Cardiac Surgery Operations on the Heart and Great Vessels

in Adults and Children

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Gerhard Ziemer
Axel Haverich
Editors

Cardiac Surgery
Operations on the Heart and Great Vessels
in Adults and Children
Editors
Gerhard Ziemer Axel Haverich
Department of Surgery HTTG - Surgery
The University of Chicago Medizinische Hochschule Hannover
Chicago, IL Hannover
USA Germany

ISBN 978-3-662-52670-5     ISBN 978-3-662-52672-9 (eBook)

DOI 10.1007/978-3-662-52672-9

Library of Congress Control Number: 2017939170

© Springer-Verlag Berlin Heidelberg 2017

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 v

Preface

The majority of the various comprehensive the third and latest edition of this German
textbooks available cover either cardiac textbook in 2010 [3].
surgery in adults, mostly synonymous for In the spirit of our German teacher
acquired heart disease, or pediatric cardiac Hans Borst’s honored guest’s address at the
surgery, synonymous for congenital heart 65th Annual Meeting of the American
defects. This separation of the spectrum of Association for Thoracic Surgery in New
cardiac surgery is not appropriate anymore, Orleans 1985: Hands across the ocean,
especially as the majority of children oper- German-­American relations in thoracic
ated for congenital heart disease reach surgery [4], we expanded the project of our
adulthood, potentially needing further sur- German textbook and planned for an
gical attention. On the other hand, although updated English language edition.
a rare phenomenon in the Western world, Among the authors and co-authors
cardiac surgeons have to deal with acquired contributing to the latest German edition
heart disease in children as well. (mainly from Germany, Austria, and Swit-
Surgery and catheter interventions, zerland), many had received at least part of
competing therapeutic strategies in the their specialty and subspecialty training in
beginning, have become complementary: clinical cardiac surgery or research in
interventional valve implantation may be English-­speaking countries, most of them
performed by cardiac surgeons, and aortic in North America, but also in the United
stent implantation is well established in Kingdom, Australia, and South Africa.
the thoracic domain. This development This our first English language edition
also blurred the boundaries of involved entitled Cardiac Surgery: Operations on the
specialties, necessitating close coopera- Heart and Great Vessels in Adults and Chil-
tion not only between cardiologists and dren comprises the view of 71 authors not
cardiac surgeons, but also involving vas- only from 30 German, Austrian, Swiss,
cular surgeons, radiologists, and others. French, and Luxembourgian Cardiac Units,
Furthermore, hybrid procedures per- but also from Boston, MA; Chicago, IL;
formed in parallel or in sequence with Greenville, NC; Houston, TX; Los Angeles,
open surgery and catheter intervention in CA; Miami, FL; Milwaukee, WI; St. Peters-
the same setting by different groups of burg, FL; Toronto, ON; and Washington, DC.
specialists (e.g., surgeons and catheter Starting rather traditionally, with a
interventionalists) have changed the tra- chapter on the history of cardiac surgery,
ditional field of surgery. we continue with risk scores and principles
Only a few textbooks cover such a of quality assurance, followed by quality
broad spectrum of cardiac surgery. Our control in cardiac surgery in the United
predecessors as editors, Hans Georg Borst, States, and an overview of databases in car-
Werner Klinner, and Åke Senning, started diac surgery.
this endeavor, when they published the This introduction is completed with a
first and only German textbook on cardiac section of chapters on technical prerequi-
surgery, “Herz + herznahe Gefäße” 1978 sites for cardiac surgery in which we focus
[1], the year, in which both of us (G.Z. and separately on postoperative critical care for
A.H.) just finished medical school. adults and children. There also is a chapter
For the second edition, published in on tissue engineering in cardiac surgery.
1991, now named “Herzchirurgie” [2], The major part of this book is divided
edited by Hans Borst, Werner Klinner, and into sections on congenital anomalies and
Hellmut Oelert, we could contribute as those for acquired diseases, also ­addressing
junior faculty in our primary fields of minimally invasive cardiac surgery as well as
interest. This led us to become editors of endovascular treatment of aortic diseases.
vi Preface

