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Yildirim Y, Reuter L, Odah S, Petersen J, Pahrmann C, Reichenspurner H, Pecha S. Nanotechnological Coating Reduces Bacterial Growth on Vascular Prostheses: An In Vitro Bioluminescence Imaging Study. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Pecha S, Burger H, Chung DU, Möller V, Madej T, Maali A, Osswald B, De Simone R, Monsefi N, Ziaukas V, Erler S, Perthel M, Wehbe MS, Ghaffari N, Sandhaus T, Busk H, Schmitto JD, Bärsch V, Easo J, Albert M, Treede H, Nägele H, Zenker D, Hegazy Y, Gessler N, Knaut M, Reichenspurner H, Willems S, Butter C, Hakmi S. Safety and Efficacy of Laser Lead Extraction in Octo- and Nonagenarians: A Subgroup Analysis from the GALLERY Registry. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Chung D, Burger H, Kaiser L, Osswald B, Baersch V, Naegele H, Knaut M, Reichenspurner H, Willems S, Butter C, Pecha S, Hakmi S. Procedural outcome and risk prediction in patients with implantable cardioverter-defibrillator (ICD) undergoing transvenous lead extraction: a GALLERY subgroup analysis. Europace 2022. [DOI: 10.1093/europace/euac053.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Device complications, such as infection or lead dysfunction necessitating transvenous lead extraction (TLE) are continuously rising amongst patients with indwelling transvenous implantable cardioverter-defibrillator (ICD).
Objectives
Aim of this study was to characterize the procedural outcome and risk factors of patients with indwelling 1- and 2-chamber ICD undergoing TLE.
Methods
We conducted a subgroup analysis of all 1- and 2-chamber ICD patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for procedural failure and all-cause mortality were assessed.
Results
A total of 854 patients with ICD undergoing TLE were identified, who were younger (62.9±13.8 vs. 70.7±13.0 years; p<0.001), less likely to be female (20.8 vs. 27.1%; p<0.001) and had a higher proportion of patients with coronary artery disease (51.5 vs. 38.6%; p<0.001) and highly reduced ejection fraction (32.0 vs. 23.0%; p>0.001), when compared to non-ICD patients. Leading extraction indication was lead dysfunction (48.0 vs. 21.9%; p<0.001), followed by device-related infection (45.6 vs. 73.0%; p<0.001). There were no differences in overall procedural complications (4.3 vs. 4.3%; p=0.980), clinical success rate (97.9 vs. 97.8%; p=0.861) or procedure-related (0.8 vs. 0.5%; p=0.292) and all-cause mortality (3.4 vs. 3.7%; 0.742) between groups. Multivariate analysis revealed lead age≥10 years (OR:5.75, 95%CI:2.0-16.2; p=0.001) as independent predictor for procedural failure. Systemic infection as extraction indication (OR:9.57, 95%CI:2.2-42.4; p=0.003) and procedural complications (OR:8.0, 95%CI:2.8-23.3; p<0.001) were identified as risk factors for all-cause mortality. Predictors for systemic infection in ICD patients were atrial fibrillation (OR: 2.22, 95%CI: 1.51-3.27; p<0.001), diabetes mellitus (OR: 2.28, 95%CI: 1.59-3.25; p<0.001) and chronic kidney disease (OR: 2.0, 95%CI: 1.39-2.89; p<0.001).
Conclusions
Transvenous lead extraction is safe and efficacious in patients with 1- and 2-chamber ICD. Although lead dysfunction is the leading indication for extraction, systemic device-related infection is the main driver of all-cause mortality for ICD patients undergoing TLE.
