www.ssrcts.org
Scientific Secretariat SSRCTS
Gunnhildur Jóhannsdóttir, Office Manager
Landspitali - University Hospital
IS-101 Reykjavik, Iceland
[email protected]
Conference venue
Bardøla Høyfjellshotell
Tlf: +47 32 09 45 02
www.bardola.no
4
SSRCTS 2015
Program at a glance
Thursday
12 February
Friday
13 February
Saturday
14 February
14:0014:50
Arrival and
registration
14:0015:00
Oral Session III
Abstracts A12-A16
14:5015:00
Welcome
15:0015:10
Coffee break
15:0016:00
Oral Session I
Abstracts A01-A05
15:1016:34
16:0016:15
Coffee break
16:3517:20
16:1517:30
Oral Session II
Abstracts A06-A11
17:3018:00
Coffee break
17:2017:50
Coffee break
17:1517:45
Coffee break
18:0018:50
Invited lecture
17:5018:35
Main topic, basic
science
Arkady Rutkovskiy:
The basic
mechanism of
valvular
calcification
17:4518:35
Postgraduate
course
Robert James
Cusimano:
14:3016.00
Oral Session V
Abstracts A24-A29
Oral Session IV
Abstracts A17-A23
15:4516:15
Coffee break
Main topic, clinical
16:1517:15
Invited lecture
Pascal Dohmen:
The decellularized
homograft
Cardiac tumors
Johan PillgramLarsen:
Thoracic trauma
and the
cardiothoracic
surgeon
Robert James
Cusimano:
Education of
cardiothoracic
surgeons in Canada
18.5019.00
Coffee break
18:3518:50
Coffee break
18:3519:00
Beer and Business
19:0020:10
Poster Session
Abstracts P01-P10
18:5019:50
State-of-the-art
lecture
19:30
Awards
20:00
Presidential dinner
with pompous
speeches
Göran Dellgren:
Heart and lung TX
20:10
Dinner
20:00
Dinner (buffet)
5
SSRCTS 2015
Scientific program
Thursday, 12 February
14:00-14:50 Arrival and registration
14:50-15:00 Welcome
Mari-Liis Kaljusto, Oslo, Norway
Tómas Guðbjartsson, Reykjavík, Iceland
15:00-16:00 Oral session I
Chairman:
Anders Jeppsson, Gothenburg, Sweden
9+3 minutes for each presentation
15:00 A01
Functional and biomechanical performance of stentless
extracellular matrix tricuspid tubegraft in pigs
DM Røpcke, C Ilkjær, T Hejslet, AV Sørensen, H Jensen, MOJ Jensen, VE
Hjortdal, SL Nielsen
15:12 A02
Impedance aggregometry for quality assessment of platelet
concentrates
S Singh, C Hesse, A Jeppsson
15:24 A03
A validation study of near infrared fluorescence imaging of
lymphatic vessels in humans
J Grønlund, N Telinius, SN Skov, M Ølgaard, VE Hjortdal
15:36 A04
Primary adenocarcinoma in the lung re-classified – histological
subtypes and outcome
GN Oskarsdottir, J Bjornsson, S Jonsson, HJ Isaksson, T Gudbjartsson
15:48 A05
Bronchial basal cells acquire mesenchymal traits in idiopathic
pulmonary fibrosis and in culture
HR Jonsdottir, AJ Arason, R Palsson, SR Franzdottir, T Gudbjartsson, HJ
Isaksson, G Gudmundsson, Th Gudjonsson, MK Magnusson
16:00-16:15 Coffee break
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SSRCTS 2015
16:15-17:30 Oral session II
Chairman:
Theis Tønnessen, Oslo, Norway
9+3 minutes for each presentation
16:15 A06
Preoperative measurement of platelet aggregability identifies
ticagrelor-treated CABG patients with increased risk of
perioperative bleeding complications
CJ Malm, E Hansson, CS Hakimi, A Jeppsson
16:27 A07
Design of custom-made TAVI valve for low-cost valve concept
testing
D Bruus, I Lindhardt, PBS Weng, R Galsgaard, P Johansen
16:39 A08
Children with ASD – long-term follow-up using registries
Z Karunanithi, C Nyboe, VE Hjortdal
16:51 A09
Novel assessment of strain distribution with high spatiotemporal resolution on aortic valve leaflets
S Heide-Jørgensen, SK Krishna, J Taborsky, T Bechsgaard, JL Hønge, R
Zegdi, P Johansen
17:03 A10
Dual antiplatelet therapy with ticagrelor or clopidogrel and the
risk for bleeding complications after CABG
V Fröjd, A Jeppsson
17:15 A11
Tissue engineering and cell therapy – novel therapeutic
approaches for thoracic diseases
P Jungebluth, S Sjöqvist, ML Lim, P Macchiarini
17:30-18:00 Coffee break
Invited lecture
Chairwoman: Mari-Liis Kaljusto, Oslo, Norway
18:00-18:50 Cardiac tumors
Robert James Cusimano, MD, Toronto, Canada
18:50-19:00 Coffee break
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SSRCTS 2015
19:00-20:00 Poster session
Chairman:
Vibeke Hjortdal, Århus, Denmark
3+3 minutes for each presentation
19:00
P01 The in-vivo comparison of a new semi flexible mitral
annuloplasty ring to rigid, flat- and fully flexible mitral
annuloplasty rings in a porcine model
19:06
P02 Development of a new valve prosthesis concept for infant
cardiac surgery
19:12
P03 The effect of TAVI oversizing on valve tissue stresses
MJ Tjørnild, DM Røpcke, SN Skov, C Ilkjær, SL Nielsen
MB Jensen, MH Smerup, P Johansen
SK Krishna, R Galsgaard, S Heide-Jørgensen, T Bechsgaard, R. Zegdi, L
Bräuner, JV Nygaard, P Johansen
19:18
P04 Comparison of the aortic root remodeling techniques - with
and without a supporting annular ring. An vitro evaluation
TS Lading, DM Røpcke, T Lindskow, T Bechsgaard, P Johansen, H
Nygaard, JM Hasenkam, SL Nielsen
19:24
P05 Are all flexible mitral annuloplastic rings the same? An in vivo
study
19:30
P06 Giant right atrial myxoma presenting as chronic obstructive
pulmonary disease
19:36
P07 Metachronous metastatic hepatocellular carcinoma to the
right ventricle
19:42
P08 Cavitation in patiens with bileaflet mechanical heart valves
19:48
P09 Major ischemic stroke caused by air embolism from a ruptured
giant pulmonary bulla
J Rasmussen, MJ Tjørnild, DM Røpcke, SN Skov, C Ilkjær, SL Nielsen
S Kumar, C Howes, A Delvecchio, PN Bonde
S Kumar, AA Mangi
P Johansen, TS Andersen, JM Hasenkam, H Nygaard, PK Paulsen
JF Gudmundsdottir, BL Thorarinsson, G Myrdal, P Hannesson, T
Gudbjartsson
19:54
P10 David versus Yacoub aortic root repair: Assessment and
comparison of stress distribution in the aortic root - a clinical
porcine experimental study
T Lindskow, MJ Tjørnild, T Bechsgaard, DM Røpcke, SL Nielsen
20:10
Dinner (buffet)
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SSRCTS 2015
Friday, 13 February
14:00-15:00 Oral session III
Chairman:
Arnar Geirsson, Reykjavík, Iceland
9+3 minutes for each presentation
14:00 A12
Ischemic preconditioning in advance of segmental arteries
sacrificing protects the spinal cord
J Herajärvi, T Anttila, H Haapanen, H Sarja, C Mustonen, T Laukka, T
Starck, M Kallio, H Tuominen, K Kiviluoma, P Karppinen, V Anttila, T
Juvonen
14:12 A13
Design, calibration and preliminary results of force transducers
for aortic root repairs
T Bechsgaard, S Laugesen, JL Hønge, H Nygaard, SL Nielsen, P Johansen
14:24 A14
Carbonic anhydrase 9 deposits are associated with increased
ascending aortic dilatation
E Niinimaki, P Muola, S Parkkila, H Haapasalo, T Paavonen, A
Mennander
14:36 A15
The persistence and significance of acute aortic dissection:
Incidence and mortality derived from a nationwide population
study in Iceland 1992-2013
IH Melvinsdottir, SH Lund, B Agnarsson, T Gudbjartsson, A Geirsson
14:48 A16
Physical modeling studies of vibration transmittance to assess
healing after sternotomy
A Joutsen, J Hautalahti, A Paldanius, J Hyttinen, J Laurikka
15:00-15:10 Coffee break
15:10-16:34 Oral session IV
Chairman:
Philipp Jungebluth, Heidelberg, Germany
9+3 minutes for each presentation
15:10 A17
New concept for quantifying two-dimensional forces acting on
an implanted mitral annuloplasty ring
SN Skov, DM Røpcke, AW Siefert, C Ilkjær, MJ Tjørnild, A Yoganathan, H
Nygaard, SL Nielsen, M Jensen
15:22 A18
Living arrangements of octogenarians after isolated coronary
artery bypass surgery. A nationwide study
K Thorsteinsson, JJ Andreasen, C Torp-Pedersen, G Gislason, K Fonager
15:34 A19
Retrograde lung perfusion in the treatment of massive
pulmonary embolism. A randomized porcine study
B Kjærgaard, JL Hønge, SO Magnusdottir, BS Rasmussen, UTh
Baandrup, JM Hasenkam, SR Kristensen
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SSRCTS 2015
15:46 A20
Clinical presentation of native mitral valve infective
endocarditis determines outcome after surgery
S Ragnarsson, J Sjögren, M Stagmo, P Wierup, S Nozohoor
15:48 A21
Surgery for active infective endocarditis in Iceland 1997-2013
RM Johannesdottir, T Gudbjartsson, A Geirsson
16:10 A22
Short and long-term outcome of mitral valve repair in Iceland
JF Gudmundsdottir, S Ragnarsson, A Geirsson, R Danielsen, T
Gudbjartsson
16:22 A23
Common sequence variants associated with coronary artery
disease correlate with the extent of coronary atherosclerosis
E Bjornsson, DF Gudbjartsson, A Helgadottir, Th Gudnason, T
Gudbjartsson, K Eyjolfsson, RS Patel, N Ghasemzadeh, G Thorleifsson,
AA Quyyumi, U Thorsteinsdottir, G Thorgeirsson, K Stefansson
Main topic, clinical
Chairman: Jarle Vaage, Oslo, Norway
16:35-17:20
The decellularized homograft
Pascal Dohmen, MD, PhD, Leipzig, Germany
17:20-17:50
Coffee break
Main topic, basic sciences
Chairwoman: Mari-Liis Kaljusto, Oslo, Norway
17:50-18:35
The basic mechanism of valvular calcification
Arkady Rutkovskiy, MD, PhD, Oslo, Norway
18:35-18:50
Coffee break
State-of-the-art-lecture
Chairman: Tómas Guðbjartsson, Reykjavík, Iceland
18:50-19:50
Heart and lung TX
Göran Dellgren, MD, PhD, Gothenburg, Sweden
20:00
Dinner (buffet)
10
SSRCTS 2015
Saturday, 14 February
14:30-15:42 Oral session V
Chairman:
Ari Mennander, Tampere, Finland
9+3 minutes for each presentation
14:30 A24
Osteogenic potential of valvular interstitial cells is increased in
patients with calcific aortic valve disease
M Bogdanova, A Malashicheva, J Vaage, A Rutkovskiy
14:42 A25
Single center surgical experience of native aortic valve
infective endocarditis: Preliminary results
S Ragnarsson, P Timane, J Sjögren, M Stagmo, P Wierup, S Nozohoor
14:54 A26
Acute kidney injury is an independent risk factor for morbidity
and mortality following aortic valve replacement for aortic
stenosis
D Helgason, SA Viktorsson, AW Orrason, IL Ingvarsdottir, S Helgadottir,
A Geirsson, T Gudbjartsson
15:06 A27
Remote ischemic preconditioning protects spinal cord after
segmental arteries cutoff
H Haapanen, J Herajärvi, O Arvola, T Anttila, T Starck, M Kallio, V
Anttila, H Tuominen, K Kiviluoma, T Juvonen
15:18 A28
Early statin treatment dampens recovery after experimental
cardiac arrest
A Mennander, V Vuohelainen, M Hämäläinen, T Paavonen, E Moilanen
15:30 A29
Acute volume-overload impacts early on intramyocardial
arteries; an experimental rat study
C Huuskonen, R Bolkart, T Soininen, M Hämäläinen, T Paavonen, E
Moilanen, A Mennander
15:45-16:15
Coffee break
Invited lecture
Chairman: Theis Tønnessen, Oslo, Norway
16:15-17:15
Thoracic trauma and the cardiothoracic surgeon
Johan Pillgram-Larsen, MD, Oslo, Norway
17:15-17:45
Coffee break
Postgraduate course
Chairman: Tómas Guðbjartsson, Reykjavík, Iceland
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SSRCTS 2015
17:45-18:35
Education of cardiothoracic surgeons in Canada
Robert James Cusimano, MD, Toronto, Canada
18:35-19:00
Beer and business
19:30
20:00
Awards
Presidential dinner with pompous speeches
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SSRCTS 2015
Abstracts - Oral presentations
A01
Functional and biomechanical performance
extracellular matrix tricuspid tubegraft in pigs
1,2
2
1
3
1,2
of
stentless
1
1
DM Røpcke , C Ilkjær , T Hejslet , AV Sørensen , H Jensen , MOJ Jensen , VE Hjortdal ,
1,2
SL Nielsen
1
2
Department of Cardiothoracic and Vascular Surgery, Department of Experimental &
3
Clinical Research and Department of Cardiology, Aarhus University Hospital, Aarhus,
Denmark
[email protected]
Objectives: A stentless porcine extracellular matrix tricuspid tubegraft has been
developed for tricuspid valve reconstruction. This study purpose was to compare
biomechanical and functional performance of native and tubegraft tricuspid
valves in an acute porcine model.
