Roland Hetzer – författare

This is an open access book.Beside the fascination in the feasibility and the remarkable advances in the impressive development of transplantation medicine, it is beset with a considerable issues and concerns which still remain to be addressed to in a meaningful context: equity in organ allocation, the contradiction between a high acceptance of organ donation in the German society according to surveys and the low willingness to give consent, and deficit in reporting possible organ donors from the hospital.With informed consent as a useful legal frame, this likewise impels the next of kin to make a decision for or against organ donation during the grueling moments at the bedside of their beloved moribund relative. What layouts in the healthcare system as well as in legal and ethical structures can promote or obviate organ donation as an indispensable essential for a transplantation? Is xenotransplantation a hopeful alternative to human organ transplantation?With remarkable accuracy and elaborate knowledge, this book offers an interesting and absorbing yet provocative evidence-based avenue, of expounding into these questions. Although based on German experience, it will provide a valuable and updated governance to all those who, even in other countries, for private or professional interests, want to be informed and comprehensively reckon with the diverse medical, ethical, organizational, political and economic facets of an extraordinary field of medicine.

Beside the fascination in the feasibility and the remarkable advances in the impressive development of transplantation medicine, it is beset with a considerable issues and concerns which still remain to be addressed to in a meaningful context: equity in organ allocation, the contradiction between a high acceptance of organ donation in the German society according to surveys and the low willingness to give consent, and deficit in reporting possible organ donors from the hospital.With informed consent as a useful legal frame, this likewise impels the next of kin to make a decision for or against organ donation during the grueling moments at the bedside of their beloved moribund relative. What layouts in the healthcare system as well as in legal and ethical structures can promote or obviate organ donation as an indispensable essential for a transplantation? Is xenotransplantation a hopeful alternative to human organ transplantation?With remarkable accuracy and elaborate knowledge, this book offers an interesting and absorbing yet provocative evidence-based avenue, of expounding into these questions. Although based on German experience, it will provide a valuable and updated governance to all those who, even in other countries, for private or professional interests, want to be informed and comprehensively reckon with the diverse medical, ethical, organizational, political and economic facets of an extraordinary field of medicine.This is an open access book.

CARDIAC VALVE ALLOGRAFTS (HOMOGRAFTS) highlights the current controversy about freehand subcoronary aortic valve and root replacement with regard to postoperative morbidity and long term durability. It discusses particular implantation techniques of preference in young patients and in different root pathology. Other chapters address intermediate- and long-term results on cardiac valve and vascular homografts for treating complicating cardiac valve and aortic infections.The chapter on basic science additionally makes this book a highly authoritative reference source for cardiac surgeons, physicians and scientists.This work provides a current survey of the state-of-the-art.

CARDIAC VALVE ALLOGRAFTS (HOMOGRAFTS) highlights the current controversy about freehand subcoronary aortic valve and root replacement with regard to postoperative morbidity and long term durability. It discusses particular implantation techniques of preference in young patients and in different root pathology. Other chapters address intermediate- and long-term results on cardiac valve and vascular homografts for treating complicating cardiac valve and aortic infections.The chapter on basic science additionally makes this book a highly authoritative reference source for cardiac surgeons, physicians and scientists.This work provides a current survey of the state-of-the-art.

Marfan Syndrome is a hereditary disorder of connective tissue which primarily affects the eyes, skeleton, blood vessels, and various structures of the heart. Since 1943, when the cardiovascular manifestations of Marfan Syndrome were first described, understanding of its nature, diagnostic tools, and surgical treatment have been remarkably improved. Although the specific surgical procedures have reached an advanced standard and general acceptance, many questions remain unanswered and have given rise to ongoing controversy. Cardiovascular Aspects of Marfan Syndrome presents the advances in understanding the cause and pathogenesis of Marfan Syndrome and its current specific surgical therapy.

Marfan Syndrome is a hereditary disorder of connective tissue which primarily affects the eyes, skeleton, blood vessels, and various structures of the heart. Since 1943, when the cardiovascular manifestations of Marfan Syndrome were first described, understanding of its nature, diagnostic tools, and surgical treatment have been remarkably improved. Although the specific surgical procedures have reached an advanced standard and general acceptance, many questions remain unanswered and have given rise to ongoing controversy. Cardiovascular Aspects of Marfan Syndrome presents the advances in understanding the cause and pathogenesis of Marfan Syndrome and its current specific surgical therapy.

