Michael Schmoeckel

Klinikum Großhadern der LMU · Herzchirurgische Klinik und Poliklinik

Cardiac xenotransplantation has seen remarkable success in recent years and is emerging as the most promising alternative to human cardiac allotransplantation. Despite these achievements, acute vascular rejection still presents a challenge for long-term xenograft acceptance and new insights into innate and adaptive immune responses as well as detai...

Zusammenfassung Die Transplantation genetisch veränderter Schweineherzen und -nieren kann in den nächsten Jahren eine Lösung für den bestehenden Mangel an Organspendern darstellen. Fortschritte im Bereich des „Genetic Engineering“, aber auch verbesserte Organpräservationstechniken, eine Immunsuppression mit Kostimulationsblockade (Anti-CD40/CD40L-m...

Intraoperative antithrombotic drug removal by haemoadsorption is a novel strategy to reduce perioperative bleeding in patients on antithrombotic drugs undergoing cardiac surgery. The international STAR registry reports real-world clinical outcomes associated with this application. All patients underwent cardiac surgery before completing the recomme...

This report comprises the contents of the presentations and following discussions of a workshop of the German Heart Transplant Centers in Martinsried, Germany on cardiac xenotransplantation. The production and current availability of genetically modified donor pigs, preservation techniques during organ harvesting, and immunosuppressive regimens in...

Heart transplantation is widely regarded as the most effective and durable treatment option for patients with advanced/terminal cardiac failure. However, the need for organs by far surmounts the donations and the corresponding long waiting lists carry a considerable mortality. Currently, mechanical assist devices are the major alternative, but they...

Objectives Patients on ticagrelor undergoing urgent cardiac surgery are at high risk for perioperative bleeding complications. We sought to determine whether intraoperative hemoadsorption could remove ticagrelor and lower circulating drug concentrations. Methods The hemoadsorption device was incorporated in the cardiopulmonary bypass (CPB) circuit...

Purpose: To analyse the outcome of coronary artery bypass grafting (CABG) in octogenarians with coronary multivessel disease and the impact of different graft strategies and other factors. Methods: Out of 1654 patients with multivessel disease who underwent CABG at our institution between January 2014 and March 2020, we investigated 225 consecutive...

Remarkable progress has been made in the pharmacological management of patients with cardiovascular disease, including the frequent use of antithrombotic agents. Nonetheless, bleeding complications remain frequent and potentially life-threatening. Therapeutic interventions relying on prompt antithrombotic drug reversal or removal have been develope...

Background: Patients on direct oral anticoagulants are at high risk of perioperative bleeding complications. We analyzed the results of intraoperative hemoadsorption (HA) in patients undergoing cardiac surgery who were also on concurrent therapy with apixaban. Methods: we included 25 consecutive patients on apixaban who underwent cardiac surgery...

Background Intraoperative hemadsorption is indicated for ticagrelor and rivaroxaban removal in patients undergoing urgent cardiac surgery and has been previously shown to reduce bleeding complications. However, whether this application is cost effective is currently unknown. Methods Between June 2017 and June 2021, we evaluated the outcomes of 72...

Background: Antithrombotic drugs increase the risk of bleeding, especially in patients who need urgent surgery without an adequate wash-out period. This review aims to evaluate perioperative bleeding complications in patients on dual antiplatelet therapy (DAPT) or direct-acting oral anticoagulants (DOACs) undergoing high-bleeding risk cardiovascul...

Objectives: There are disparities in the adherence to guideline-recommended therapies after coronary artery bypass graft (CABG). We therefore sought to evaluate the effect of guideline-adherent medical secondary prevention on 1-year outcome after CABG. Methods: Data were taken from the randomized 'Ticagrelor in CABG' trial. From April 2013 until...

Objective: To analyze the results of hemoadsorption in patients with cardiac surgery to thoracic aortic surgery, who had been loaded beforehand with either Factor Xa inhibitor rivaroxaban or P2Y12 receptor antagonist ticagrelor. Methods: We investigated 21 of 171 consecutive patients (median age 71 [interquartile range 62, 76] years) who underwe...