Material / methods: Fourteen 65 kg pigs were randomized to a tubegraft (n=7)
or control with native valve preservation (n=7). Anterior papillary muscle force
was measured with a dedicated force transducer implanted on the papillary
muscle tip. Microtip pressure catheters were placed in the right atrium and right
ventricle. To assess dynamic 3D valve geometry and leaflet motion, thirteen
sonomicrometry crystals were implanted: Six in the tricuspid annulus, one on
each leaflet free edge, one on each papillary muscle tip and one in the right
ventricular apex. The level of significance was p <0.05.
Results: No tricuspid regurgitation was observed after tricuspid tubegraft
implantation. No significant differences in intracavitary pressures, annular
motion or leaflet excursion angles were observed between groups. Tricuspid
annulus and leaflet orifice area, annular diameters and the septal segment of
the annulus were significantly smaller in the tubegraft group. Accordingly,
anterior papillary muscle force was significantly lower in the tubegraft group,
despite the fact that anterior leaflet and -tenting areas were significantly larger.
Discussion: An extracellular matrix tubegraft was implanted in the tricuspid
position, producing a competent valve with physiological biomechanical and
functional performance compared with native valves. We anticipate that
annulus-remodelling effects following tubegraft implantation reduce leaflet
stress distribution, which may protect repair durability.
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SSRCTS 2015
A02
Impedance aggregometry for quality assessment of platelet
concentrates
1
2
S Singh , C Hesse , A Jeppsson
1
1,3
2
Department of Cardiothoracic Surgery, Department of Clinical chemistry and
3
Transfusion Medicine and Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
[email protected]
Objectives: Transfusion of platelet concentrates is used to improve hemostasis
in patients with ongoing bleeding. Storage impairs the quality of the
concentrate. We have previously shown that platelet aggregability attenuates
over time in platelet concentrates and in vitro platelet aggregometry may thus
be a quick and simple method for quality assessment. The aim of the present
study was to describe the association between in vitro aggregability and other
biomarkers of platelet storage lesion.
Materials and methods: Eight apheresis platelet concentrates were investigated
1, 4, and 7 days after preparation. Collagen-induced platelet aggregation was
assessed with impedance aggregometry (Multiplate®). The expression of three
markers of platelet activity; the granule proteins CD62p and CD63 and
phosphatidylserine exposure was determined with flow cytometry. In addition,
lactate and glucose levels, platelet count, and pH were analyzed in the
concentrate.
Results: A significant and gradual reduction in collagen-induced platelet
aggregation during storage was observed. Storage significantly increased the
expression of CD62p and phosphatidylserine from day 1 to day 4 and further
increased phosphatidylserine expression to day 7. Lactate levels increased while
glucose levels, platelet count and pH decreased over time. Collagen-induced
platelet aggregation correlated significantly with phosphatidylserine expression
(r = −0.67, p<0.001), pH (r = 0.68, p<0.001), glucose level (r = 0.53, p<0.001) and
lactate level (r = −0.82, p<0.001).
Discussion: Collagen-induced platelet aggregation correlates strongly with other
markers of platelet storage lesion. The results support the use of impedance
aggregometry for in vitro quality assessment of platelet concentrates.
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SSRCTS 2015
A03
A validation study of near infrared fluorescence imaging of
lymphatic vessels in humans
J Grønlund, N Telinius, SN Skov, M Ølgaard, VE Hjortdal
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
[email protected]
Objectives/Aims: The aim of this study is to validate and gain experience of near
infrared fluorescence (NIRF) imaging of human lymphatic vessels. The study will
examine the inter and intraindividual variability, and furthermore how time,
temperature and muscle activity will alter the parameters measured. This study
will shed light on the strengths and weaknesses of the technique, as well as the
considerations that are necessary when using it.
Materials and methods: Ten healthy volunteers were included in the study.
Lymph propulsion in lymphatic vessels on the lower leg was visualized using 3
intradermal injections of the fluorescent dye Indocyanine green. A custom built
camera setup consisting of a EM-CCD camera with appropriate filters and a 785
nm laser was used to visualize the fluorescent dye. Each test subject was
examined twice with 14 days between each examination.
Lymphatic activity and changes in activity over time were examined. Lymphatic
activity was defined as a contraction frequency and lymph packet velocity. Tests
to quantify the vessel activity such as pumping pressure and refill time were also
performed. Lymphatic activity before and after two interventions, physical
activity and local hyperthermia, were examined. Sequences were analyzed by
plotting “regions of interests” on the vessels, where a contraction is seen as a
significant decrease in the differentiated intensity curve.
Results: All 10 subjects have completed the study. The collected data have been
blinded and are currently being analyzed.
Discussion: This study provides valuable insight in regard to the viability of NIRF
imaging of lymphatic vessels in humans. The technique has the potential to
become an important tool in research and diagnostics of diseases with a
lymphatic component, by providing real time visualization and quantification of
the lymphatic vasculature system.
15
SSRCTS 2015
A04
Primary adenocarcinoma in the lung reclassified – histological
subtypes and outcome
3,5
4
3,4
2
1,5
GN Oskarsdottir , J Bjornsson , S Jonsson , HJ Isaksson , T Gudbjartsson
1
2
3
Departments of Cardiothoracic Surgery, Pathology and Pulmonology, Landspitali
4
5
University Hospital. Department of Pathology, Akureyri Hospital, Faculty of Medicine,
University of Iceland, Reykjavik, Iceland
[email protected]
Objective: Non-small cell lung cancer (NSCLC) comprise 85% of primary lung
cancer, where adenocarcinoma, squamous cell and large cell carcinoma are the
most common histological types. Our previous data have indicated that
adenocarcinoma histology predicts improved survival compared to other
histological types in patients operated with lobectomy for NSCLC in Iceland.
Recently a new classification of primary adenocarcinomas of the lung was
published. The aim of this study was to review the histology of all primary lung
adenocarcinomas operated on in Iceland during a 20 year period, 1991-2010,
using the new criteria and assess the impact of histology on survival.
Materials and methods: This retrospective nationwide study included 312
patients with primary lung adenocarcinoma (mean age 65.6 yrs., 56% female)
that underwent resection in Iceland between 1991-2010. Tumors were
reclassified according to the current IASLC/ATS/ERS pulmonary adenocarcinoma
classification system. Overall survival was estimated by the Kaplan-Meier
method.
Results: Preliminary results for the first 277 cases show that acinar predominant
adenocarcinoma (APA) was the most common subtype (46%), solid predominant
(SPA) with mucin production comprised 25% of the cases, lepidic predominant
(LPA) 17% and papillary predominant (PPA) 8%. There were two cases of preinvasive adenocarcinoma and 3 cases of minimally invasive adenocarcinoma.
Overall survival at 1 year for all histological subtypes of adenocarcinoma was
79% and 42% at 5 years. A statististically significant difference in survival
between the histological subtypes was not seen (log-rank test, p=0.55) (Fig. 1).
Conclusions: Acinar and solid predominant adenocarcinoma are the most
common histological subtypes followed by mucin production subtype and
lepidic predominant adenocarcinoma. Overall survival at 5 years is 42% which is
in the lower range compared to other studies with no apparent diffence
between subtypes. These findings suggest that other factor than histologic
subtype explain the higher survival of adenocarcinoma in recently pubished
data.
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SSRCTS 2015
Fig 1. Overall survival according to adenocarcinoma subtype
A05
Bronchial basal cells acquire mesenchymal traits in idiopathic
pulmonary fibrosis and in culture
1,2
1,2
1,2,4
1,2
3,7
HR Jonsdottir , AJ Arason , R Palsson , SR Franzdottir , T Gudbjartsson , HJ
4
5,6
1,2
1,2,6
Isaksson , G Gudmundsson , Th Gudjonsson , MK Magnusson
1
Stem Cell Research Unit, Biomedical Center, Faculty of Medicine, University of Iceland,
2
3
4
Department of Laboratory Hematology, Cardiothoracic Surgery, Pathology and
5
6
Respiratory Medicine and Sleep, Landspitali University Hospital, Department of
7
Pharmacology and Toxicology, Faculty of Medicine, University of Iceland, Faculty of
Medicine, University of Iceland
[email protected]
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with
high morbidity and mortality. The cellular source of the fibrotic process is
currently under debate with one suggested mechanism being epithelial-tomesenchymal transition (EMT) in the alveolar region. In this study we show that
bronchial epithelium overlying fibroblastic foci in IPF contains a layer of p63
positive basal cells while lacking ciliated and goblet cells. This basal epithelium
shows increased expression of CK14, Vimentin and N-cadherin while retaining Ecadherin. The underlying fibroblastic foci showed both E- and N-cadherin
positive cells. To determine if p63 positive basal cells were able to undergo EMT
17
SSRCTS 2015
in culture we treated VA10, a p63 positive basal cell line, with the serum
replacement UltroserG™. A subpopulation of treated cells acquired a
mesenchymal phenotype, including an E- to N- cadherin switch. After isolation,
these cells portrayed a phenotype presenting major hallmarks of EMT (loss of
epithelial markers, gain of mesenchymal markers, increased migration and
anchorage independent growth). This phenotypic switch was prevented in p63
knockdown cells. In conclusion, we show that bronchial epithelium overlying
fibroblastic foci in IPF lacks its characteristic functional identity, shows increased
reactivity of basal cells and acquisition of a partial EMT phenotype. This study
suggests that some p63-positive basal cells are prone to phenotypic changes and
could act as EMT progenitors in IPF.
A06
Preoperative measurement of platelet aggregability identifies
ticagrelor-treated CABG patients with increased risk of
perioperative bleeding complications
1,2
1,2
1,2
CJ Malm , E Hansson , CS Hakimi , A Jeppsson
1
1,2
2
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Department of
Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University
of Gothenburg, Gothenburg, Sweden
[email protected]
Background: The ADP-receptor inhibitor ticagrelor reduces risk of thrombotic
advents in patients with acute coronary syndrome but increases the risk for nonsurgical and surgical bleeding complications. Current guidelines recommend that
ticagrelor should be discontinued at least 5 days prior to surgery but this cannot
always be achieved. We investigated if preoperative measurement of platelet
aggregability in CABG patients with ticagrelor treatment <5 days before surgery,
identifies patients with increased risk of perioperative bleeding complications.
Methods: Seventy-seven CABG patients with ticagrelor treatment within 5 days
of surgery were included in a prospective observational study. Median time
from last ticagrelor dose was 30 hours (interquartile range 24-72 h).
Preoperative platelet aggregability was assessed with the Multiplate®
instrument. Poor ADP-dependent platelet aggregability was defined as <30
aggregation units as previously suggested. Bleeding complications were
registered using the new universal definition of perioperative bleeding (UDPB).
In addition, pre- and perioperative variables factors univariately associated with
bleeding complications were identified.
18
SSRCTS 2015
Results: Poor preoperative ADP-dependent platelet aggregability was detected
in 52/77 (68%) of the patients. Bleeding complications occurred in 28/77 (36%)
patients. Twenty-four of the 28 (86%) bleeding complications occurred in
patients with poor ADP-dependent platelet aggregability. Accordingly, the risk of
bleeding complications was significantly higher in patients with poor
aggregability compared with patients with acceptable aggregability (46% vs 16%,
p=0.012). The only factors univariately associated with an increased risk of
bleeding complications were cardiopulmonary bypass (CPB) time (p=0.01) and
poor ADP-dependent platelet aggregability (p=0.002).
Conclusions: Preoperative measurement of ADP-dependent platelet
aggregability identifies patients with high risk of bleeding complications. In nonurgent cases, surgery can be postponed until tests are satisfactory. In acute
cases, poor ADP-dependent platelet aggregability may motivate early use of procoagulant drugs or blood products.