The publication of this book was signifi- References

cantly delayed due to the sudden death of
our highly valued German Illustrator Rein- 1. Borst HG, Klinner W, Senning A (Hrsg.) (1978)
hold Henkel, who had been responsible for Herz + herznahe Gefäße Kirschnersche allge-
meine und spezielle Operationslehre M.
our anatomical figures before. In memory of
Kirschner (Hsg.) Operationslehre Bd 6. Springer,
him and his longstanding contribution, we Berlin/Heidelberg/New York
had to complete this edition without being 2. Borst HG, Klinner W, Oelert H (Hsg.) (1991) Her-
able to use his artwork throughout. zchirurgie: Die Eingriffe am Herzen und an den
We thank Claus-Dieter Bachem for herznahen Gefaessen 2.Aufl.Kirschnersche
allgemeine und spezielle Operationslehre
serving as our project coordinator and
G.Heberer, R.Pichlmayr (Hsg.) Band VI. Teil 2
Ellen Blasig and Gabriele Schroeder from Springer, Berlin/Heidelberg/New York
Springer as publishing editors. 3. Ziemer G, Haverich A (Hsg.) (2010) Herzchirur-
At the University of Chicago, we had gie. Die Eingriffe am Herzen und an den herz-
native speaker editing support from Liz nahen großen Gefäßen. 3. Aufl. 889 pp., 824
fig.,. Springer, Berlin/Heidelberg/New York
Johnson, Grace Macek, and Melanie Sojka.
4. Borst HG (1985) Hands across the ocean.
Our hope is that this comprehensive German-­ American relations in thoracic sur-
but still concise textbook is suitable not gery. J Thorac Cardiovasc Surg 90:477–489
only for cardiac surgical residents in train-
ing, but may also serve as reference for all
surgeons, physicians, nurses, and techni-
cians caring for patients with heart disease
of any type, at any age.

Gerhard Ziemer
Chicago, IL, USA
Axel Haverich
Hannover, Germany
 vii

Contents

I Introduction
1 The History of Cardiac Surgery............................................................................................. 3
Knut H. Leitz and Gerhard Ziemer

2 Risk Scores in Cardiac Surgery.............................................................................................. 33

Dietmar Boethig and Jeffrey Phillip Jacobs

3 Principles of Quality Assurance and Risk Management Risk............................ 67

Juergen Ennker and Tobias Walker

4 Quality Control in Cardiac Surgery in the United States..................................... 85

Matthias Loebe and Mark G. Davies

5 Databases in Cardiac Surgery................................................................................................ 95

Wolfgang Schiller and Jan F. Gummert

II Technical Prerequisites
6 Extracorporeal Circulation and Myocardial Protection
in Adult Cardiac Surgery........................................................................................................... 111
Christof Schmid

7 Advances in Cardiopulmonary Bypass for the Neonate and Infant............. 153

Richard A. Jonas

8 Cardiovascular Tissue Engineering.................................................................................... 171

Mathias H. Wilhelmi and Axel Haverich

9 Cardiac Surgical Intensive Care............................................................................................ 195

Andreas Markewitz, Axel Franke, René H. Bombien, and Ali Khoynezhad

10 Critical Care in Pediatric Cardiac Surgery...................................................................... 251

Renate Kaulitz, Allison L. Thompson, and Gerhard Ziemer

III Congenital Anomalies of the Heart and Great Vessels

11 Surgery for Congenital Heart Defects: A Historical Perspective.................... 291
Aldo R. Castañeda

12 Anomalous Pulmonary Venous Connections and Congenital

Defects of the Atria, the Atrioventricular Septum,
and the Atrioventricular Valves............................................................................................ 299
Vladimir Alexi-Meskhishvili, Axel Unbehaun, and Roland Hetzer
viii Contents

13 Definite Palliation of Functional Single Ventricle.................................................... 425

Rüdiger Lange and Jürgen Hörer

14 Ventricular Septal Defects....................................................................................................... 463

Markus K. Heinemann

15 Congenital Heart Disease with Anomalies of the Right Ventricular

Outflow Tract..................................................................................................................................... 481
Gerhard Ziemer and Renate Kaulitz

16 Anomalies of the Left Ventricular Outflow Tract....................................................... 531

Viktor Hraška and Joachim Photiadis

17 Surgery for Aortic Atresia, Hypoplastic Left Heart Syndrome,

and Hypoplastic Left Heart Complex................................................................................ 581
Rudolf Mair and Eva Sames-Dolzer