Background: Atrial fibrillation is the most common type of cardiac arrhythmia; the lifetime risk for a 55-year-old person to develop atrial fibrillation is 37%. In recent years, years there have been various distinct changes in the clinical management of AF. Methods: This review is based on a selective search for literature on the treatment of A...

Background: Atrial fibrillation is the most common type of cardiac arrhythmia; the lifetime risk for a 55-year-old person to develop atrial fibrillation is 37%. In recent years, there have been various distinct changes in the clinical management of AF. Methods: This review is based on a selective search for literature on the treatment of AF and the...

Objectives We aimed to describe the feasibility of a surgical left thoracotomy for catheter ablation of scar-related ventricular tachycardia (VT) in patients with inaccessible pericardial access.Background Pericardial adhesion due to prior cardiac surgery or previous epicardial ablation procedures limits epicardial access in patients with drug-refr...

Objectives: Both balloon-expandable and self-expanding transcatheter aortic valves are used for transcatheter aortic valve implantation (TAVI). We compared procedural and clinical outcome variables of Sapien 3 and Evolut R/Pro in an all-comers collective. Methods: In this single-center registry, patients were consecutively treated with the Sapie...

Aims: Failure of Transcatheter Mitral Valve Repair (fTMVR) therapy has a decisive prognostic influence, and complex retreatment is of higher risk. The aim of this analysis is to evaluate the survival outcome of percutaneous procedures and surgery after unsuccessful TMVR interventions for different etiologies. Methods and results: Of 824 consecut...

Bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG) has traditionally been limited. This review looks at the recent outcome data on BIMA in CABG focusing on the management of risk factors for mediastinitis, one of the potential barriers for more extensive BIMA utilization. A combination of pre-, intra- and postoperati...

Background: Tumors invading the inferior vena cava (IVC) and hepatic veins pose a challenge for surgeons. Hannoun et al.1 were able to show that the resection of these tumors can be done under hypothermia in the Ante-Situm position. Additionally, not only the localization of the tumor but the remaining volume of the remnant liver (FLR) needs to be...

Aims We sought to assess the impact of different manifestations of heart failure (HF) at baseline on the short- and long-term outcomes of transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). Methods and results Of 361 patients undergoing TAVI between May 2013 and April 2015, 185 (51%) showed clinical signs of HF at the time of...

Background: The purpose of this study was to analyze the results of Cytosorb (CytoSorbents, Monmouth Junction, NJ) adsorption during emergency open heart operations in patients at high risk of bleeding due to treatment with coagulation-active substances. Methods: We investigated 55 consecutive patients (median age 70 years; interquartile range:...

Aims: The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing coronary artery bypass grafting (CABG) is unclear. We prospectively compared the efficacy of ticagrelor and aspirin after CABG. Methods and results: We randomly assigned in double-blind fashion patients scheduled for C...

Background According to current guidelines, acute pericarditis is an inflammatory pericardial syndrome with or without pericardial effusion. Case Description We report on a patient who was treated for purulent pericarditis and developed a fistula from the ascending aorta to the right ventricle (RV), leading to cardiac decompensation. Operative clos...

Background: There is a growing interest in using negative pressure wound therapy in closed surgical incision to prevent wound complications which continue to persist following surgery despite advances in infection measures. Objectives: To estimate the cost-effectiveness of single use negative pressure wound therapy (sNPWT) compared to standard o...

This article explores the significance of Melanchthon for the development of modern contract doctrine. In 1521 and 1525 Melanchthon regarded private settlements as the sole way for free and equal subjects to create binding law among them. Although his reasoning was the necessary fruit of his theology, he drew on Aristotle to enhance the persuasiven...