A07
Design of custom-made TAVI valve for low-cost valve concept
testing
1
1
1
1
12
D Bruus , I Lindhardt , PBS Weng , R Galsgaard , P Johansen ,
1
2
Dept. of Engineering, Faculty of Science and Technology, Aarhus University, Dept. of
Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
[email protected]
Objectives: Transcatheter aortic valve implantation is an alternative to the
conventional open-heart surgery for patient suffering from aortic valve
dysfunction. This technique is used in patients with high operative risk and is
appealing because of the reduced hospitalization and comparable outcome to
surgical valve implantation. However, there are still circumstances where the
deployed valve does not reach the optimal geometries that it was designed for
(e.g. as a non-circular deployment or size mismatch (oversizing)). During such
conditions the valve function may be impaired, and the stress in the leaflets may
be increased, potential leading to accelerated non-calcific tissue degradation,
hence reduced valve longevity.
To further investigate these events it will be beneficial to establish an in vitro
setup at which detailed analyses can be performed. To increase the precision
and reproducibility at various valve alteration scenarios it could be beneficial to
develop a model of a TAVI valve which can be produced incorporating such
alterations.
19
SSRCTS 2015
Therefore, the aim of this study is to design a low cost 3D-printed TAVI stent
with attached bovine pericardial tissue leaflets initially in a circular fitted
geometry and later in various altered configurations based on clinical data.
Materials and methods: The design of the custom-made stent is inspired by the
Edwards Sapiens 3 valve. The stent will not be crimped nor designed for
catheter insertion. It will be optimized for installment in a pulsatile mock
circulatory in vitro flow loop. The stent is designed as a 3D CAD model and
printed in stainless steel (316L). However, as the stent is manufactured using 3D
print it must meet some restrictions concerning angles and thickness of
material. The leaflets and skirt are made of bovine pericardial tissue and GoreTex and sutured to the stent frame, as seen on Figure 1. The valve will initially be
evaluated hemodynamically and biomechanically in its non-altered
configuration.
Results: Pending
Discussion: The opportunity to 3D print a custom-made TAVI valve on location is
useful to provide flexible and reproducible test protocols for TAVI valve concept
models and also to keep future in vitro TAVI valve experiments on a low-cost
level.
Figure 1. a: 3D CAD model of stent.
Dimensions, h: 20mm, id: 24,8 mm od:
26 mm. b: First version of the stent with
a pulmonary artery from a heart of a
pig sutured to the stent frame.
A08
Children with ASD – long-term follow-up using registries
Z Karunanithi, C Nyboe, VE Hjortdal
Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
[email protected]
The objective of the study is to estimate the risk of developing atrial fibrillation
and stroke in adult patients with atrial septal defects (ASD), by investigating if
20
SSRCTS 2015
adult patients with ASD closure during childhood have an increased use of
antiarrhythmic or anticoagulation medicine in adulthood compared with the
general population.
Adult patients with ASD diagnosed in childhood but without closure have
increased risk of atrial fibrillation, stroke and atrial fibrillation related medicine
use in adulthood compared with the general population.
The data originates from hospital records, The Danish Civil Registration Registry,
The Danish National Patient Registry (DNPR) and The Danish National
Prescription Registry. By using specific ICD codes we will include Danish patients
diagnosed between 1963 and 1994, before the age of 18 and born before 1994,
with or without closure. Patients with other concomitant heart disease or no
sign of ASD in the hospital record upon review were excluded. For each patient
included in the study we match 10 controls by age- and gender. The outcomes
(defined by ICD codes) are atrial fibrillation, stroke, vitamin K antagonist,
digitalis glycosides and antiarrhythmic drugs.
The risk of atrial fibrillation and stroke will be estimated using Cox regression
analysis with age as an underlying time scale and entry at 18 years. The analyses
are adjusted for hypertension, ischemic heart disease, pulmonary disease and
diabetes. Cumulative incidences are performed for 10 and 20 years and
compared with the control group with death as a competing risk.
A total of 2111 patients have the ASD diagnosis and are currently being
validated. Of the 1815 patients validated, 926 are included in the study
population at present. Of these patients the mean age at operation is 9.29 years
[8.77; 9.81]. When the validation finishes and the study population is fully
defined, we connect to the database in Statistics Denmark to obtain more data
on each individual patient, after which we start performing the statistical
analyses.
The results obtained at the beginning of the year will be presented at the
meeting.
A09
Novel assessment of strain distribution with high spatio-temporal
resolution on aortic valve leaflets
1
1
1
1,2
2
3
S Heide-Jørgensen , SK Krishna , J Taborsky , T Bechsgaard , JL Hønge , R Zegdi , P
1,2
Johansen
21
SSRCTS 2015
1
2
Dept. of Engineering, Faculty of Science and Technology, Dept. of Cardiothoracic
3
Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark, Hôpital Européen Georges
Pompidou, Service de Chirurgie Cardiovasculaire, Paris, France
[email protected]
Objectives: In order to estimate the wear and tear of the tissue valves, mainly
prosthesis, assessment of valve stress and strain is warranted. The traditional
approaches for strain measurements are using strain gauges. However, this is
not a feasible approach for heart valves as the size, mass, and application of the
strain gauge may interfere with the dynamics of the valve.
The aim of this study is to develop a platform for non-contact heart valve
deformation analysis with high spatio-temporal resolution.
Materials and methods: Deformation analyses are performed in a pulsatile in
vitro system using ARAMIS (GOM), which offers means of acquiring strain
analyses with high temporal and spatial resolution, enabling the material
independent pattern recognition software to apply frame-by-frame cross
correlation based strain estimates. The images are acquired at 2000 frames per
second through two high speed cameras for 3D analyses. Evaluation of this
platform is done using homemade TAVI valves.
Results: The study showed that ARAMIS was able to recognize stochastic pattern
and estimate strain on the TAVI leaflets. Both major and minor strain along with
deformation was successfully assessed for all leaflets from the analysis. The
spatio-temporal development of a very detailed strain pattern was revealed
with a 0.5 msec time resolution.
22
SSRCTS 2015
A10
Dual antiplatelet therapy with ticagrelor or clopidogrel and the
risk for bleeding complications after CABG
V Fröjd, A Jeppsson
Dep of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
[email protected]
Background: Dual antiplatelet therapy reduces the risk for thrombotic
complications in patients with acute coronary syndrome but increases the risk
for perioperative bleeding complications. It is therefore recommended that the
ADP-inhibitor is discontinued five days before elective surgery. Ticagrelor
reduces the risk for thrombotic events further compared to clopidogrel, without
increasing the overall risk for CABG-related bleeding complications. It is unclear
if this holds true if the ADP-receptor inhibitor cannot be discontinued in time.
We compared the risk for major bleeding between clopidogrel and ticagrelor
when the ADP-receptor inhibitor was discontinued <5 days before surgery.
Methods: 1960 CABG patients (mean age 67±9 years, 78 % men) were included
in a retrospective case control study. 421/1960 (21%) were treated with dual
antiplatelet therapy <5 days before surgery, 327 with clopidogrel and 94 with
ticagrelor. Major bleeding was defined according to the BART–criteria
(postoperative blood loss >1500 ml/12 h, or re-exploration, or red blood cell
transfusion >10 units, or death because of bleeding). Independent predictors for
major bleeding were identified with logistic regression.
Results: 205 (10.5%) of the patients suffered a major bleeding complication.
Dual antiplatelet therapy with clopidogrel or ticagrelor <5days before surgery
was an independent predictor of major bleeding (odds ratio 1.83 (95%
confidence interval 1.29-2.59), p=0.001) together with EuroSCORE,
intraoperative bleeding >0.5 l, preoperative eGFR and age. The risk for bleeding
complications was higher with ticagrelor (OR 2.61, CI 1.50-4.53, p=0.001) than
with clopidogrel (OR 1.63, CI 1.11-2.39, p=0.012) after adjustment for all other
independent risk factors. When ticagrelor was compared to clopidogrel, the
odds ratio was 1.79 (1.06-3.04, p=0.030). The risk for major bleeding decreased
with 28 % for each day of discontinuation with ticagrelor (OR 0.72, CI 0.56-0.92,
p=0.008) and with 19 % for clopidogrel (OR 0.81, 0.69-0.95, p=0.011).
Conclusions: Treatment with dual antiplatelet therapy <5 days before surgery
increases the risk for major bleeding complications. The risk is significantly
higher with ticagrelor than with clopidogrel. The bleeding risk is markedly
reduced for each day the ADP-inhibitor can be withdrawn before surgery.
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SSRCTS 2015
A11
Tissue engineering and cell therapy – novel therapeutic
approaches for thoracic diseases
1,2
1
1
P Jungebluth , S Sjöqvist , ML Lim , P Macchiarini
1
1
2
Karolinska Institutet, Stockholm, Sweden; Thoraxklinik at Heidelberg University Hospital,
Heidelberg, Germany
[email protected]
Objectives/aims: Regenerative medicine, including tissue engineering and cell
therapy, is a promising and growing field for the treatment of both acute and
chronic diseases affecting thoracic tissues and organs.
Materials and methods: Various tissue engineering approaches using both
decellularized (DNase, deoxycholate, SDS) tissues and synthetic (molding
technic, electrospinning, 3-D-printing) scaffolds seeded with different cell types
(MSCs, MNCs, epithelial cells, chondrocytes) have been applied to investigate
regenerative mechanisms and functionality both in vitro and in vivo. Small and
large animals models have been utilized to generate tissue engineered grafts for
the trachea, lungs, esophagus, heart, heat valves and the diaphragm. Initial
clinical transfer has been performed for the trachea. Cell therapy has been
examined in experimental disease models and initial clinical transfer realized in
patients suffering from acute lung disease.
Results: the decellularized scaffolds of the different tissues/organs have been
approved to be biocompatible and non-immunogenic. The generated grafts
mimic the native architecture, resist mechanical stress and induce angiogenesis.
Seeded allogeneic mesenchymal stromal cells spontaneously differentiate
(proven by gene-, protein and functional evaluations) on particular decellurized
scaffolds. Both the reseeded biological and synthetic scaffolds are used to
heterotopically investigate their immunogenicity and orthotopically replace the
native tissue. Tissue engineered scaffolds for the trachea, the esophagus and the
diaphragm have been demonstrated their functionality in animal models. Early
clinical data (5-year follow-up) provide initial evidence for successful tracheal
replacement using tissue engineered solutions. Cell-based therapy resulted in
significant improvement in acute and chronic lung diseases both in experimental
studies and clinical setting.
Discussion: Regenerative medicine may represent a promising therapeutic
alternative in the future. However, further efforts are necessary to detect
underlying mechanisms and investigate the real impact of these new
approaches for the treatment of thoracic diseases.
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SSRCTS 2015
A12
Ischemic preconditioning in advance of segmental arteries
sacrificing protects the spinal cord
1
1
1
1
1
5
2
J Herajärvi , T Anttila , H Haapanen , H Sarja , C Mustonen , T Laukka , T Starck , M
2
3
4
5
1
1
Kallio , H Tuominen , K Kiviluoma , P Karppinen , V Anttila , T Juvonen
1
2
3
4
Departments of Surgery, Clinical Neurophysiology, Pathology and Anesthesiology,
5
Oulu University Hospital, Department of Medical Biochemistry and Molecular Biology,
University of Oulu, Oulu, Finland
[email protected]
Objectives: Following the repair of thoracic and thoracoabdominal aortic
aneurysms (TAA/A) paraplegia remains one of the most serious complications.
Strategies in order to prevent paraplegia are still inconsistent. Preconditioning
has shown to be a promising method to mitigate neurological damage. In this
study we focus on the mechanism of ischemic preconditioning preserving spinal
cord function following segmental arteries sacrificing.
Materials and methods: Sixteen female piglets are randomized into an ischemic
preconditioning, group (n=8) and a control group (n=8). The intervention group
undergoes 4 cycles of 5-minute left iliac artery occlusion ischemia-reperfusion
episodes. The left subclavian artery and step-by-step segmental arteries
sacrificing procedure is identical for both groups. Motor evoked potential (MEP)
monitoring is performed from both hind limbs. Peripheral nerve stimulation is
carried out to ensure no irreversible disadvantage occurring while using
ischemic preconditioning. Continuous electrocardiogram and hemodynamics are
monitored peri-, intra- and postoperatively to assess autonomic nerve system
responses. Pulmonary artery blood samples are collected in several time points.
After a 2-hour follow up period piglets are extubated and transferred to a
recovery room. Postoperatively 24 hours the neurological assessment is carried
out. At the end of the experiment thoracolumbar spinal cord is harvested for
histopathological analysis.
Results and discussion: Results are pending but preliminary data will be
presented at the meeting.