Advances in heart surgical treatment have been impressive in the last 15 years. In end-stage heart disease, procedures are now performed routinely which were only experimental one or two decades ago. Heart transplantation has become a well-established procedure. According to the Gen­ eral Registry of the International Society of Heart and Lung Transplantation. 40,738 heart transplantations had been performed through the end of 1997 with survival rates of 78 % at one year, 65 % at five years, and 42 % at ten years. The progress in this field has been due to intense efforts in understanding and modulating immune responses to the trans­ planted heart, to elaborate therapeutic strategies to constrain infections, and to improved out-patient care. Accordingly, heart transplantation is integrated into the facilities of the health care systems, the routine of physicians, and the awareness of patients. The resulting increase in potential organ recipients has not been met, however, by an equivalent increase of available donor organs. This increasing discrepancy has forced the technical improvement and clinical evalua­ tion of mechanical circulatory support systems as an option for treatment of critically ill patients with a failing heart. Initially, these assist devices were only used to maintain sufficient circulation in post-cardiotomy heart failure until myocardial function had recov­ ered. Since the late 1980s, their primary use has been that of bridging patients with heart failure until a suitable organ is available so that heart transplantation can be performed.

Advances in heart surgical treatment have been impressive in the last 15 years. In end-stage heart disease, procedures are now performed routinely which were only experimental one or two decades ago. Heart transplantation has become a well-established procedure. According to the Gen­ eral Registry of the International Society of Heart and Lung Transplantation. 40,738 heart transplantations had been performed through the end of 1997 with survival rates of 78 % at one year, 65 % at five years, and 42 % at ten years. The progress in this field has been due to intense efforts in understanding and modulating immune responses to the trans­ planted heart, to elaborate therapeutic strategies to constrain infections, and to improved out-patient care. Accordingly, heart transplantation is integrated into the facilities of the health care systems, the routine of physicians, and the awareness of patients. The resulting increase in potential organ recipients has not been met, however, by an equivalent increase of available donor organs. This increasing discrepancy has forced the technical improvement and clinical evalua­ tion of mechanical circulatory support systems as an option for treatment of critically ill patients with a failing heart. Initially, these assist devices were only used to maintain sufficient circulation in post-cardiotomy heart failure until myocardial function had recov­ ered. Since the late 1980s, their primary use has been that of bridging patients with heart failure until a suitable organ is available so that heart transplantation can be performed.

Imaging of the aortic root.- Perioperative imaging for assessing aortic and mitral valve diseases and surgical procedures.- Innovations in aortic valve surgery.- The aortic root.- Percutaneous transluminal aortic valve replacement: The CoreValve prosthesis.- Transapical aortic valve implantation - A truly minimally invasive option for high-risk patients.- From minimally invasive to percutaneous aortic valve replacement.- Sutureless equine aortic valve replacement.- The Ross operation: Aortic valve and root replacement with pulmonary autograft.- Pulmonary autograft or aortic allograft for surgical treatment of active infective aortic valve endocarditis: a review of the literature.- The Ross operation: two decades of clinical experience.- Aortic valve repair and valve sparing root procedures.- The bicuspid aortic valve.- From dynamic anatomy to conservative aortic valve surgery: the tale of the ring.- Yacoub/David techniques for aortic root operation: success and failures.- Aortic annuloplasty.- Correction of aortic valve incompetence combined with ascending aortic aneurysm by relocation of the aortic valve plane through a short-length aortic graft replacement.- Using BioGlue to achieve hemostasis in aortic root surgery.- Endocarditis.- Challenges in the surgical management of infective endocarditis.- Clinical results of the Shelhigh® stentless bioprosthesis in patients with active infective endocarditis:.- Double valve endocarditis and evolving paraannular abscess formation.- Aortic root abscess: reconstruction of the left ventricular outflow tract and allograft aortic valve and root replacement.- Implantation techniques of freehand subcoronary aortic valve and root replacement with a cryopreserved allograft for aortic root abscess.- Surgery for atrial fibrillation.- Cryoablation for the treatment of atrial fibrillation in patients undergoing minimally invasive mitral valve surgery.- Minimally invasive endoscopic ablation on the beating heart in patients with lone atrial fibrillation.- Hemodynamic evaluation of the bioprosthetic aortic valves.- Evaluation of bioprosthetic valve performance as a function of geometric orifice area and space efficiency- A reliable alternative to effective orifice area.- Long-term results of biological valves.- Stented and stentless aortic bioprostheses: competitive or complimentary?.- Edwards Prima Plus Stentless Bioprosthesis: Long-term clinical and hemodynamic results.- The Cryo-Life O'Brien stentless valve: 1991-2008.- Medtronic stentless Freestyle® porcine aortic valve replacement.- The ATS 3f Aortic Bioprosthesis.- The Vascutek Elan stentless porcine prosthesis - The Glasgow experience.- Sorin pericardial valves.- The changing role of pericardial tissue in biological valve surgery: 22 years' experience with the Sorin Mitroflow stented pericardial valve.- 20 years' durability of Carpentier-Edwards Perimount stented pericardial aortic valve.- Twenty-year experience with the St. Jude Medical Biocor bioprosthesis in the aortic position.- 20-Year durability of bioprostheses in the aortic position.- Clinical results including hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis up to ten years.- Aortic root replacement with the BioValsalva prosthesis.- Valve replacement in renal dialysis patients: bioprostheses versus mechanical prostheses.- Replacement of bioprostheses after structural valve deterioration.- Predictors of patient's outcome.- Predicted outcomes after aortic valve replacement in octogenarians with aortic stenosis.- Predicted patient outcome after bioprosthetic AVR and the Ross operation.- Anticoagulation.- Anticoagulation and self-management of INR: mid-term results.- Tissue engineering.- Biomatrix-polymer hybrid material for heart valve tissue engineering.- Standards for the in vitro fabrication of heart valves using human umbilical cord cells.- Tissue engineering with a decellularized valve matrix.- Regularatory issues on tissue valves.- Human tissues for car