18 Common Arterial Trunk.............................................................................................................. 597

Boulos Asfour and Lennart Duebener

19 Congenitally Corrected Transposition and D-Transposition

of the Great Arteries..................................................................................................................... 607
Sabine H. Daebritz and Michel Ilbawi

20 Congenital Anomalies of the Coronary Arteries and Coronary

Diseases of Children and Adolescents............................................................................. 641
Christoph Haller and Christian Schlensak

21 Congenital Anomalies of the Great Vessels.................................................................. 663

Gerhard Ziemer and Renate Kaulitz

IV Acquired Diseases of the Heart and Great Vessels

22 Coronary Artery Disease........................................................................................................... 721
Jochen T. Cremer, Jan Schöttler, and Grischa Hoffmann

23 Left Ventricular Reconstruction and Conventional Surgery

for Cardiac Failure......................................................................................................................... 743
Friedhelm Beyersdorf and Matthias Siepe

24 Acquired Lesions of the Aortic Valve............................................................................... 759

Martin Misfeld, Efstratios I. Charitos, and Hans-Hinrich Sievers

25 Surgery for Acquired AV-Valve Diseases....................................................................... 795

Parwis B. Rahmanian and Thorsten C. W. Wahlers

26 Minimally Invasive Cardiac Surgery................................................................................. 831

Jens Garbade, Sreekumar Subramanian, and Friedrich-­Wilhelm Mohr
 ix
Contents

27 Aneurysm and Dissection of the Thoracic and

Thoracoabdominal Aorta..................................................................................................... 869
Matthias Karck and Klaus Kallenbach

28 Endovascular Surgical Therapy of Thoracic and Thoracoabdominal

Disease of the Aorta................................................................................................................ 913
Ali Khoynezhad, René H. Bombien, and Aamir Shah

29 Surgical Therapy of Atrial Fibrillation......................................................................... 947

Timo Weimar and Kai-Nicolas Doll

30 Device Therapy of Rhythm Disorders.......................................................................... 965

Heiko Burger, Tibor Ziegelhöffer, and Kai-Nicholas Doll

31 Cardiac Tumors and Pericardial Diseases.................................................................. 995

Christof Schmid

32 Cardiac Injury.............................................................................................................................. 1009

Thierry Carrel

33 Combined Procedures in Cardiac and Vascular Surgery................................. 1017

Heinz G. Jakob and Stephan C. Knipp

34 Combined Cardiac and Thoracic Surgery.................................................................. 1033

Mark K. Ferguson

35 Pulmonary Embolectomy and Pulmonary

Thromboendarterectomy.................................................................................................... 1041
Stein Iversen

36 Lung Transplantation............................................................................................................. 1061

Clemens Aigner and Walter Klepetko

37 Heart and Heart–Lung Transplantation..................................................................... 1079

Bruno Meiser and Bruno Reichart

38 Cardiac Assist Devices and Total Artificial Heart.................................................. 1103

Reiner Koerfer, Sotirios Spiliopoulos, and Gero Tenderich

39 Postoperative Sternal Complications.......................................................................... 1129

Christof Schmid and Shahab A. Akhter

Service Part
Index.................................................................................................................................................... 1139
 xi

Contributors

Clemens Aigner, MD, MBA, FETCS Aldo R. Castañeda, MD, PhD

Department of Thoracic Surgery Emeritus, Department of Pediatric Cardiac
Medical University of Vienna Surgery
Vienna, Austria Boston Children’s Hospital/
Harvard Medical School
Shahab Akhter, MD
Boston, MA, USA
Division of Cardiac Surgery,
Department of Cardiovascular Sciences Efstratios I. Charitos, MD, PhD
East Carolina Heart Institute Department of Cardiac
at East Carolina University and Thoracic Vascular Surgery
Greenville, NC, USA University Hospital Schleswig-Holstein
Lübeck, Schleswig-Holstein, Germany
Vladimir Alexi-Meskhishvili, MD, PhD
Department of Cardiac, Thoracic, and Vascular Jochen T. Cremer, MD, PhD
Surgery, German Heart Center Berlin Department of Cardiac and Vascular Surgery
Berlin, Berlin, Germany University Hospital Schleswig-Holstein
Kiel, Schleswig-Holstein, Germany
Boulos Asfour, MD, PhD
Department of Congenital Heart Surgery, Sabine H. Daebritz, MD, PhD
German Pediatric Heart Center Department of Cardiovascular Surgery
Sankt Augustin, North Rhine-Westphalia, Heart Center Duisburg, Duisburg
Germany North Rhine-Westphalia, Germany