A13
Design, calibration and preliminary results of force transducers
for aortic root repairs
1,2
2
2
2
2
T Bechsgaard , S Laugesen , JL Hønge , H Nygaard , SL Nielsen , P Johansen
25
1,2
SSRCTS 2015
1
Department of Engineering, Faculty of Science and Technology, Aarhus University,
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus,
Denmark
2
[email protected]
Objectives: Patients with aortic regurgitation secondary to ascending aortic
dilation or aneurism can be treated with valve sparing techniques such as the
David reimplantation or the Yacoub remodeling technique. In order to quantify
the impact of these two repair procedures, new force transducers have been
developed and tested.
Materials and methods: Two transducers have been developed. The first
transducer is an annulus transducer which can be placed subvalvular to the
aortic valve to measure the in plane forces of the aortic annulus. The second
transducer is a commissural transducer which can be placed extravascular to the
aortic root at the commissural level in order to measure the forces in the valve
commissures. The force transducers have been manufactured using rapid
prototyping techniques in titanium. Micro strain gauges have been meticulously
mounted on the transducer and sealed with two-component epoxy glue. The
transducers were calibrated under static conditions using loads applied to the
transducer. The output was recorded and plotted as a function of the input load.
For the experiments aortic roots were excised from pig hearts collected at a
local slaughterhouse and installed in a pulsatile in vitro model mounted with the
developed force transducers.
Results and discussion: A linear fit was made to the static calibration of the
commissural transducer (R-squared value of 0.99) with a sensitivity of 184mV/N.
Preliminary results from the porcine aortic roots tested in our in vitro model,
using the newly developed force transducers showed a force of about 1.2N at
the commissural points at fluid pressures of 130mmHg (Figure 1).
Fig 1: Preliminary commissural
force data acquired at 130 mmHg
fluid pressure.
26
SSRCTS 2015
A14
Carbonic anhydrase 9 deposits are associated with increased
ascending aortic dilatation
2
2
3
2
2
E Niinimaki , P Muola , S Parkkila , H Haapasalo , T Paavonen , A Mennander
1
1
2
Heart Center, Tampere University Hospital, Department of Pathology, Tampere
3
University Hospital and Tampere University, Department of Anatomy, Tampere
University,Tampere, Finland
[email protected]
Objectives: Inflammatory factors defining ascending aortic wall stiffness
attribute to aortic wall dilatation. Arterial wall carbonic anhydrase 9 (CA9)
deposits during inflammation indicate local hypoxia. We studied whether CA9
deposits are associated with inflammatory remodeling of the ascending aorta in
patients undergoing surgery for aortic dilatation.
Material and methods: Aortic wall histology and immunohistochemistry for
CA9, leukocytes, T- and B-lymphocytes, plasma cells, macrophages, endothelial
cells, smooth muscle cells, cell proliferation, elastase and Van-Gieson-staining
were performed to 30 selected patients that underwent surgery for ascending
aorta, and the samples were grouped according to presence of CA9 deposits.
Results: 20 out of 30 patients had CA9 deposits mainly within the adventitia,
whereas 10 patients lacked CA9 deposits. Adventitial inflammation, mainly
consisting of macrophages and plasma cells, were increased in CA9 positivity as
compared with CA9 negativity (p < 0.01). The mean diameter of the ascending
aorta at the sinotubular junction was 59 ± 2 mm for all patients, and was
significantly increased in patients with CA9 positivity as compared with CA9
negativity (63 ± 3 vs 53 ± 2, mm, p < 0.02). Receiver operating characteristic
curve analysis confirmed the association of CA9 positivity with increased
ascending aortic dilatation (AUC 0.766; S.E. 0.090; p = 0.020; 95% C.I. 0.5900.941). However, root dilatation was equally present in CA9 positive and CA9
negative patients (50% and 60%, respectively).
Discussion: Positive CA9 suggests carbonic anhydrase activity during ascending
aortic dilatation. Intervening with CA9 may add an armament against aortic
dilatation and extension of surgery.
27
SSRCTS 2015
A15
The persistence and significance of acute aortic dissection:
Incidence and mortality derived from a nationwide population
study in Iceland 1992-2013
1
1
2,3
1,3
IH Melvinsdottir , SH Lund , B Agnarsson , T Gudbjartsson , A Geirsson
1
2
3
3
University of Iceland, Department of Pathology and Department of Cardiothoracic
Surgery, Landspitali University Hospital, Reykjavik, Iceland
[email protected]
Objectives: Acute thoracic aortic dissection is a life threatening disease where
correct diagnosis and management is essential in order to modulate the high
morbidity and mortality associated with the condition. Utilizing a nationwide
data comprising the whole Icelandic population we determined the true
incidence, mortality and the time-dependent mortality risk of acute aortic
dissection.
Material and methods: In order to capture all diagnosis of aortic dissection in
Iceland from 1992-2013 the diagnosis databases of all regional hospitals in
Iceland and Landspitali University Hospital as well as clinical and forensic
autopsies databases of the Medical Examiner Office were queried for aortic
dissection codes (ICD-9 and ICD-10). Demographics, medical history, risk factors
and clinical symptoms variables were collected for all patients. Incidence was
calculated using age and gender specific information derived from the National
Statistics Iceland. Cox proportional hazards model was used to estimate hazards
ratios.
Results: A total of 148 individuals were diagnosed with acute aortic dissection
resulting in age and gender adjusted yearly incidence of 2.55 per 100,000
person. There was no significance change in incidence during the study period.
The mean age was 66.4±13.4 years and 62% were male. Of all cases 16% died
outside of hospital settings while for the patients that arrived alive to a hospital,
29% died within 24 hours and the 30-day mortality was 45%. The 10-year overall
survival was 37.6%. During the course of the study the short-term mortality rate
decreased by 0.96, per year, (95% CI: 0.923- 0.996) and the 10-year survival
improved significantly.
Discussion: Acute thoracic aortic dissection remains a significant medical
problem associated with high mortality. The incidence remained unchanged
over the course of 23 years. We observed significant decline in short- and longterm mortality during the course of the study indicating improved overall
outcome in patient diagnosed with acute aortic dissection.
28
SSRCTS 2015
A16
Physical modeling studies of vibration transmittance to assess
healing after sternotomy
1,2
1
1,2
2
A Joutsen , J Hautalahti , A Paldanius , J Hyttinen , J Laurikka
1
1
2
Heart Center, Tampere University Hospital, Department of Electronics and
communications engineering, Tampere University of Technology, Tampere, Finland
[email protected]
Objectives: Sternal instability following a sternotomy is a risk factor in the early
postoperative period for mediastinitis causing morbidity and mortality. A device
measuring vibration transmittance has been developed to assess sternal healing.
To learn how the measuring geometry affects the transmittance, a bench test
using artificial physical models was conducted.
Materials and methods: The developed device includes two units, an actuator
and a sensor, that are placed in contact with the measured object. The actuator
emits a 3 s long 20 Hz – 2 kHz vibration stimulus and an accelerometer inside the
sensor measures the transmittance of the vibration. Three simple block models
and one anatomical model based on CT images were built to simulate sternal
anatomy. Synthetic ballistic gel, 3D printed polylactate and polyurethane rubber
modeled thoracic soft tissue, bone and cartilage respectively.
Results: The three block models simulated intact (A), split (B) and steel wire
bound (C) sternums. The actuator – sensor distance was 6 cm. Ten repeated
measurements were made on the block models to assess the vibration
transmittance. The measured power of the transmitted vibration was was A > C
> B. All the comparisons between the conditions were statistically significant
(p<0.001).
The anatomical model simulated intact sternum (D), intact sternum with soft
tissue incision (E), split sternum (F), loose closure (G) and tight closure (H) using
steel sutures. The actuator and sensor were placed bilaterally on the 2nd, 3rd,
4th and 5th costal cartilages, 6 cm apart. 20 repeated measurements were made
on each costal level 2-5 and condition (D-H). The results showed very high
variance between the costal levels and conditions with no trend, contrary to
what was found in the block model conditions A-C.
Discussion: Our results show that in the simple block models the vibration
transmittance is behaving as expected: intact > bound > split. However, the
more elaborate anatomical model failed to give consistent results, possibly due
to gel separation from the 3D printed frame during the model manipulation,
29
SSRCTS 2015
surface unevenness below the measuring device and manual holding of the
device during a long measurement session. The device may be useful in
assessing sternal healing, but further work is needed to discover the most
suitable mode of operation.
A17
New concept for quantifying two-dimensional forces acting on an
implanted mitral annuloplasty ring
1,2
1
3
1
1
3
1
SN Skov , DM Røpcke , AW Siefert , C Ilkjær , MJ Tjørnild , A Yoganathan , H Nygaard ,
1
3
SL Nielsen , M Jensen
1
2
Dept. of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Dept. of
Engineering, Faculty of Science and Technology, Aarhus University, Aarhus, Denmark,
3
Dept. of Biomedical Engineering, Georgia Institute of Technology and Emory University,
Atlanta, USA
[email protected]
Objectives: The objective of this study was to assess the feasibility of quantifying
in-plane and out-of-plane forces acting on an implanted annuloplasty ring.
Materials and methods: The design of an X-shaped transducer in the present
study was optimized for simultaneous in- and out-of-plane force measurements.
The force transducer was implanted in two groups with five 80 kg porcine
animals in each group. The native group received the transducer implanted only.
A second group had the transducer attached to a rigid Edwards Lifesciences
Classic Annuloplasty Ring size 32 that was subsequently implanted in the
annulus (Figure 1A). Transducer and ring dimensions were chosen to be
truesized when implanted in an 80 kg porcine model to evaluate the impact of
the healthy mitral valve force balance on the annuloplasty ring.
Results: Calibrated out-of-plane forces in the native group were found to be
0.83 ± 0.6 N and 0.42 ± 0.3 N in the anterior and posterior segments
respectively. The commissural segments were found to be 1.10 ± 0.7 N and 0.60
± 0.5 N in the anterior and posterior commissural segments respectively. The
calibrated in-plane forces were found to be 1.29 ± 0.7 N in the septal-lateral
direction and 1.95 ± 1.1 N in the commissure-to-commissure direction (Figure
1B). Measurements with the force transducer attached to the Classic
Annuloplasty Ring indicated a significant decrease in amplitude.
Discussion: Measuring the forces in clinical mitral valve annuloplasty rings was
demonstrated. Experiment results indicated a change of the force balance with
and without a stiff annuloplasty ring. Further experimentation with this
30
SSRCTS 2015
transducer will provide a detailed and refined insight into the impact of these
devices on mitral annular and device force distribution.
A
B
Fig 1: (A) Transducer attached to annuloplasty ring prior to insertion (B) Selected force curves from
the native group demonstrates the cyclic forces. ACOM, Anterior commissure; SL, Septal-lateral.
31
SSRCTS 2015
A18
Living arrangements of octogenarians after isolated coronary
artery bypass surgery. A nationwide study
1,2
1,2
3
4
K Thorsteinsson , JJ Andreasen , C Torp-Pedersen , G Gislason , K Fonager
3,5
1
Department of Cardiothoracic Surgery, Center for Cardiovascular Researdh, Aalborg
2
3
University Hospita;, Department of Clinical Medicine, Aalborg University, Department of
4
Health Science and Technology, Faculty of Medicine, Aalborg University, Department of
5
Cardiology, Copenhagen University Hospital, Gentofte, Department of Social Medicine,
Aalborg University Hospital, Aalborg, Denmark
[email protected]
Background: Proportion of octogenarians undergoing isolated coronary artery
bypass surgery (CABG) is rapidly increasing. Data on living arrangements after
surgery are scarce. The purpose of this study was to evaluate living
arrangements in a nationwide cohort of octogenarians one year after isolated
coronary artery bypass surgery.
Methods: All patients who underwent isolated CABG between January 1996 and
December 2012 in Denmark were included. All patients living in a nursery home
previous to surgery were excluded. Patients were identified through nationwide
administrative registers. Aalen Johansen estimator was used for the cumulative
incidence of moving to a nursery home. A multivariate cox model was
constructed to identify predictors for living in a nursery home one year after
isolated CABG. Survival at 30 days and1 year was estimated by Kaplan-Meier
estimates.
Results: A total of 38,487 patients were included. Number of octogenarians was
1,455 (3.8%), median age was 65.4 ± 9.5 years. Males comprised 80% of the
patients. 30-day mortality was 2.8%, increasing with age (1.2% in patients < 60
years, 7.6% in octogenarians). Long-term mortality at 1 year was 2.2% (age < 60
years) and 13.9% (age > 80 years). Proportion of patients living at a nursery
home at 1, 5 and 10 years after surgery were 0.1%, 0.2% and 0.9% (<60
years),0.2%, 1% and 3.1% (60-69 years), 0.4%, 2.5% and 7% (70-74 years), 0.5%,
3.1% and 9% (75-79 years),1.5%, 7.7% and 17% (>80 years) respectively. Main
predictors for living at a nursery home one year after surgery were: alcohol
abuse (HR 2.47, 95% CI 1.9-3.2), stroke prior to surgery (HR 1.59, 95% CI 1.381.8), stroke < 30 days after surgery, female sex (HR 1.44, 95% CI 1.29-1.6),
diabetes (HR 1.58, 95% CI 1.39-1.8), chronic renal insufficiency (HR 1.62, 95% CI
1.27-2.1) and heart failure (HR 1.28, 95% CI 1.13-1.5). Neither preoperative
myocardial infarction, urgent or emergency surgery were significant predictors
for living at a nursery home 1 year after surgery.