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Maldonado Gaekel D, Pecha S, Bernhardt A, Reichenspurner H, Barten M. Vital Necessity of Total Pacemaker Lead Extraction Following Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Stolfa P, Petersen J, Alassar Y, Reichenspurner H, Pecha S. Predictors of Rhythm Outcome in Patients Undergoing Concomitant AF Ablation: A Single-Center Experience of More than 1,000 Patients. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pecha S, Yildirim Y, Petersen J, Tönnis T, Kirchhof P, Reichenspurner H. Minimally Invasive Epicardial Left-Ventricular Lead Implantation and Simultaneous Left Atrial Appendage Clipping. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pausch J, Bhadra OD, Mersmann J, Barten M, Tönnis T, Pecha S, Reichenspurner H, Bernhardt A. Prognostic Impact of Implantable Cardioverter Defibrillators in Patients with Continuous Flow Left Ventricular Assist Devices. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yildirim Y, Yildirim S, Petersen J, Alassar Y, Sinning C, Conradi L, Reichenspurner H, Pecha S. Left-Atrial Strain Predicts Rhythm Outcome in Patients with Persistent Atrial Fibrillation Undergoing Left-Atrial Cryoablation during Minimally Invasive Endoscopic Mitral Valve Repair. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sarwari H, Bhadra O, Ludwig S, Schirmer J, Schofer N, Pecha S, Seiffert M, Blankenberg S, Reichenspurner H, Conradi L, Westermann D, Schäfer A. Transcatheter Aortic Valve Implantation after Previous Mitral Valve Repair or Replacement: Technical Considerations and Clinical Outcomes. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Petersen J, Yildirim Y, Tönnis T, Reichenspurner H, Pecha S. Transvenous Lead Extraction in Patients with Grownup Congenital Heart Disease. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Böning H, Petersen J, Sinning C, Yildirim S, Yildirim Y, Reichenspurner H, Pecha S. Echocardiographic Evaluation of Different LAA Closure Techniques during Concomitant Surgical AF Ablation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Petersen J, Castro L, Bengaard AK, Pecha S, Steenpass A, Meyer C, Reichenspurner H, Jespersen T, Eschenhagen T, Christ T. IK,ACh Does Not Mediate Negative Inotropy and Antiarrhythmic Action of Muscarinic Receptor Activation in Human Atrium. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Petersen J, Gebauer A, Böning H, Chokair F, Girdauskas E, Conradi L, Reichenspurner H, Pecha S. Rhythm Outcome after Cryoablation and LAA Clipping during Minimally Invasive Mitral Valve Surgery Using 3D Endoscopy. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pecha S, Ziegelhoeffer T, Yildirim Y, Choi YH, Willems S, Reichenspurner H, Burger H, Hakmi S. Safety and Efficacy of Transvenous Lead Extraction of Very Old Leads. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pecha S, Petersen J, Hakmi S, Yildirim Y, Tönnis T, Reichenspurner H. Safety and Efficacy of Transvenous Laser Lead Extraction in Octogenarians. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yildirim Y, Pecha S, Bernhardt A, Brickwedel J, Schofer N, Seiffert M, Reichenspurner H. Investigation of a Retrograde Implantation Technique for Distal Limb Perfusion during ECMO Therapy. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yildirim Y, Petersen J, Tönnis T, Reichenspurner H, Pecha S. Hybrid Transvenous Lead Extraction during Valvular Endocarditis Surgery. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schirmer J, Ludwig S, Schofer N, Schäfer A, Seiffert M, Pecha S, Blankenberg S, Reichenspurner H, Conradi L, Westermann D. Feasibility, Safety and Efficacy of Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction (BASILICA) during Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chung D, Pecha S, Burger H, Moeller V, Madej T, Osswald B, Ghaffari N, Baersch V, Naegele H, Gosau N, Knaut M, Butter C, Willems S, Hakmi S. 1255Comprehensive analysis of pacemaker patients with and without abandoned leads undergoing transvenous lead extraction: A GALLERY subgroup analysis. Europace 2020. [DOI: 10.1093/europace/euaa162.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
OnBehalf
GALLERY investigators
Background
The number of cardiac implantable electronic device (CIED)-associated complications such as infection, lead dysfunction or thrombotic events is continuously rising and thus making transvenous lead extraction (TLE) an ever more needed procedure in clinical practice today. Patients with abandoned leads represent a special cohort with a potentially higher susceptibility to CIED-related infections and vascular complications. Moreover, according to literature abandoned leads seem to be associated with more procedural complications and mortality during TLE.
Aim
The aim of this study was to provide an insight on safety, procedural outcome and risk prediction on pacemaker patients with abandoned leads undergoing TLE from the largest national laser-sheath registry to date.
