Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSRESULTS: At baseline conditions none of the valves had MR, but annular dilatationand PM displacement induced significant MR (Fig 1A). Annuloplasty alonedecreased MR, but did not eliminate it completely at both PM locations (Fig 1A).CT-cut technique reduced residual MR to trace levels only when the PMs wereapically displaced, but did not have a positive effect when the PMs were apicallylaterally-posteriorlydisplaced from their physiological positions (Fig 1A). Tentingarea was reduced to the baseline conditions after CT-cutting in the apical-displacementcase but not in the apical-lateral-posterior displacement case (Fig 1B).CONCLUSION: This study demonstrates that the location of the PMs and theextent of leaflet tethering impact the outcomes of the secondary chordal cuttingsubvalvular repair technique, explaining the variability seen in clinical studies.Therefore, pre-operative assessment of the 3D mitral valve geometry is imperativefor appropriate patient selection for the procedure, optimal surgical planning andimproved outcomes of this procedure.128
AMERICAN ASSOCIATION FOR THORACIC SURGERYF5. Successful Resuscitation After Prolonged Periods of CardiacArrest – A New Field in Cardiac SurgeryGeorg Trummer, 1 Katharina Foerster, 1 Gerald D. Buckberg, 2* Christoph Benk, 1Claudia Heilmann, 1 Irina Mader, 1 Friedrich Feuerhake, 1 Oliver Liakopoulos, 2Kerstin Brehm, 1 Friedhelm Beyersdorf 1*1. University Hospital Freiburg, Freiburg, Germany; 2. David Geffen School ofMedicine, University of California, Los Angeles, CA, USAInvited Discussant: Ani AnyanwuOBJECTIVE: Cardiopulmonary resuscitation (CPR) after cardiac arrest (CA) willrestore normal cerebral and myocardial function only, if it is applied within 3–5mins after CA. CPR attempted later on results in sharply increasing mortality ratesand poor neurolgic recovery. State-of-the-art CPR, which restores circulation withinconsistent blood-flow and pressure, may cause an ischemia-reperfusion injury ofthe whole body and the brain.We assessed the hypothesis that whole-body controlled reperfusion using peripheralextracorporal circulation will limit reperfusion injury after 15 mins of normothermicCA with improved survival and neurologic recovery.METHODS: Eleven pigs (54.9 ± 4.5 Kg BW) were anesthesized and ventilated.Animals were exposed to normothermic ischemia for 15 mins after induction ofventricular fibrillation (VF). Thereafter, either conventional CPR-ALS (controlgroup, n = 4) or peripheral extracorporal circulation (ECC) was started (experimentalgroup, n = 7). In the ECC-group, conditions of reperfusion were controlledregarding pressure, flow and the composition of the reperfusate. ECC was stoppedafter 60 mins and the animals were allowed to regain consciousness. Neurologicassessment followed a scoring system (Neurologic Deficit Score (NDS): 0 = normal;500 = brain death) while MRI and brain histology were performed at the end ofthe experiment (day 7).RESULTS: In the experimental group all (n = 7) animals survived. 6/7 had 100%neurological recovery within 48 hours until day 7 (NDS = 0 ± 0), 1 fully consciouspig was not able to walk. This animal showed an incomplete recovery (NDS = 145)and had to be sacrificed after 30 hours. All animals (n = 7) regained full cardiac,kidney, liver and lung recovery, and only mild changes in ischemia-sensitive brainareaswere revealed by MRI and brain histology. All animals in the control group(n = 4) died within 20 min despite continuous CPR-ALS.CONCLUSION: This study demonstrates for the first time complete functionalneurologic recovery after a period of 15 mins CA. This is in contrast to currentlyused conventional treatment methods, where successful resuscitation has beenreported only after 3–5 mins of CA. This new surgical technique to limit ischemiareperfusioninjury of the whole body including the brain by controlling the conditionsof reperfusion using ECC is a new approach toward survival and functionalrecovery of patients undergoing sudden death.TUESDAYMorning* AATS Member129
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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Boston - American Association for Thoracic Surgery

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