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SSRCTS 2015
Conclusion: Octogenarians live at home in years to come after CABG. The risk of
moving to a nursery home seems to be more dependent on the patient’s
preoperative comorbidities than the surgical procedure itself.
A19
Retrograde lung perfusion in the treatment of massive
pulmonary embolism. A randomized porcine study
1,2
2
3
4
5
B Kjærgaard , JL Hønge , SO Magnusdottir , BS Rasmussen , UTh Baandrup , JM
2
6
Hasenkam , SR Kristensen
1
Department of Cardiothoracic Surgery, Cardiovascular Research Centre, Aalborg
2
University Hospital, Aalborg, Institute of Clinical Medicine, Aarhus University, Aarhus,
3
4
Biomedical Research Laboratory and Department of Anaesthesiology and Intensive
5
Care, Cardiovascular Research Centre, Aalborg University Hospital, Center for Clinical
Research, Vendsyssel Hospital, Hjoerring, Department of Medicine, Aalborg University,
6
Department of Clinical Biochemistry, Cardiovascular Research Centre, Aalborg University
Hospital, Aalborg, Denmark
[email protected]
Background: The treatment of massive pulmonary embolism with an associated
cardiac arrest is controversial; however, surgical thrombectomy with
extracorporeal circulation (ECC) is an option for treatment. It is difficult to
remove all thrombembolic material. Theoretically, retrograde blood perfusion
through the lungs may be beneficial. The purpose of the study was to investigate
whether retrograde blood perfusion through the lungs during a thrombectomy
is beneficial.
Methods: Twelve pigs were prepared for ECC. Repetitive injections of preformed
blood trombi into the right atrium resulted in cardiac arrest. ECC was
established after 10 minutes of cardiac arrest, and after a sternotomy, the main
pulmonary artery was incised as much thrombotic material as possible was
removed from the pulmonary arteries. The pigs were randomized to ECC for one
hour either with or without retrograde perfusion in the pulmonary circulation.
After one hour, the released material was removed from the pulmonary
arteries, and the incision was sutured. The pigs were weaned from the ECC.
After sacrificing the pigs, they were autopsied with a special attention to the
amount of remaining thrombi. Additional histologic analyses were performed
with special attention to microembolisms, atelectases, and signs of tissue
damages.
Results: All of the pigs were weaned from the ECC. The amount of the embolic
material removed varied considerably, as did the amount removed after the
33
SSRCTS 2015
retrograde or antegrade perfusion, and there was no significant difference
between the two treatment modalities. There were no signs of tissue damage in
the lungs.
Conclusion: Retrograde lung perfusion was not generally beneficial in the
treatment of massive pulmonary embolism in this setup; however, it may be an
option if only modest amount of material is accessibly in the pulmonary artery.
A20
Clinical presentation of native mitral valve infective endocarditis
determines outcome after surgery
1
1
2
1
S Ragnarsson , J Sjögren , M Stagmo , P Wierup , S Nozohoor
1
1
2
Department of Cardiothoracic Surgery and Department of Cardiology, Lund University
and Skåne University Hospital, Lund, Sweden
[email protected]
Objective: To examine the effect of the preoperative clinical presentation on
long-term survival of patients undergoing surgery for isolated native mitral valve
infective endocarditis (IE).
Methods: A retrospective study was carried out on 100 patients who had
undergone mitral valve surgery from 1998 to 2014 for ongoing isolated infective
endocarditis. Patients were stratified depending on presenting symptoms:
clinical stroke due to septic cerebral embolism, congestive heart failure, and
uncontrolled sepsis. Group A had none of the clinical symptoms, Group B had
one of the above clinical symptoms, and Group C had ≥2 symptoms. Follow-up
was performed in March 2014 and was 100% complete for survival (median 3.8
years, IQR 0.8-7.7). Event rates were estimated with the Kaplan-Meier method
and Cox-regression was performed.
Results: Overall 30-day mortality was 5% (n=5); 0% in Group A; 8% in Group B
(n=4); and 8% in Group C (n=1) (p=0.24). Five-year survival was 87.0±6.1% in
Group A, 62.6±7.1% in Group B, and 33.8±15.2% in Group C. Grouping by clinical
presentation was found to be an independent predictor of mortality (Group B,
HR 2.37, 95% CI: 1.02-5.50; Group C, HR 4.07, 95% CI: 1.56-10.6). Other
independent predictors of mortality were age (HR 1.04 per 1-year increment,
95% CI: 1.01-1.07, p=0.014), diabetes mellitus (HR 4.31, 95% CI: 2.28-8.51,
p<0.001), preoperative renal failure requiring dialysis (HR 4.58, 95% CI: 1.5014.0, p=0.008), and Staphylococcus aureus infection (HR 3.43, 95% CI: 1.71-6.87,
p=0.001).
34
SSRCTS 2015
Conclusions: Survival after surgery for native mitral valve IE was independently
influenced by the presence of preoperative embolic stroke, congestive heart
failure or uncontrolled bacteremia alone or in combination. Delaying surgical
treatment may increase the probability and severity of preoperative
complications and consequently postoperative mortality.
A21
Surgery for active infective endocarditis in Iceland 1997-2013
1
1,2
RM Johannesdottir , T Gudbjartsson , A Geirsson
1
1
2
Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of
Medicine, University of Iceland, Reykjavik, Iceland
[email protected]
Introduction: Endocarditis is a serious infection of the heart valves and often
needs operation for cure. Common risk factor for endocarditis are bicuspid
aortic valve, intravenous drug abuse and immune compromised patients.
Symptoms include fever, weight loss and general weakness and if the infection
gets severe enough can consist of sepsis, embolic events, complete insufficiency
of the infected valve, heart block and severe heart failure.
35
SSRCTS 2015
Materials and methods: This is a retrospective study in the years 1997-2013.
Information was retrieval from medical records. Over these years 307 patients
were admitted to the Lanspitali University Hospital with the diagnosis of
endocarditis of which 38 (12.3%) patients underwent surgery for active
endocarditis.
Results: The aortic valve was most commonly infected or in 26 (68%) cases. The
most common pathogens cultured from blood were gram positive cocci,
Staphylococcus aureus overall 26 patients had positive blood cultures. Most
common antibiotics to be used were 3rd generation Cephalosporins and
Penicillin. Complications following the procedures were myocardial injury,
respiratory failure and reoperation due to bleeding.
Conclusion: Infective endocarditis remain a serious disease and can be very
difficult to manage. Relatively few patients diagnosis of endocarditis require
operative treatment. Complications following these operation are common with
moderately high operative mortality.
A22
Short and long-term outcome of mitral valve repair in Iceland
1
4
1
2
JF Gudmundsdottir , S Ragnarsson , A Geirsson , R Danielsen , T Gudbjartsson
1
1,3
2
Departments of Cardiothoracic Surgery & Cardiology, Landspitali University Hospital,
4
Faculty of Medicine, University of Iceland, Department of Cardiothoracic Surgery,
Anesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden
3
[email protected]
Objectives: To study, for the first time, the outcome following mitral valve repair
(MVR) in Iceland.
Material and methods: All MVR-patients (average age 64 yrs, 74% males)
operated in Iceland 2001-2012. All 125 patients had mitral regurgitation; either
due to myxomatous degeneration (group M, 56%) or functional regurgitation
(group F, 44%). Reoperations and mitral insufficiency due to endocarditis, or
acute MI were excluded.
Results: The number of MVRs increased two-fold for the later 6 yrs of the study.
The mean EuroSCORE was 12.9% and 10% had history of previous cardiac
surgery. A ring annuloplasty was performed in 98% of cases and posterior leaflet
resection in 41%, 28 patients received artificial chordae and 7 Alfieri-stitch.
Concomitant heart surgery was performed in 83% of cases, most often CABG or
Maze-procedure. Major complications occurred in 56% of the cases; peri-op. MI
and re-operation for bleeding being the most common. Two patients later
36
SSRCTS 2015
required mitral valve replacement. Eight patients died within 30 days (6%) and
5-year overall survival was 79%; 84 and 74% for the M and F-groups,
respectively (p=0.08).
Conclusions: Mitral valve repairs in Iceland have increased significantly.
Complications are common but operative mortality and long-term survival is
similar to contemporary studies.
A23
Common sequence variants associated with coronary artery
disease correlate with the extent of coronary atherosclerosis
1,2
2
1,2
3
1,3
E Bjornsson , DF Gudbjartsson , A Helgadottir , Th Gudnason , T Gudbjartsson , K
3
4,5
4
2
4
Eyjolfsson , RS Patel , N Ghasemzadeh , G Thorleifsson , AA Quyyumi , U
1,2
1,3
1,2
Thorsteinsdottir , G Thorgeirsson , K Stefansson
1
2
3
Faculty of Medicine, University of Iceland; deCODE Genetics; Landspitali University
4
Hospital; Reykjavik, Iceland, Emory University School of Medicine, Atlanta, Georgia USA,
5
University College London, London, United Kingdom
[email protected]
Objective: Single nucleotide polymorphisms predisposing to coronary artery
disease (CAD) have been shown to predict cardiovascular risk in healthy
individuals when combined into a genetic risk score (GRS). We examined
whether the cumulative burden of known genetic risk variants associated with
risk of CAD influences the development and progression of coronary
atherosclerosis.
Approach and results: We investigated the combined effects of all known CAD
variants in a cross-sectional study of 8,622 Icelandic patients with
angiographically significant CAD (≥50% diameter stenosis). We constructed a
GRS based on 50 CAD variants and tested for association with the number of
diseased coronary arteries on angiography. In models adjusted for traditional
cardiovascular risk factors, the GRS associated significantly with CAD extent
-17
(difference per SD increase in GRS, 0.076; P=7.3x10 ). Compared to the bottom
GRS quintile, patients in the top GRS quintile were roughly 1.67x more likely to
have multivessel disease (odds ratio, 1.67; 95% confidence interval, 1.45-1.94).
The GRS significantly improved prediction of multivessel disease over traditional
2
cardiovascular risk factors (χ likelihood ratio 48.1, P<0.0001) and modestly
improved discrimination, as estimated by the C-statistic (without GRS vs. with
GRS, 64.0% vs. 64.8%) and the integrated discrimination improvement (0.52%).
Furthermore, the GRS associated with an earlier age at diagnosis of angiographic
CAD. These findings were replicated in an independent sample from the Emory
37
SSRCTS 2015
Biobank study (n=1,853).
Conclusions: When combined into a single GRS, known genetic risk variants for
CAD contribute significantly to the extent of coronary atherosclerosis in patients
with significant angiographic disease.
A24
Osteogenic potential of valvular interstitial cells is increased in
patients with calcific aortic valve disease
1,2
2
3,4
M Bogdanova , A Malashicheva , J Vaage , A Rutkovskiy
1,3
1
Department of Physiology at the Institute of Basic Medical Sciences, University of Oslo,
2
Norway; Almazov Federal Heart Centre, Institute of Molecular Biology and Genetics, Saint
3
Petersburg, Russian Federation; Department of Emergency and Critical care, Oslo
4
University Hospital, Ullevål, and Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
[email protected]
Background: Calcific aortic valve disease (CAVD) is caused by changes in the cell
biology of valve leaflets leading to calcification of the valve and aortic stenosis.
The dominant cell type in aortic valves is interstitial cells (VICs). VICs may
transform into osteoblast-like cells causing calcification, but the mechanisms of
this process are unclear. Our hypothesis was that the osteogenic potential of
VICs is increased in valves from patients with CAVD.
Methods: Primary VICs were isolated from the aortic valves of five patients.
Valves from two patients had no calcification whereas valves from three
patients displayed calcification from moderate to extremely severe
(ossification). The cells were isolated following the removal of endothelium
using 24-hour enzymatic digestion. The phenotype of cells was confirmed by
staining for desmin, vimentin and alpha-amooth muscle actin. The VICs were
subjected to treatment with osteogenic medium supplemented with betaglycerophosphate, dexamethasone and ascorbic acid. After a 21-day treatment
the cells were stained with Alizarin Red to visualize calcification. Expression of
mRNA of bone morphogenetic protein 2 and osteopontin was evaluated by PCR
Results: VICs from all donors differentiate into osteoblast-like cells over the
course of 21 days when subjected to the osteogenic medium. Expression of
BMP2 and osteopontin as well as calcification increased in the cultured VICs. The
osteogenic potential of VICs was proportional to the degree of calcification in
the harvested valves.