This volume highlights the controversy about freehand subcoronary aortic valve and root replacement with regard to postoperative morbidity and long-term durability. It discusses particular implantation techniques of preference in young patients and in different root pathology. Other chapters address intermediate- and long-term results on cardiac valve and vascular homografts for treating complicating cardiac valve and aortic infections.

Surgical options for the treatment of degenerative, ischemic, inflammatory, and functional mitral valve diseases have expanded greatly in recent decades. Still, a dilemma exists with employing prosthetic mitral valves – in that mechanical valves exhibit good durability but require anticoagulation versus the unpredictable durability of biological valve prostheses. Over the past few years, it has become clear that reconstruction of the mitral valve with autologous tissues effectively addresses this dilemma, with no need for anticoagulation and excellent durability, combining the best qualities of both prosthetic options without the disadvantages. Moreover, newer repair strategies, such as autologous pericardial leaflet augmentation and artificial choral replacement have expanded reparative approaches into virtually all pathologies, with excellent long-term results as compared to prosthetic valve replacement. At present, mitral repair is becoming the dominant procedure for treatment of virtually all patients with mitral valve disease. This book is designed to illustrate contemporary and sometimes diverse surgical techniques for various types of mitral valve repair with contributions from many of the leaders in the field.Mitral Valve Repair and the recently published Aortic Root Surgery are book publications arising from the Berlin Heart Valve Symposium 2008 entitled “ The Biological Solution”. The Mitral Valve Repair session was postponed to June 2009 and was featured as the Berlin Mitral Valve Symposium at the joint meeting of the Society for Heart Valve Diseases and the Heart Valve Society of America in Berlin. The book contains a collection of proceedings on current techniques and outcomes of mitral valve repair by many of the experts in this field which provide an authoritative reference source for cardiac surgeons, family practitioners and clinicians.

The surgical results of bioprosthetic aortic valve replacement in the 1960s and 1970s were not very satisfactory. The search for the ideal substitute for the diseased aortic valve led Donald Ross to develop the concept of the aortic allograft in 1962 and the pulmonary autograft in 1967 for subcoronary implantation, and later, in 1972, as a full root for replacing the aortic root in the infected aortic valve with a root abscess. The aortic al- graft and pulmonary autograft surgical procedures were revo- tionary in the history of cardiac valve surgery in the last m- lennium because they compete well with the bioprosthesis, are nonthrombogenic (thus, requiring no postoperative anticoa- lation), are resistant to infection, restore the anatomic units of the aortic or pulmonary outflow tract, and offer unimpeded blood flow and excellent hemodynamics, giving patients a b- ter prognosis and quality of life. Surgery for congenital, degenerative, and inflammatory aortic valve and root diseases has now reached a high level of maturity; yet an ideal valve for valve replacement is not available.The- fore, surgeons are focusing their skills and their clinical and s- entific knowledge on optimizing the technical artistry of val- sparing procedures.