Objective: To assess the results of catheter-based and surgical reintervention in primary mitral regurgitation (PMR) after failed MitraClip therapy. Methods: We report on 21 consecutive symptomatic patients with PMR (median age 78 years) who underwent either repeat MitraClip therapy (n=7) or mitral valve surgery (n=14) after failure of the index...

Aims: Conduction abnormalities (CA), in particular complete atrioventricular block (CAVB), requiring permanent pacemaker (PPM) implantation, are frequent complications after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). However, the potential mechanisms are still incompletely understood. The objective...

Background: To analyze the results of open-heart surgery and bleeding complications after administration of novel oral anticoagulants (NOAC). Methods: We investigated 81 consecutive patients (age: 74 [IQR 68, 78] years) who underwent open-heart operations at our institution between July 2014 and June 2016. All patients presented for surgery whil...

Aims Antegrade-transseptal approach to treat left ventricular tachyarrhythmia (LVT) is useful and widespread. Meanwhile, Mitraclip has been recently introduced as an alternative to mitral valve surgery for severe mitral regurgitation, usually coexisting with ventricular arrhythmias. However, data on the antegrade approach for mapping and ablating L...

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Background:MitraClip (MC) therapy is a percutaneous treatment option for surgical high-risk patients with both degenerative (DMR) and functional mitral regurgitation (FMR). We compared the acute hemodynamic outcomes of MC therapy in DMR and FMR patients. Methods:A total of 339 successfully treated patients (77 ± 9 years; 215 men [63%]; 129 DMR [38%...

Background: For patients with coronary artery disease undergoing coronary bypass surgery, acetylsalicylic acid (ASA) currently represents the gold standard of antiplatelet treatment. However, adverse cardiovascular event rates in the first year after coronary artery bypass grafting (CABG) still exceed 10%. Graft failure, which is predominantly med...

Objectives: The aim of this study was to assess the 1-year outcome after transcatheter aortic valve replacement (TAVR) of the Direct Flow Medical (DFM) valve in patients with severe symptomatic aortic stenosis who were contraindicated or high risk for surgery. Background: The DFM transcatheter heart valve is a new-generation, nonmetallic aortic...

Background: As a step towards clinical cardiac xenotransplantation, our experimental heterotopic intrathoracic xenotransplantation model offers a beating and ejecting donor heart while retaining the recipient's native organ as a backup in case of graft failure. Clinically applicable immunosuppressive regimens (IS) were investigated first, then tre...

Background: This study analyzed the results of atrial fibrillation (AF) ablation concomitant to open heart operations using continuous monitoring. Methods: We investigated 70 consecutive patients (mean age, 72.1 ± 6 years; European System for Cardiac Operative Risk Evaluation II: 9.7% ± 8.2%) who underwent AF ablation concomitant to cardiac oper...

Background: The objective of this study was to analyze the results of open heart mitral valve operations for survival prediction in patients with previously unsuccessful MitraClip procedures. Methods: Thirty-three consecutive patients who underwent mitral valve surgery in our institution were studied. At a median of 41 days, they had previously...

Topical hemostatic agents that can seal tissues and assist in the coagulation cascade of patients undergoing surgery have been readily available for several decades. Using either synthetic or animal/plant-derived materials, these agents represent a powerful tool to reduce postoperative bleeding complications in cases where mechanical or energy-driv...

Background: Graft survival is the most important factor for morbidity and mortality in cardiac transplantation. Improved immunosuppression significantly reduced early graft rejection. However, acute rejection may predispose to chronic rejection. Targeting both phases of the recipient's immune-reactivity by means of long-acting recombinant adeno-as...

Aims: To report the first described case of a mitral valve infective endocarditis (IE) post MitraClip®. Methods and results: An 88-year-old patient at high surgical risk (log. EuroSCORE 30.4%) underwent a MitraClip procedure for severe eccentric organic mitral regurgitation (MR) due to prolapse with a flail leaflet of the P2 segment (flail gap 6 mm...