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SSRCTS 2015
Conclusions: We established a cellular model of osteogenic differentiation with
human aortic valve interstitial cells. Even VICs from non-calcified valves
produced calcium deposits when subjected to the osteogenic medium,
suggesting high plasticity of the phenotype of VICs. The osteogenic potential of
VICs correlated with the degree of calcification of the aortic valve, indicating a
change in basic cellular biology of these cells during the development of the
disease.
A25
Single center surgical experience of native aortic valve infective
endocarditis: Preliminary results
1
1
1
2
1
S Ragnarsson , P Timane , J Sjögren , M Stagmo , P Wierup , S Nozohoor
1
1
2
Department of Cardiothoracic Surgery and Department of Cardiology, Lund University
and Skåne University Hospital, Lund, Sweden
[email protected]
Objective: Surgery for active infective endocarditis (IE) is performed in up to half
of all IE cases but the associated mortality remains high. We describe the single
center experience of patients undergoing surgery for isolated native aortic valve
infective endocarditis (IE) and report short-term and long-term mortality.
Methods: A retrospective study with 72 of the 120 patients that underwent
aortic valve surgery at Skane University Hospital in Lund from 1998 to 2014 for
ongoing isolated infective endocarditis. Data was extracted from the
department’s surgical database and patient records. Follow-up on survival was
performed in January 2015 and was 100% complete (median follow up 8.5 years,
IQR 5.1-11.2.). Event rate was estimated with the Kaplan-Meier method.
Results: The mean age was 57.7±16.8 years and 21% (n=15) were females.
Preoperatively, 41 patients (57%) had congestive heart failure with NYHA class III
or IV, 22 (31%) had septic embolism including 3 (4%) with embolic stroke. The
most common pathogens were oral Streptococci (n=24, 33%), Staphylococcus
aureus (n=11, 15%), and Enterococcus faecalis (n=11, 15%). Intraoperative
inspection revealed a large vegetation (>10 mm) in 42 (58%) and annular
involvement in 19 (26%). Biological prostheses were used in 30 (42%),
mechanical prostheses in 27 (38%), a homograft in 11 (15%), pulmonary
autograft (Ross procedure) in 3 (4%) and a biological Bentall procedure in 1
(1.4%). Overall 30-day mortality was 2.7% (n=2) and 90-day mortality 4.2%
(n=3). The one-year survival was 94.3±2.8%, five-year survival was 83.8±4.5%,
and 10-year survival 71.8±6.0%.
39
SSRCTS 2015
Conclusions: The short term mortality was low despite the high number of
patients with congestive heart failure, septic embolism and annular
involvement. The five-year survival was similar to that of patients that
underwent surgery for isolated mitral IE at our institution.
A26
Acute kidney injury is an independent risk factor for morbidity
and mortality following aortic valve replacement for aortic
stenosis
D Helgason, SA Viktorsson, AW Orrason, IL Ingvarsdottir, S Helgadottir, A Geirsson, T
Gudbjartsson
Departments of Cardiothoracic Surgery, Landspitali University Hospital. Faculty of
Medicine, University of Iceland, Reykjavik, Iceland
[email protected]
Objective: Acute kidney injury (AKI) is a common complication after cardiac
surgery. So far most AKI-studies have focused on short-term outcome following
CABG. We reviewed the incidence and risk factors for AKI after aortic valve
replacement (AVR) in a population based cohort, and studied its effects on
short-term outcomes and long-term survival.
Materials and methods: Retrospective review of 366 patients undergoing AVR
for aortic stenosis between 2002 and 2011. AKI was defined according to the
RIFLE criteria. All patients requiring dialysis were followed-up in a centralized
registry. Risk factors for AKI were analyzed with uni- and multivariate analysis
and survival estimated with the Kaplan-Meier method.
Results: The incidence of AKI following surgery according to RIFLE was 83/366
(22.7%). Forty patients fell in the RISK-; 29 in the INJURY-; and 14 in the
FAILURE-group. Preoperative reduction in kidney function (GFR<60
mL/min/1.73m2) was present in 37 (44.6%) of patient who suffered AKI.
Postoperative dialysis was required in 17 patients (4.6%), including one patient
who required permanent dialysis. Major postoperative complication, such as
perioperative MI (24/83, 29% vs. 25/283, 9%), multi organ failure (34/83, 41%
vs. 4/283, 1%), and reoperation due to bleeding (24/83, 29% vs. 31/283, 11%)
were more common in the AKI group (p<0.01). In multivariate analysis female
sex (OR=1.10), high BMI (OR=1.02) and prolonged CPB-time (OR=1.03) were
independent risk factors for AKI. 30-day mortality in the AKI group was 18%
(15/83) vs. 2% (6/283) in the non-AKI group (p<0.001). Five-year survival of the
AKI group was 66% compared to 87% in the non-AKI group (p<0.001). AKI was an
40
SSRCTS 2015
independent predictor of operative mortality in multivariate analysis (HR=1.69,
95% CI=1.01-2.79) but not for long-term survival (HR=1.11, 95% CI= 0.59-2.12).
Conclusions: One out of every four patients undergoing AVR developed AKI
postoperatively. Complications were significantly increased in the AKI-group and
mortality increased 9-fold. AKI following AVR is an independent risk factor for
operative mortality but does not determine long-term survival.
A27
Remote ischemic preconditioning protects spinal cord after
segmental arteries cutoff
1
1
1
1
2
2
1
H Haapanen , J Herajärvi , O Arvola ,T Anttila , T Starck , M Kallio , V Anttila , H
3
4
1
Tuominen , K Kiviluoma , T Juvonen
1
2
3
4
Departments of Surgery, Clinical Neurophysiology, Pathology and Anesthesiology,
Oulu University Hospital, Oulu, Finland
[email protected]
Objective: Thoracoabdominal aneurysm procedures jeopardize the
vascularization of the spinal cord and therefore, in spite of the improvement of
surgical techniques and adjuncts the risk of paraplegia still remain. The
neuroprotective ability of the remote ischemic preconditioning (RIPC) has been
proven in several studies. This study aimed to demonstrate the effect of RIPC to
the preservation of spinal cord function after segmental arteries (SA) sacrificed.
Materials and methods: Twenty native stock piglets were randomized into the
RIPC group (n=10) and the control group (n=10). The RIPC group underwent
transient left hind limb ischemia prior to intermittent left subclavian artery and
SAs cut off to the level of diaphragm. Motor evoked potential (MEP) monitoring
was performed from the hind limbs. Afterwards, thoracic and lumbar spinal cord
was harvested and analysed.
Results: The elevation of the MEP amplitude after RIPC was significant whereas
amplitude was constantly decreased in the control group. Additionally, the onset
latency was significantly shorter after RIPC during the SA cut off. The control
group achieved sooner the fifty per cent decrease of MEP amplitude in the right
hind limb. Histological analysis is pending and the results will be presented in
the conference.
Conclusions: The remote ischemic preconditioning seems to preserve spinal
cord function after the left subclavian artery and SAs sacrifice as indicated by
the MEP amplitudes. Simultaneously, the effect can be seen more clearly in the
41
SSRCTS 2015
right hind limb confirming the blood supply of the spinal cord being regulated by
vascular network.
A28
Early statin treatment dampens recovery after experimental
cardiac arrest
1
1
2
3
A Mennander , V Vuohelainen , M Hämäläinen , T Paavonen , E Moilanen
1
2
2
Heart Hospital, Cardiac Research, The Immunopharmacology Research Group,
Department of Pathology, Fimlab; University of Tampere School of Medicine and
Tampere University Hospital, Tampere, Finland
3
[email protected]
Objectives: Statin treatment after cardiac arrest is controversial. Myocardial
infarction (MI) is a devastating entity after cardiac arrest due to permanent
ischemia-reperfusion injury. We experimentally investigated the impact of early
statin treatment on myocardial recovery after cardiac arrest and MI.
Materials and methods: 28 syngeneic Fisher rats underwent heterotopic cardiac
transplantation to induce reversible ischemia reperfusion after cardiac arrest
(Controls). 56 rats also underwent permanent ligation of the left anterior
descending coronary artery (LAD) to yield MI after cardiac arrest, of which 12
rats received Lipitor 10 mg/kg subcutaneously. Histology and qRT-PCR for
endothelial nitric oxide synthase (eNOS), induced nitric oxide synthase (iNOS)
and vascular cell adhesion molecule 1(VCAM-1) were performed to investigate
for myocardial recovery and induction of inflammation.
Results: 1 hour after reperfusion, the relative ischemia of remote
intramyocardial arteries decreased temporarily in MI treated with Lipitor as
compared with Controls and untreated MI (0.12±0.05 vs 2.69±1.35 and
3.50±3.58, PSU, p=0.032). After 1 day, the relative ischemia of intramyocardial
arteries of the left ventricle increased in MI treated with Lipitor as compared
with Controls and untreated MI (6.20±3.82 vs 0.33±0.10 and 0.95±0.42, PSU,
p=0.025). Indicating myocardial ischemia, eNOS and VCAM-1 expressions
increased in MI treated with Lipitor vs Controls and MI alone (3.67 vs 1.43 and
2.20, FC, p=0.040 and 9.57 vs 1.78 and 3.85, FC, p=0.028, respectively). At 1 day,
no differences were observed in eNOS, iNOS or VCAM-1 expressions among the
groups.
Discussion: The initial temporary decrease of ischemic remote intramyocardial
arteries after MI and cardiac arrest subsides soon during statin treatment; early
statin intensifies ischemic myocardial response after MI and cardiac arrest.
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SSRCTS 2015
A29
Acute volume-overload impacts early on intramyocardial arteries;
an experimental rat study
1
1
1
2
3
2
C Huuskonen , R Bolkart , T Soininen , M Hämäläinen , T Paavonen , E Moilanen , A
1
Mennander
1
2
Heart Hospital, Cardiac Research, The Immunopharmacology Research Group,
Department of Pathology, Fimlab; University of Tampere School of Medicine and
Tampere University Hospital, Tampere, Finland
3
[email protected]
Objectives: Acute volume-overload (AVO) leads to a devastating cardiac entity
after surgery, often resulting in increased cardiac oxygen consumption; the
histological outcome may reveal myocardial cellular destruction. We
investigated whether acute AVO impacts on intramyocardial arteries early after
experimental rat arterial-venous fistula.
Material and methods: 27 syngeneic Fisher rats underwent surgical abdominal
arterial-venous fistula to induce AVO. One day after surgery, the hearts were
procured for regional and quantitative histology. 6 hearts without AVO served as
Controls.
Results: 23 rats survived until day 1 after AVO, while 4 rats were lost due to
acute cardiac failure. Presence of subendocardial and myocardial edema,
hemorrhage, inflammation and ischemia of the left and right ventricles did not
differ in hearts with AVO as compared with Controls. Instead, ischemic
intramyocardial arteries were abundant in the septum of the hearts with AVO as
compared with Controls (0.32±0.04 vs 0.12±0.05, PSU, p=0.011), while did not
differ in the right and left ventricles (0.22±0.04 vs 0.17±0.06, PSU, p=0.384 and
0.22±0.07 vs 0.19±0.05, PSU, p=0.473, respectively).
Discussion: Early susceptibility of the septum is eminent after AVO; aiming
treatment towards protecting intramyocardial arteries may provide novel insight
against global cardiac detrition after AVO.
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SSRCTS 2015
Abstracts - Poster presentations
P01
The in-vivo comparison of a new semi flexible mitral annuloplasty
ring to rigid, flat- and fully flexible mitral annuloplasty rings in a
porcine model
1
1,2
1
1
1,2
MJ Tjørnild , DM Røpcke , SN Skov , C Ilkjær , SL Nielsen
1
2
Institute of Clinical Medicine and Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Denmark
[email protected]
Objectives: The aim of this study is to conduct an integrated in-vivo
experimental evaluation of a newly developed semi-rigid mitral annuloplasty
ring. The new ring will be compared a well-known annuloplasty rings used in
today´s clinical practice: The Carpentier Edwards Classic Annuloplasty Ring, and
the native heart. The evaluation and comparison of the rings will be based on,
3D geometry of the mitral annulus, leaflet coaptation geometry and leaflet
curvature during heart cycle.
Materials and methods: The two ring types will be implanted and tested in an
acute experimental porcine model, where series of seven pigs will be
randomized to receive one of the two rings. Before and after ring implantation,
the dynamic 3D geometry and leaflet coaptation will be assessed by
sonomicrometry and by 2D echocardiography, respectably. The recordings of
the 3D leaflet geometry will be used for description of the leaflet curvature,
commissure-commissure and septal-lateral mitral annular dimensions.