Friedhelm Beyersdorf, MD, PhD Mark G. Davies, MD, PhD, MBA

Division Cardiac and Vascular Surgery Department of Cardiovascular Surgery
University Heart Center Vascular Surgery Training Programs
University of Freiburg, The Methodist Hospital
Freiburg, Baden-Württemberg, Houston, TX, USA
Germany
Kai-Nicolas Doll, MD, PhD
Dietmar Boethig, MD, PhD, MS Sana Cardiac Surgery Stuttgart
Department Cardiac, Thoracic, Stuttgart, Baden-Württemberg, Germany
Transplantation, and Vascular Surgery
Lennart Duebener, MD, PhD
Hannover Medical School
Department of Congenital Heart Surgery
Hannover, Lower Saxony, Germany
German Pediatric Heart Center
René H. Bombien, MD, PhD Sankt Augustin, North Rhine-Westphalia,
Division of Cardiothoracic Surgery Germany
Cedars-Sinai Medical Center
Juergen Ennker, MD, PhD
Los Angeles, CA, USA
Heart Center
Heiko Burger, MD Heliosklinikum Siegburg
Department of Cardiac Surgery Siegburg, North Rhine-Westphalia,
Kerckhoff-Klinik Germany
Bad Nauheim, Hessen, Germany
Mark K. Ferguson, MD
Thierry Carrel, MD, PhD Division Cardiac and Thoracic Surgery,
Clinic for Cardiac and Vascular Surgery Department of Surgery
University Hospital Berne The University of Chicago
Berne, Switzerland Chicago, IL, USA
xii Contributors

Axel Franke, MD, PhD Michel Ilbawi, MD

Department for Cardiovascular Surgery Department of Pediatric
Central Military Hospital Cardiovascular Surgery
Koblenz, Rhineland-Palatinate, Advocate Children’s Hospital
Germany Oak Lawn, IL, USA

Jens Garbade, MD, PhD Stein Iversen, MD, PhD

Department of Cardiac Surgery Klinik Für Kardiovaskularchirurgie
Heart Center, University of Leipzig Heliosklinikum Siegburg
Leipzig, Saxonia, Germany Siegburg, North Rhine-Westphalia, Germany

Jan F. Gummert, MD, PhD Jeffrey Ph. Jacobs, MD, FACS, FACC
Department of Thoracic Johns Hopkins All Children’s Heart Surgery
and Cardiovascular Surgery Johns Hopkins All Children’s Heart Institute
HDZ NRW – Ruhr University Bochum Saint Petersburg, FL, USA
Bad Oeynhausen, North Rhine - Westphalia,
Heinz G. Jakob, MD, PhD
Germany
Department of Thoracic
Christoph Haller, MD and Cardiovascular Surgery
Division of Cardiovascular Surgery West German Heart Center Essen
The Hospital for Sick Children University of Duisburg-Essen
Toronto, ON, Canada Essen, North Rhine-Westphalia, Germany

Axel Haverich, MD, PhD Richard A. Jonas, MD

Department Cardiac, Thoracic, Department of Cardiac Surgery
Transplantation, and Vascular Surgery Children’s National Heart Institute
Hannover Medical School Children’s National Medical Center
Hannover, Lower Saxony, Germany Washington, DC, USA