Aims: Transcatheter mitral valve-in-valve implantation (TMViVI) for the treatment of failing mitral xenografts or recurrent mitral regurgitation after surgical ring implantation is an emerging therapy for patients in need of repeated mitral valve surgery. Despite the fact that these procedures have been shown to be feasible and effective, haemodyn...

Objectives: The second-generation Jenavalve prosthesis (Jenavalve Technology, Inc., Munich, Germany) is the first transcatheter valve Conformité Européene (CE) marked for treatment of both aortic stenosis (AS) and pure aortic regurgitation (AR). Although the feasibility of the Jenavalve transcatheter aortic valve implantation (TAVI) in patients wi...

Die Bedeutung der Thrombozytenaggregationshemmung in der Therapie der koronaren Herzkrankheit ist unumstritten. Nach koronaren Ereignissen und Interventionen verbessert die Anwendung einer dualen Plättchenhemmung das Outcome von Patienten erheblich. Folgerichtig muss dieses Therapiekonzept in der Herzchirurgie fortgeführt werden. So wird die duale...

Recent data suggest continuous monitoring by implanted loop recorder (ILR) to be the criterion standard for rhythm surveillance after atrial ablation. Studies describing patient compliance and pitfalls in the perioperative period are lacking. It was the aim of this study to evaluate patient compliance and time invested by physicians for obtaining d...

Objectives There is an ongoing discussion if valve-in-valve implantations into failing mitral xenografts should be performed only via a transapical approach. Background In selected high-risk patients, transcatheter valve implantation is an emerging therapy for degenerated mitral xenografts in need of repeated valve replacement. Methods Here we desc...

Prospective multicenter non-randomized evaluation of the DFM system for the treatment of severe aortic stenosis. The Direct Flow Medical transcatheter aortic valve (DFM) system is a non-metallic design with a pressurized support structure which allows precise positioning, retrieval and assessment of valve performance prior to permanent implantation...

This study analyzed the effect of failed percutaneous mitral intervention with the MitraClip device (Abbott Laboratories, Abbott Park, IL) on subsequent mitral valve (MV) operations. Nineteen patients (74 ± 9 years) with treatment failure after implantation of 37 MitraClips (mean, 1.9 ± 0.8; range, 1 to 4) for functional or degenerative MV disease...

Xenotransplantation is a potential solution for the worldwide persisting donor organ shortage. However, immunological and physiological barriers need to be overcome before the first clinical trials can be started. Nonhuman primates are considered the most suitable recipients in preclinical xenotransplantation models. Heterotopic abdominal cardiac x...

Objective: To analyse the results of three-dimensional (3D) prosthetic ring annuloplasty for functional tricuspid valve (TV) disease in patients with chronic ischemic mitral regurgitation (MR) concomitant to mechanism-specific restrictive 3D mitral valve (MV) annuloplasty and coronary artery bypass grafting (CABG). Methods: Since 2006 twenty-three...

Objectives: Sternal wound infections (SWI) are a major cause of prolonged hospital stay and account for substantial mortality after cardiac operations. Surgical treatment is discussed controversially and commonly accepted guidelines are lacking. We evaluated our single center treatment algorithm and describe the different surgical techniques with t...

Objective: Percutaneous mitral valve (MV) intervention with the MitraClip device (Abbott Lab., Illinois, USA) has been recently used in an increasing number of patients. However, surgical options after failed clipping are crucial and the effects on surgery and prognosis are unknown. Methods: Eleven patients (age: 72±9 years) with severe mitral reg...

Left atrial cardiac myxomas are among the most common cardiac masses. However, occurrence of left atrial myxomas in post-transplant patients is very rare and often misdiagnosed as left atrial thrombus formation. We report the case of a 67-year old female, who was referred due to suspected left atrial thrombus but was found to have a pediculated mas...

In this investigation, we hypothesize that quality of oral anticoagulation (OA) and long-term outcome after mechanical heart valve (MHV) replacement with self-management (Self-M) of OA is superior to conventional anticoagulation treatment (Conv-T), even in outside trial conditions. One hundred sixty patients (78.8% aortic valve replacements) were t...