Dedicated force transducers attached directly to the annuloplasty rings will
measure annular deformational forces in the septal-lateral and commissural
dimensions. A comprehensive analysis of the impact of flexible properties of the
annuloplasty rings on mitral leaflet motion and stress distribution will be
performed from simultaneous recordings and calculations of the mentioned
parameters throughout the cardiac cycle.
Results: Preliminary resultants are shown in Table 1 but more will be reviled at
the conference.
Conclusion: With this study, the hope is to expand the current knowledge of the
complex issues concerning mitral annuloplasty. In particular, a semi-rigid
annuloplasty ring might show advantages in comparison to today´s annuloplasty
rings. The perspectives of the current study are to increase the number of repair
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SSRCTS 2015
strategies in mitral annuloplasty surgery for long term valvular support and
contribute to the development of future innovative annuloplasty ring designs.
Type/Forces
New-ring
Classic
Native
ANT [N]
POST [N]
ACOM [N]
PCOM [N]
SL [N]
CC [N]
-0.09 ±
0.22
0.27 ±
0.79
-0.18 ±
0.78
-0.04 ±
0.10
0.01 ±
0.23
-0.29 ±
0.51
0.12 ±
0.18
0.30 ±
0.24
0.62 ±
0.69
0.07 ±
0.27
-0.10 ±
0.60
0.04 ±
0.27
0,30 ±
0.49
-0.38 ±
0.52
-0.37 ±
1.35
-0.13 ±
0.22
0.97 ±
1.14
-0.12 ±
2.41
Table 1. Data stated as mean ± STD and as mid diastolic - mid systolic. ANT: Anterior Segment, POST:
Posterior Segment, ACOM: Anterior Commissure, PCOM: Posterior Commissure, SL: Septal-Lateral,
CC: Commissure-Commissure.
P02
Development of a new valve prosthesis concept for infant cardiac
surgery
1
2
MB Jensen , MH Smerup , P Johansen
1,2
1
Cardiovascular Experimental Lab (CAVE Lab), Dept. of Engineering, Aarhus University,
Dept. of Cardiothoracic Surgery, Aarhus University Hospital, Denmark
2
[email protected]
Background: Congenital heart disease is the most common form of birth defect
and are the leading cause of death from birth abnormalities in the first year of
life. Approximately 8 in 1000 live births are affected by these conditions. While
some conditions need immediate treatment, others might not affect the child
for many years. Severe cases might need interventional catheterization, valve
surgery or valve replacement.
The size of an infant varies very much depending on its age. Hence, the cases
where heart valve substitution is needed, it would be of great help, to be able to
design a heart valve on the bench that exactly suits the individual infants.
A new developed technique may be able to present such new paradigm in infant
cardiac surgery. Through direct anatomical valve measures the surgeon can
make an artificial heart valve based on fixated bovine pericardium and
predefined templates in such a short time, that it can be done during
cardiopulmonary bypass. However, initial design concept tests of the infant
valve should be carefully caried out.
Method: Initial experiments are conducted using upscaled heart valve designs.
With a pulsatile left heart in vitro model the heart valve will be tested, to see
45
SSRCTS 2015
how it function and operate under various physiological conditions. Tests for
hemodynamic properties will be carried out to investigate the transvalvular
pressure gradient along with instantaneous flow recordings. Moreover, highspeed visualization of the valve will be carried out. These measures will present
the hemodynamic characterization (pressure gradient, vascular impedance,
valve leakage, geometric and effective orifice areas). The results will be
compared to results found from identical testing with a native aortic root from a
pig.
Biomechanical testing will determine the stresses and strain in the various valve
structures through high speed cameras and digital image correlation. This tissue
load information may provide information that can be extrapolated to estimate
the durability of the valve.
Results: Pending.
Discussion: We expect that the initial in vitro testing will result in further
development of the design concepts of the infant valvesubstitute, which
subsequently will be further tested with proper infant heart valve dimensions in
vitro and in vivo at our animal experimental facilities.
P03
The effect of TAVI oversizing on valve tissue stresses
1
1
1
1,2
3
1
SK Krishna , R Galsgaard , S Heide-Jørgensen , T Bechsgaard , R. Zegdi , L Bräuner , JV
1
1,2
Nygaard , P Johansen
1
2
Dept. of Engineering, Faculty of Science and Technology, Aarhus University, Dept. of
3
Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark, Hôpital
Européen Georges Pompidou, Service de Chirurgie Cardiovasculaire, Paris, France
[email protected]
Objectives: Patients who suffer from aortic stenosis are most often treated with
valve replacement. Traditionally, this requires an invasive procedure involving
open-heart surgery and cardiopulmonary bypass. Not all patients are eligible for
such treatment, and may therefore instead benefit of insertion of percutaneous
valves through transcatheter aortic valve implantation (TAVI). Pre-procedural,
the TAVI patients undergo CT-scanning for planning the access path and to
determine the size of the TAVI valve. The TAVI valve is often selected a size
larger than the aortic circumference of the patient, for better secure
deployment of the valve and to minimize paravalvular leakage. The oversizing
may lead to inappropriate deformations of the leaflets, altering their dynamic
stress fields and reduce longevity.
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SSRCTS 2015
The aim of this study is therefore to develop a Finite Element model to analyse
the stress and strain fields on the TAVI valve leaflets during different sizing
conditions.
Materials and methods: CT images of a 26 mm TAVI valve, deployed in a fitted
diameter tube will be obtained. This will be used to establish a 3 dimensional
shell geometry CAD model. Surface smoothing and convenient mesh will be
accomplished in SolidWorks. The diameter of the TAVI valve will be reduced
from 26 mm to 24 mm, 22 mm, 20 mm and 18 mm, and the same
aforementioned procedure will be accomplished for every TAVI valve size. Stress
and strain analyses will be performed using COMSOL multi-physics, under
different hemodynamic conditions.
Results: Pending.
P04
Comparison of the aortic root remodeling techniques - with and
without a supporting annular ring. An vitro evaluation
1
1
1
2
2
2
TS Lading , DM Røpcke , T Lindskow , T Bechsgaard , P Johansen , H Nygaard , JM
1
1
Hasenkam , SL Nielsen
1
Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital,
Department of Engineering, Faculty of Science and Technology, Aarhus University,
Denmark
2
[email protected]
Objectives: The aim of this study is to characterize the CAVIAAR technique
(Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the
Aortic Root) in vitro, comparing biomechanics of the native aortic root and valve
to the root and valve after a Yacoub and a David repair technique. All three
groups (native, Yacoub and David aortic roots) will be analyzed with and without
a supportive external annular ring. The measurements used for comparison are
leaflet dynamics, annular and aortic force distribution and hemodynamics.
The CAVIAAR technique is based on wellknown repair techniques of the aortic
root (David and Yacoub) adding an external subvalvular aortic annuloplasty ring,
combining advantages of the original remodeling technique with the advantages
of a supportive annuloplasty ring.
Materials and methods: Fifteen porcine aortic roots (80 kg) will be prepared and
randomized to either no aortic remodeling (n=5) or to a David (n=5) or a Yacoub
(n=5) repair technique, which will be performed ex vivo before mounting the
aortic root in the in vitro model.Two circular force transducers will be placed in
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the aortic annulus and at the sinotubular junction, respectively, These
transducers will measure annular contraction and dilation of the root. The
annulus transducer consists of six strain gauges allowing individual force
measuremets at each strain gauge point of the ring. The forces at each
commisure of the aortic valce will be measured by attachment of three strain
gauges mounted on the transducer ring at the sinotubular junction. Microtip
pressure catheters will be used for pressure measurements, and a highspeed
camera will be used for digital imaging of the leaflet motion and -dynamics
throughout heart cycle.
Results: Pending
Discussion: Biomechanical and hemodynamic analysis of the CAVIAAR technique
will hopefully provide knowledge for optimizing surgical procedures for aortic
root repair in the relevant patient groups. This will lead to longer-lasting
treatment results, lowering of costs related to re-operation, and hopefully
improve the quality of life for each patient, since further knowledge allows a
optimized and individualized surgical treatment of patients with aortic root
pathologies.
P05
Are all flexible mitral annuloplastic rings the same? An in vivo
study
1
1
1,2
1
1
1,2
J Rasmussen , MJ Tjørnild , DM Røpcke , SN Skov , C Ilkjær , SL Nielsen
1
2
Institute of Clinical Medicine and Department of Cardiothoracic and Vascular Surgery,
Aarhus University Hospital, Denmark
[email protected]
Objectives: The purpose of this experimental study is to assess the individual
characteristics and different biomechanical properties of two different flexible
TM
TM
mitral annuloplasty rings (Medtronic Simulus and Medtronic Duran ). This
will be done with special emphasis on the rings different impact on mitral
annular dynamics and force distribution and also the remodeling effect on the
entire mitral valve apparatus. The evaluation and comparison of the rings will be
based on 3D geometry of the mitral annulus, leaflet coaptation geometry and
leaflet curvature during the heart cycle. Force quantification and distribution on
the valve will also be evaluated.
Material and methods: The two different types of annuloplasty rings will be
surgically implanted and tested in an acute porcine model. To establish a
TM
reference, a completely rigid mitral annular plastic ring (Medtronic Classic )
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SSRCTS 2015
and the native heart without any implant, will be tested using the exact same
procedures. Twenty animals (80 kg) will be used for testing, equally distributed
amongst the four groups of either a ring or the native heart. Before and after
ring implantation, the dynamic 3D geometry and leaflet coaptation will be
assessed by sonomicrometry and by 2D echocardiography, respectably. The
recordings of the 3D leaflet geometry will be used for description of the leaflet
curvature, commissure-commissure and septal-lateral mitral annular
dimensions. Force transducers attached directly to the annuloplasty rings will
measure annular deformational forces. A comprehensive analysis of each rings
impact on the mitral valve and its leaflets motion and stress distribution will be
performed from simultaneous recordings of the mentioned parameters
throughout the cardiac cycle.
Results: Pending.
TM
Conclusion: We hypothesize that the Medtronic Simulus ring, compared to
TM
the Medtronic Duran ring, provide better support of the mitral annulus by
reducing annular motion and the resulting deformational forces of mitral
TM
annulus during the cardiac cycle. We anticipate that the Medtronic Simulus
ring, hereby, possess the ability to reshape the mitral annulus in specific regions,
a feature usually associated with the more rigid annuloplasty rings, while
allowing physiological motion of the annulus and leaflets due to its flexible
properties.
P06
Giant right atrial myxoma presenting as chronic obstructive
pulmonary disease
1
2
3
S Kumar , C Howes , A Delvecchio , PN Bonde
1
1
2
Section of Cardiac Surgery and Section of Cardiology, Yale University School of Medicine,
3
New Haven, Connecticut, Department of Cardiology, Greenwich Hospital, Greenwich,
Connecticut, USA
[email protected]
Background: Myxomas are the commonest benign tumour of heart with upto
20% located in the right atrium (RA). This rare case of giant RA myxoma
presented as chronic obstructive pulmonary disease.
Material and methods: 47 years old female was being followed for increasing
dyspnea for 6 months duration. She gave a history of polysubstance abuse using
cocaine and marijuana. Her shortness of breath started insidiously with
moderate efforts and gradually progressed with mild efforts. She had dry cough
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and progressive edema of lower extremities for 1 week associated with fatigue.
There was no associated history suggestive of fever, chills, palpitation, chest
pain, syncopal episodes, dizziness and orthopnea or paroxysmal nocturnal
dyspnea. She had been treated as chronic obstructive pulmonary disease with
Albuterol and Salmeterol /Fluticasone without any response to treatment.
Result: The echocardiogram revealed 6.5x5.5 cm RA mass prolapsing through
the tricuspid valve into right ventricle. She made an uneventful recovery
following excision of RA myxoma through median sternotomy under cardiopulmonary bypass.
Discussion: The dyspnoea should not be a real cardiac symptom when there is a
right atrial occupation like in this case, but dyspnoea can also be present in
right-sided pathology.
P07
Metachronous metastatic hepatocellular carcinoma to the right
ventricle
S Kumar, AA Mangi
Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut,
USA
[email protected]
Background: We present a very rare case of isolated metastasis to the right
ventricle (RV) from hepatocellular carcinoma (HCC) for which he underwent a
left hepatectomy a few years earlier.
Material and methods: 71 year old gentleman presented with an episode of
atypical chest pain. He had extended left hepatectomy with caudate lobectomy
for hepatocellular carcinoma 3 years earlier, with no evidence of recurrence on
restaging scans 1 year ago. ECG revealed sinus rhythm with new right bundle
branch block and stress test with anterior ischemic, affixed inferoseptal defect
and inferior ischemia. TTE showed a normal EF but a large RV mass. His hepatitis
panel, CEA and AFP were negative. CT chest showed a 8x5x4.5 cm mass
involving the anterior wall of the RV, extending from the level of the outflow
tract to the apex. CT abdomen/pelvis showed no evidence of recurrent or
metastatic disease. Cardiac catheterization showed right coronary artery (RCA)
with ostial and proximal 80% lesions just prior to a large saccular aneurysm
arising from the proximal vessel. MRI revealed a large hypervascular 7x5x4.5 cm
enhancing RV mass involving approximately 50% of the RV free wall and the
entire anterior wall. There was 50% invasion of the interventricular septum with
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slight narrowing of the RV outflow tract without hemodynamically significant
obstruction.