Markus K. Heinemann, MD, PhD Klaus Kallenbach, MD, PhD

Department of Cardiac, Department of Cardiac Surgery
Thoracic, and Vascular Surgery INCCI Haerz Zenter
University of Mainz Medicine Luxembourg City, Luxembourg
Mainz, Rhineland - Palatinate, Germany
Matthias Karck, MD, PhD
Roland Hetzer, MD, PhD Department of Cardiac Surgery
Emeritus, Department of Cardiac, Thoracic, University Hospital Heidelberg
and Vascular Surgery Heidelberg, Baden-Württemberg,
German Heart Center Berlin Germany
Berlin, Berlin, Germany
Renate Kaulitz, MD, PhD
Grischa Hoffmann, MD Division Pediatric Cardiology and Pediatric
Department of Cardiac and Intensive Care Medicine
Vascular Surgery Tübingen University Children’s Hospital
University Hospital Schleswig-Holstein Tübingen, Baden-Württemberg,
Kiel, Schleswig-­Holstein, Germany Germany

Jürgen Hörer, MD, PhD Ali Khoynezhad, MD, PhD, FACS, FACC
Department of Congenital Heart Disease Division of Cardiothoracic Surgery
Hopital Marie Lannelongue Department of Surgery
Les Plessis Robinson, France Cedars-Sinai Medical Center
Los Angeles, CA, USA
Victor Hraška, VH, MD, PhD
Pediatric Heart Surgery Walter Klepetko, MD, PhD
Herma Heart Center Department of Thoracic Surgery
Children’s Hospital of Wisconsin Medical University of Vienna
Milwaukee, WI, USA Vienna, Austria
 xiii
Contributors

Stephan C. Knipp, MD Friedrich-Wilhelm Mohr, MD, PhD

Department of Thoracic Department of Cardiac Surgery
and Cardiovascular Surgery Heart Center, University of Leipzig
West German Heart Center Essen Leipzig, Saxonia, Germany
University of Duisburg-Essen
Joachim Photiadis, JP, MD, PhD
Essen, North Rhine-Westphalia,
Department of Surgery for Congenital Heart
Germany
Disease-Pediatric Cardiac Surgery
Reiner Koerfer, MD, PhD German Heart Center Berlin
Department for Surgical Treatment Berlin, Berlin, Germany
of Endstage Heart Failure
Parwis B. Rahmanian, MD, PhD
and Mechanical Circulatory Support
Department of Thoracic
Evangelisches und Johanniter
and Cardiovascular Surgery
Klinikum Niederrhein
Heart Center, University of Cologne
Duisburg, North Rhine-Westphalia, Germany
Cologne, North Rhine-Westphalia, Germany
Rüdiger Lange, MD, PhD
Bruno Reichart, MD, PhD
Department of Cardiovascular Surgery
Consortium Xenotransplantation
German Heart Center Munich
German Research Foundation Transplant Center
Munich, Bavaria, Germany
University of Munich
Knut H. Leitz, MD, PhD Munich, Bavaria, Germany
Emeritus, Department of Thoracic, Heart
Eva Sames-Dolzer, MD
and Vascular Surgery
Department of Cardiac, Vascular,
Krankenhaus Links der Weser
and Thoracic Surgery
Bremen, Bremen, Germany
General Hospital Linz/University Hospital III
Mattthias Loebe, MD, PhD Linz, Austria
Division of Heart and Lung
Wolfgang Schiller, MD
Transplantation and VAD
Division of Cardiac Surgery
Department of Surgery
Department of Surgery
University of Miami/Jackson Memorial Hospital
University Hospital of Bonn
Miami, FL, USA
Bonn, North Rhine-Westphalia, Germany
Rudolf Mair, MD, PhD
Christian Schlensak, MD, PhD
Department of Cardiac, Vascular,
Department of Thoracic,
and Thoracic Surgery
Cardiac, and Vascular Surgery
General Hospital Linz/University Hospital III
University Hospital Tübingen
Linz, Austria
Tübingen, Baden-Württemberg, Germany
Andreas Markewitz, MD, PhD, Col.
Christof Schmid, MD, PhD
Department for Cardiovascular Surgery
Department of Cardiothoracic Surgery
Central Military Hospital
University Medical Center Regensburg
Koblenz, Rhineland - Palatinate,
Regensburg, Bavaria, Germany
Germany
Jan Schöttler, MD, PhD
Bruno Meiser, MD, PhD
Department of Cardiac and Vascular Surgery
Transplant Center Munich
University Hospital Schleswig-Holstein
University of Munich Medical Center
Kiel, Schleswig-­Holstein, Germany
Munich, Bavaria, Germany
Aamir Shah, BA, MD
Martin Misfeld, MD, PhD
Divisions of Cardiothoracic
Department of Cardiac Surgery
and Vascular Surgery
Heart Center
Department of Surgery
University of Leipzig
Cedars-­Sinai Medical Center
Leipzig, Saxonia, Germany
Los Angeles, CA, USA
xiv Contributors