Whilst macrohemodynamic function of porcine xenografts transplanted into baboons has been assessed perioperatively, the ability of the xenograft to maintain systemic microcirculatory perfusion has not been investigated after pig-to-baboon xenotransplantation so far. We investigated the sublingual microcirculation of six baboons undergoing orthotopi...

For short-term ventricular and pulmonary support the extracorporeal membrane oxygenation (ECMO) system using the Bio-Medicus centrifugal pump (Medtronic®, Minneapolis, MN, USA) was applied in 108 patients with cardiac low-output. From December 1996 to July 2006 the ECMO was implanted in 108 patients (73 adult, mean age: 49.3±18.0 yrs and 35 childre...

This analysis was undertaken to evaluate the results of persistent atrial fibrillation (pAF) ablation procedures concomitant to coronary surgery and to identify the risk factors for pAF recurrence. Since 2001, a total of 126 consecutive patients with pAF (duration: 0.5-33 years) underwent ablation concomitant to coronary surgery (isolated or in com...

This analysis was undertaken to evaluate the results of persistent atrial fibrillation ablation procedures concomitant to open surgery and to identify risk factors for persistent atrial fibrillation recurrence. Since 2001, a total of 325 consecutive patients with persistent atrial fibrillation (duration, 0.5-33 years) have undergone persistent atri...

Background This study was a pre-planned country-specific secondary analysis of results in Germany from a multinational multicenter observational study to retrospectively evaluate clinical outcomes with caspofungin in patients with probable and proven invasive fungal infection following solid organ transplantation (SOT). Methods Data were retrospect...

Zusammenfassung Patienten mit ventrikulären Unterstützungssystemen haben ein potenziell hohes Infektionsrisiko, welches mit über 35% angenommen wird [1]. Auch wenn die Mehrzahl dieser Infektionen durch grampositive Bakterien verursacht wird, steigt das Auftreten invasiver Pilzinfektionen („invasive fungal infection“, IFI) seit einigen Jahren deutli...

Glucocorticoids play a major role in the consolidation and retrieval of traumatic information. They act through the glucocorticoid receptor, for which, in humans, several polymorphisms have been described. In particular, the BclI single-nucleotide polymorphism is associated with hypersensitivity to glucocorticoids and with susceptibility to develop...

Hyperacute xenograft rejection (HXR) is characterized by complement activation and intravascular thrombosis. The pathogenesis of HXR is attributed to antibodies binding to α-Gal-epitopes on the endothelial cells (EC) of the xenograft, activating complement and thrombin-mediated coagulation mechanisms. Our aim was to evaluate the influence of thromb...

This study was a pre-planned country-specific secondary analysis of results in Germany from a multinational multicenter observational study to retrospectively evaluate clinical outcomes with caspofungin in patients with probable and proven invasive fungal infection following solid organ transplantation (SOT). Data were retrospectively collected on...

The Galalpha1-3Galbeta1-4GlcNAc-R is the major antigen on pig tissue bound by human xenoreactive natural antibodies in xenotransplant. We have investigated in vitro the influence of hypothermic storage with cardioplegic solutions on expression of Galalpha1-3Galbeta1-4GlcNAc-Rs and hyperacute xenograft rejection. To analyze effects of hypothermia on...

Catheter-based techniques of percutaneous valve intervention are recently being performed in an increasing number of patients. We finally report a case of successful, but complex surgical mitral valve repair 32 days after failed percutaneous intervention with severely aggravated mitral pathology caused by the catheter-based procedure. It is outline...

Zusammenfassung Die Xenotransplantation, d. h. die Übertragung tierischer Organe auf den Menschen, hat sich in den vergangenen 20 Jahren experimentell stetig fortentwickelt. Waren damals die Organüberlebenszeiten durch hyperakute Abstoßungsreaktionen noch im Minuten- bis Stundenbereich, so wurden durch die Einführung gentechnologischer Verfahren mi...