Result: The patient underwent debulking of RV mass, intracardiac excisional
biopsy of RV mass, plication of RCA aneurysm, and coronary artery bypass
grafting x1 with reverse saphenous vein graft to the distal RCA. The tumor was
only debulked because it was of metastatic origin on frozen section and
occupied approximately two thirds of the anterior wall of the right ventricle,
straddled the intraventricular septum and encased the midportion of the left
anterior descending coronary artery for a length of about 8 cm, and extended
onto the left ventricle for about 2 cm. He had uncomplicated recovery and was
discharged home on post-operative 7 in good condition to follow up with his
oncologist for further treatment of the residual RV tumor.
Discussion: HCC tend to metastasize to the lungs, bones, and abdominal organs
much more frequently. There is no reported case in literature of HCC
metastasizing to the heart in association with RCA aneurysm.
P08
Cavitation in patiens with bileaflet mechanical heart valves
1,2
2
2
2
2
P Johansen , TS Andersen , JM Hasenkam , H Nygaard , PK Paulsen
1
2
Dept. of Engineering, Faculty of Science and Technology, Aarhus University, Dept. of
Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark
[email protected]
Objectives: Today, the quality of mechanical heart valves is quite high, and
implantation has become a routine clinical procedure with a low operative
mortality (< 5%). However, patients still face the risks of blood cell damage,
thromboembolic events, and material failure of the prosthetic device. One
mechanism found to be a possible contributor to these adverse effects is
cavitation. In vitro, cavitation has been directly demonstrated by visualization
and indirectly in vivo by registering of high frequency pressure fluctuations
(HFPF).
Tilting disc valves are thought of having higher cavitation potential than bileaflet
valves due to higher closing velocities. However, the thromboembolic potential
seems to be the same. Further studies are therefore needed to investigate the
cavitation potential of bileaflet valves in vivo. The post processing of HFPF have
shown difficulties when applied on bileaflet vavles due to asynchronous closure
of the two leaflets. The aim of this study was therefore to isolate the pressure
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signature from each leaflet closure and perform cavitation analyses on each
component.
Materials and methods: Six patients were included in the study (St. Jude
Medical (n=3) and CarboMedics (n=3); all aortic bileaflet mechanical heart
valves). HFPFs were recorded intraoperatively through a hydrophone at the
aortic root. The pressure signature relating to the first and second leaflet closure
was isolated and cavitation parameters were calculated (RMS after 50 kHz highpass filtering and signal energy). Data were averaged over 30 heart cycles.
Results: For all patients both the RMS value and signal energy of the second
leaflet closure were higher than for the first leaflet closure.
Discussion: These results indicate that the second leaflet closure is most prone
to cause cavitation. Therefore, quantifying cavitation based on the HFPF related
to the second leaflet closure may suggest that the cavitation potential for
bileaflet valves in vivo may be higher than previous studies have suggested.
P09
Major ischemic stroke caused by air embolism from a ruptured
giant pulmonary bulla
1
2
1
3
JF Gudmundsdottir , BL Thorarinsson , G Myrdal , P Hannesson , T Gudbjartsson
1
2
1,4
3
Departments of Cardiothoracic Surgery, Neurology, and Radiology, Landspitali
4
University Hospital. Faculty of Medicine, University of Iceland, Reykjavík, Iceland
[email protected]
Introduction: Giant pulmonary bullae (GPB) occupy more than one third of the
hemithorax. They often cause complications, such as pneumothorax,
hemorrhage or lung infections. We report a case of major ischemic stroke in a
patient with giant pulmonary bulla, that ruptured during a commercial flight.
Case: A 58 year old non-smoking male, previously healthy, suddenly experienced
aphasia and right hemiplegia during a flight over the North Atlantic. After an
emergency landing he was transported to our hospital in Reykjavik. On
admission he complained of left-sided chest pain with dyspnea and a chest tube
was inserted for a left sided pneumothorax. An acute CT scan and MRI of the
head showed signs of acute ischemic cerebral infarction. Furthermore, air
bubbles consistent with air emboli could be identified in his left sided
intracerebral arteries. A chest CT then revealed a 15x13cm thin-walled GPB in
the left upper lobe. One month after admission the GPB was removed with
upper left lobectomy. Pathologic examination showed a benign thick-walled
bulla and emphysematous lung tissue. He was discharged 2 weeks later after an
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uneventful post-operative recovery and flew back to England where he is
recovering from his stroke.
Discussion. Giant pulmonary bullae are uncommon, especially in non-smokers.
Ischemic stroke caused by air embolism due to ruptured bulla is very rare, but so
far a couple of cases have been reported during a flight.
P10
David versus Yacoub aortic root repair: Assessment and
comparison of stress distribution in the aortic root - a clinical
porcine experimental study
1,3
1,3
2,3
1,3
T Lindskow , MJ Tjørnild , T Bechsgaard , DM Røpcke , SL Nielsen
1,3
1
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital,
3
Department of Biomedical Engineering and Clinical Institute of Medicine, Aarhus
University Hospital, Denmark
2
[email protected]
Objectives: Recent years of research has showed that aortic valve repair is
superior to valve substitution in patients with aortic regurgitation due to aortic
dilatation if the valve cusps themselves are normal. The aim of this study is to
assess and compare stress distribution in the aortic root after aortic root repair
using two of the most commonly accepted techniques developed by Dr Tirone E.
David (The David valve re-implantation procedure) and Sir Magdi Yacoub (The
Yacoub re-modelling procedure), respectively.
Materials and methods: Fifteen pigs (90 kg) will be randomized to either a David
repair (n=5), a Yocoub repair (n=5) or no repair at all (n=5). A median
sternotomy will be performed and cardiopulmonary bypass will be established
followed by cardioplegia and resection of the aortic root including freedissection
of the coronary buttons. Hereafter a force transducer will be sutured to the
aortic annulus just below the valve. This will enable measuring of stress
distribution both in plane (annulus dilation/contraction) and out of plane
(annulus bending). Fifteen piezoelectric crystals for sonomicrometric
measurements will be implanted at four levels around the circumference of the
aortic root (three at the annular level, three at each commissure tip, three at the
sinotubular junction, three in the ascending aorta, and one on each free edge of
the three aortic cusps). The sonomicrometric crystals will display 3D geometry of
the changes in the aortic root. Two microtip pressure catheters will be inserted
in the left ventricle and atrium for direct pressure measurements. After weaning
from cardiopulmonary bypass and hemodynamic stabilization, data will be
collected over 10 cardiac cycles.
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SSRCTS 2015
Force distribution and 3D configuration/behavior of the aortic root will be
described and compared between groups.
Results: Results are pending.
Conclusion: With this study we hope to gain more knowledge about the normal
aortic root and also gain insight into different repair techniques, hopefully
enabling surgeons to choose the right repair technique for each patient,
depending on pathology and aortic root anatomy.
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SSRCTS 2015
Authors’ index
Agnarsson B ................................ A15
Andersen TS ................................ P08
Andreasen JJ ............................... A18
Anttila T .............................. A12, A27
Anttila V .............................. A12, A27
Arason AJ .................................... A05
Arvola O ...................................... A27
Baandrup UTh ............................. A18
Bechsgaard T ..................... A09, A13,
.....................................P03, P04, P10
Bjornsson E ................................. A23
Bjornsson J .................................. A04
Bogdanova M.............................. A24
Bolkart R ..................................... A29
Bonde PN .................................... P06
Bräuner L .................................... P03
Bruus D ....................................... A07
Danielsen R ................................. A22
Delvecchio A ............................... P06
Eyjolfsson K................................. A23
Fonager K .................................... A18
Franzdottir SR ............................. A05
Fröjd V ........................................ A10
Galsgaard R ......................... A07, P03
Geirsson A...........A15, A21, A22, A26
Ghasemzadeh N.......................... A23
Gislason G ................................... A18
Grønlund J .................................. A03
Gudbjartsson DF ......................... A23
Gudbjartsson T .......... A04, A05, A15,
.................... A21, A22, A23, A26, P09
Gudjonsson Th ............................ A05
Gudmundsdottir JF ............. A22, P09
Gudmundsson G ......................... A05
Gudnason Th .............................. A23
Haapanen H ........................ A12, A27
Haapasalo H ................................ A14
Hakimi CS .................................... A06
Hämäläinen M .................... A28, A29
Hannesson P ............................... P09
Hansson E ................................... A06
Hasenkam JM ............. A18, P04, P08
Hautalahti J ................................. A16
Heide-Jørgensen S .............. A09, P03
Hejslet T ...................................... A01
Helgadottir A............................... A23
Helgadottir S ............................... A26
Helgason D .................................. A26
Herajärvi J ........................... A12, A27
Hesse C ....................................... A02
Hjortdal VE ..................A01, A03, A08
Howes C ...................................... P06
Huuskonen C ............................... A29
Hyttinen J .................................... A16
Hønge JL ......................A09, A13, A18
Ilkjær C ................ A01, A17, P01, P05
Ingvarsdottir IL ............................ A26
Isaksson HJ .......................... A04, A05
Jensen H ...................................... A01
Jensen M ..................................... A17
Jensen MB................................... P02
Jensen MOJ ................................. A01
Jeppsson A ..................A02, A06, A10
Johannesdottir RM ..................... A21
Johansen P .................A07, A09, A13,
............................ P02, P03, P04, P08
Jonsdottir HR .............................. A05
Jonsson S..................................... A04
Joutsen A .................................... A16
Jungebluth P ............................... A11
Juvonen T ............................ A12, A27
Kallio M ............................... A12, A27
Karppinen P ................................ A12
Karunanithi Z............................... A08
Kiviluoma K ......................... A12, A27
Kjærgaard B ................................ A18
Krishna SK ........................... A09, P03
Kristensen SR .............................. A18
Kumar S ............................... P06, P07
Lading TS ..................................... P04
Laugesen S .................................. A13
Laukka T ...................................... A12
Laurikka J .................................... A16
Lim ML ........................................ A11
Lindhardt I................................... A07
Lindskow T .......................... P04, P10
Lund SH ....................................... A15
Macchiarini P .............................. A11
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SSRCTS 2015
Magnusdottir SO ........................ A18
Magnusson MK ........................... A05
Malashicheva A........................... A24
Malm CJ ...................................... A06
Mangi AA .................................... P07
Melvinsdottir IH .......................... A15
Mennander A .............. A14, A28, A29
Moilanen E .......................... A28, A29
Muola P ...................................... A14
Mustonen C ................................ A12
Myrdal G ..................................... P09
Nielsen SL .................. A01, A13, A17,
.............................P01, P04, P05, P10
Niinimaki E .................................. A14
Nozohoor S ......................... A20, A25
Nyboe C ...................................... A08
Nygaard H ........... A13, A17, P04, P08
Nygaard JV .................................. P03
Orrason AW ................................ A26
Oskarsdottir GN .......................... A04
Paavonen T ................. A14, A28, A29
Paldanius A ................................. A16
Palsson R..................................... A05
Parkkila S .................................... A14
Patel RS ....................................... A23
Paulsen PK .................................. P08
Quyyumi AA ................................ A23
Ragnarsson S............... A20, A22, A25
Rasmussen BS ............................. A18
Rasmussen J................................ P05
Rutkovskiy A ............................... A24
Røpcke DM ........................ A01, A17,
.............................P01, P04, P05, P10
Sarja H ........................................ A12
Siefert AW .................................. A17
Singh S ........................................ A02
Sjögren J ............................. A20, A25
Sjöqvist S..................................... A11
Skov SN ............... A03, A17, P01, P05
Smerup MH................................. P02
Soininen T ................................... A29
Stagmo M ........................... A20, A25
Starck T ............................... A12, A27
Stefansson K ............................... A23
Sørensen AV ............................... A01
Taborsky J ................................... A09
Telinius N .................................... A03
Thorarinsson BL .......................... P09
Thorgeirsson G ............................ A23
Thorleifsson G ............................. A23
Thorsteinsdottir U....................... A23
Thorsteinsson K .......................... A18
Timane P ..................................... A25
Tjørnild MJ .......... A17, P01, P05, P10
Torp-Pedersen C ......................... A18
Tuominen H ........................ A12, A27
Vaage J ........................................ A24
Viktorsson SA .............................. A26
Vuohelainen V............................. A28
Weng PBS.................................... A07
Wierup P ............................. A20, A25
Yoganathan A .............................. A17
Zegdi R ................................ A09, P03
Ølgaard M ................................... A03
56
SSRCTS 2015
57