Atheroma

Over the 6‑month period covering April 2010 to September 2010, all patients admitted to one of our patient wards at the Division of General Surgery, Department of Surgery, Medical University of Vienna were included in this study.
The Division of General Surgery in our university hospital consists of the following teams and specializations: colorectal surgery, hepatobiliary surgery, endocrine surgery, upper gastrointestinal (GI) surgery (esophageal and stomach surgery), bariatric surgery, breast surgery, and pancreatic surgery.
The patient data were extracted by reviewing all discharge letters from that period taken from the digital archives.
Overall, 517 patients were admitted over this period, some repeatedly, leading to a total of 817 admissions. These 517 patients underwent 463 operations. The complications of these operations were then rated according to the Clavien-Dindo classification (Table 1). For easier use, the suffix “d” for permanent disability was not drawn upon.Table 1

Clavien-Dindo classification

Grade	Definition
Grade I	Any deviation from the normal postoperative course without the need for pharmacological treatment, or surgical, endoscopic, and radiological interventions.Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside
Grade II	Requiring pharmacological treatment with drugs other than such allowed for grade I complications.Blood transfusions and total parenteral nutrition are also included
Grade III	Requiring surgical, endoscopic, or radiological intervention
Grade IIIa	Intervention not under general anesthesia
Grade IIIb	Intervention under general anesthesia
Grade IV	Life-threatening complication (including central nervous system complications) requiring IC/ICU management
Grade IVa	Single organ dysfunction (including dialysis)
Grade IVb	Multiorgan dysfunction
Grade V	Death of a patient

According to Dindo et al. [6 (link)]

IC intermediate care, ICU intensive care unit

The operations were sorted according to the complexity ranking (eight groups) in the accounting system of the Austrian Chamber of Physicians (Table 2; [8 ]).Table 2

Operation groups (complexity according to the Austrian Chamber of Physicians)

Operation group	Examples
I	Abscess incisions, secondary sutures, proctoscopy, skin biopsy
II	Excisions of atheromas, fibromas, lipomas, incisions of anal abscesses
III	Toe amputation, small lymph node extirpation, thoracic drainage, colonoscopy
IV	Tracheotomy, appendectomy, hernia operation, colostomy, gastrostomy, ERCP
V	Gastroenterostomy, interventions for recurrent hernia, Cimino fistula, radical varicose vein stripping
VI	Strumectomy, cholecystectomy, splenectomy, hemicolectomy, reduction mammoplasty
VII	Partial pancreatectomy, subtotal colectomy, subsegmental and large liver resections
VIII	Esophageal resection, open surgery of aortic aneurysms, organ transplantation

IVUS was performed using the IVUS imaging system (Volcano Corporation) and a 20 MHz 3.5 F Visions PV 0.035 Digital IVUS Catheter (Volcano Corporation). For the current study 20 mm of IVUS pullback segment distal to the ostia of the RCA and the LAD was selected. The area circumscribed by the outer border of the echolucent tunica media and the luminal border was manually traced on each 1 mm IVUS frame within selected fragment. The following indices of vessel morphology were assessed: 1) lumen volume (mm³) = lumen area (the area bounded by the luminal border) × length of fragment; 2) vessel volume (mm³) = EEM area × length of fragment; 3) plaque + media volume (mm³) = vessel volume – lumen volume; 4) relative atheroma volume (%) = plaque plus media volume divided by the vessel volume × 100%.

The first step upon arrival is verification of the package, labelling and transport conditions of the container and the retrieval form. CV tissue processing, evaluation and preservation is performed in a specialised clean room facility. All steps of the protocol are performed under laminar flow Class A, in Class B environment. After dissection of the heart, the tissues are rinsed and macroscopically evaluated looking for atheroma, calcification, aneurism, fenestrations and petechial presence which may cause the tissue discard. Also any significant finding is recorded. Valvular ring and distal artery diameters are measured using calibrated Hegar dilators as well as the length of the aortic and pulmonary arteries. Moreover, a coaptation test is performed filling the conduit with media and looking for leakage to ensure proper performance of the valve. As part of the preparation of the arteries, fat is removed, an inspection for atheroma, calcification or iatrogenic damage is performed and total length and proximal and distal diameters are measured. A photograph of each tissue is taken.
When there is no discarding feature in the tissue, the validated antibiotic cocktail is prepared containing amikacyn (Normon Laboratories - Spain; 791,301), metronidazole (B. Braun Medical SA- Spain; 600,496), ciprofloxacin (Altan Farmaceuticals, S.A.; 643,494), vancomycin (Lab. Reig Jofre, S.A; 606,390) and amphotericin (Xalabarderfarma - Spain) in RPMI (Roswell Park Memorial Institute Medium, Corning, 15,040 CV). The grafts are immersed for overnight decontamination at room temperature. After decontamination, a macroscopic quality control is performed and the grafts are prepared for cryopreservation in a double cryo-bag with cryoprotectants, namely dimethylsulfoxide (DMSO, WAK CHEMIE, WAK DMSO 10) and human albumin (Grifols, 726,609,670,612) in RPMI 1640. Finally, controlled freezing is carried out into a biological chamber (Carburos Matálicos CM2010) in order to decrease the temperature to − 110 °C. Long term storage of the cryopreserved homografts is performed in liquid nitrogen tanks at − 196 °C for 5 years.
Microbiological samples are taken during preparation of the tissue and packaging steps. Biopsy samples taken from the tissue before packaging are included in thioglycollate tubs (Becton Dickinson, 221,787) for the study of bacteries and fungi. Liquid samples from transport media and preservation media are inoculated in BD BACTEC™ PLUS-Aerobic/F Medium (BD Bioscience, 442,192) and BD BACTEC™-Lytic/10 Anaerobic/F Medium (BD Bioscience, 442,265) for aerobic and anaerobic growth and fungi detection. Sistematically, after dissection all hearts are evaluated macroscopically and histologically by the Anatomical Pathology Service of HCB.