Mathias Siepe, MD, PhD Axel Unbehaun, MD, PhD

Division Cardiac and Vascular Surgery Department of Cardiac, Thoracic, and Vascular
University Heart Center Surgery, German Heart Center Berlin
University of Freiburg Berlin, Berlin, Germany
Freiburg, Baden-Württemberg
Thorsten C.W. Wahlers, MD, PhD
Germany
Department of Thoracic
Hans-Hinrich Sievers, MD, PhD and Cardiovascular Surgery
Department of Cardiac Heart Center, University of Cologne
and Thoracic Vascular Surgery Cologne, North Rhine - Westphalia, Germany
University Hospital Schleswig-Holstein
Tobias Walker, MD, PhD
Lübeck, Schleswig-­Holstein, Germany
Department of Thoracic,
Sotirios Spiliopoulos, MD Cardiac, and Vascular Surgery
Division Cardiac Surgery University Hospital Tübingen
Department of Surgery Tübingen, Baden-Württemberg, Germany
Medical University Graz
Timo Weimar, MD
Graz, Austria
Sana Cardiac Surgery Stuttgart
Sreekumar Subramanian, MD Stuttgart, Baden-Württemberg, Germany
Department of Heart Surgery
Mathias H. Wilhelmi, MD, PhD
Heart Center, University of Leipzig
Department Cardiac, Thoracic,
Leipzig, Saxonia, Germany
Transplantation, and Vascular Surgery
Gero Tenderich, MD, PhD Hannover Medical School
Department for Surgical Treatment Hannover, Lower Saxony, Germany
of Endstage Heart Failure
Tibor Ziegelhöffer, MD, PhD
and Mechanical Circulatory Support
Department of Cardiac Surgery
Evangelisches und Johanniter
Kerckhoff-­Klinik
Klinikum Niederrhein Duisburg,
Bad Nauheim, Hessen, Germany
North Rhine-Westphalia, Germany
Gerhard Ziemer, MD, PhD
Allison L. Thompson, PharmD, BCPS
Division Cardiac and Thoracic Surgery
Department of Pharmacy
­Department of Surgery
University of Chicago Medicine
The University of Chicago
Chicago, IL, USA
Chicago, IL, USA
 1 I

Introduction
Contents

Chapter 1 The History of Cardiac Surgery – 3

Chapter 2 Risk Scores in Cardiac Surgery – 33

Chapter 3 Principles of Quality Assurance and Risk

Management Risk – 67

Chapter 4 Quality Control in Cardiac Surgery

in the United States – 85

Chapter 5 Databases in Cardiac Surgery – 95

 3 1

The History of Cardiac

Surgery
Knut H. Leitz and Gerhard Ziemer

1.1 From the Beginning – 5

1.2 Operations on the Pericardium – 6

1.3 Trendelenburg’s Pulmonary

Thromboembolectomy – 7

1.4 Resection of a Right Ventricular Aneurysm

by Sauerbruch (1931) – 7

1.5 The First Successful Ligatures of a Patent

Arterial Duct by Robert Edward Gross
(1905–1988) in the United States
and by Emil Karl Frey (1888–1977)
in Germany – 7

1.6 Blocked Developments

and Missed Opportunities – 9
1.6.1 Endotracheal Intubation – 9
1.6.2 Cardiac Catheterization – 11
1.6.3 Decline of German Surgery Pre-World War II – 11

1.7 Heart Valve Surgery in the Time

Before Extracorporeal Circulation – 12

1.8 History of Extracorporeal Circulation – 13

1.9 Development of Heart Valve Surgery in the Era

of Extracorporeal Circulation – 16

1.10 Development of Coronary Surgery – 18

© Springer-Verlag Berlin Heidelberg 2017

G. Ziemer, A. Haverich (eds.), Cardiac Surgery, DOI 10.1007/978-3-662-52672-9_1