Methods + Results:
We conducted a retrospective analysis of the GALLERY database, which collected 2533 patients undergoing TLE in Germany between 2013 and 2017. Out of 903 pacemaker patients, who underwent TLE, 226 patients (25.0%) with abandoned leads were identified. Those patients had a higher number of leads per patient (3.2 ± 0.8 vs. 1.9 ± 0.3; ns) and longer lead dwell-times (168.0 ± 89.7 vs. 123.0 ± 69.2 months; p < 0.0001) compared to pacemaker patients without abandoned leads. There were no differences in age (71.5 vs. 72.3 years; ns), body mass index (26.5 ± 4.5 vs. 26.78 ± 4.8 kg/m2; ns) or gender distribution (69.0 vs. 66.5% male; ns). Leading indication for TLE was device infection with no difference between groups (79.7 vs 77.8 %; ns). There were no differences in terms of pacemaker dependency, length of hospitalization or comorbidities. Patients with abandoned leads had longer procedure times (112.0 ± 69.0 vs. 86.4 ± 53.0 minutes; p < 0.0001) and a higher incidence of procedural complications (6.6 vs. 3.1%; p = 0.03), but there were no differences in neither procedural and clinical success rates (96.5 vs. 97.3%; ns), nor all-cause mortality (1.33 vs. 2.66%; ns). Multivariate logistic regression revealed abandoned leads (OR 2.1, CI 1.0-4.4, p = 0.04) and female gender (OR 2.4, CI 1.2-4.9, p = 0.02) as independent predictors for procedural complications. Systemic infection (OR 5.4, CI 2.0-14.8, p = 0.001) and chronic kidney disease (OR 4.0, CI 1.5-10.7, p = 0.007) were strong predictors for all-cause mortality in patients with indwelling pacemaker. Patient age > 75 years (OR 3.9, CI 2.7-5.6, p < 0.0001) and a lead dwell-time > 10 years (OR 1.6, CI 1.1-2.2, p = 0.01) were identified as risk factors for an infectious cause for TLE.
Conclusion
Abandoned leads are frequently encountered in pacemaker patients undergoing TLE and pose an important risk factor for procedural complications. Systemic CIED-related infections are the strongest driver of mortality in this patient cohort and urgently call for further improvements in early diagnosis and prevention.
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Grammatika Pavlidou N, Pecha S, Reichenspurner H, Christ T, Nikolaev VO, Molina CE. P2869Role of PDE8 in cAMP dynamics in human atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac arrhythmias, such as atrial fibrillation (AF), are often related to remodeling of membrane receptors and alterations in cAMP-dependent regulation of Ca2+ handling mechanisms. For instance, decreased L-type calcium current (ICa,L) density but upregulated RyR2 are major hallmarks of AF. These inhomogeneous AF-associated changes of protein phosphorylation point to a local regulation of PKA activity within these intracellular compartments. Local cAMP compartmentation and the role of phosphodiesterase (PDEs) have ben extensively studied in ventricular myocytes from animals. However, only a few studies have evaluated the contribution of PDEs to the pathophysiology of AF and the reason for the persistent AF-associated hypophosphorylation of the L-type calcium channel (LTCC) is currently unknown. The aim of this study was to investigate whether a change in the expression level of PDE8 in human atrium may affects cAMP nearby LTCC promoting the reduction of the ICa,L observed in persistent AF.
Methods
Atrial myocytes were isolated from tissue of 47 patients in sinus rhythm (SR) and with AF. Cells were then transfect with an adenovirus (Epac1-camps or pm-Epac1-camps) in order to express the (cytosolic or membrane, respectively) FRET-based cAMP sensor and cultured during 48 hours. Föster-resonance energy transfer (FRET) was used to measure cAMP in 232 isolated human atrial myocytes. Ro-20-1724 (10 μM), Cilostamide (1 μM) and PF-04957325 (30 nM) and IBMX (100 μM) were used as PDE4, PDE3, PDE8 and non-selective phosphodiesterases (PDEs) inhibitor respectively.
Results
Effects of PDE4 and especially PDE3 inhibition on cytosolic [cAMP] are reduced in AF. Pharmacological PDE8 inhibition induces only a small increase in basal intracellular [cAMP] in AF but it showed a big synergic effect when PDE4 was inhibit at the same time. By contrast, PDE8 inhibition dramatically increased basal [cAMP] in the subsarcolemmal compartment in AF while PDE3 or PDE4 inhibition had a smaller effect that didn't change between SR and AF.
Conclusions
PDE8 controls basal cytosolic cAMP levels in human atrial myocytes from patients with persistent AF while PDE3 effects tends to be reduced in these patients. Furthermore, PDE8 is the main PDE in controlling cAMP levels at the membrane in persistent AF. Thus, our study may provide a clue for the reported reduction of the ICa,L in persistent AF.
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Molina E, Dolce B, Pecha S, Garnier A, Dobrev D, Fischmeister R, Christ T, Reichenspurner H, Nikolaev V. PDE8 Mediates L-type Ca2+ Channels Dephosphorylation in Human Atrial Fibrillation. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pecha S, Burger H, Möller V, Madej T, Osswald B, Maali A, De Simone R, Monsefi N, Ziaukas V, Erler S, Elfarra H, Perthel M, Hemmer W, Ghaffari N, Sandhaus T, Busk H, Schmitto J, Bärsch V, Easo J, Treede H, Albert M, Nägele H, Zenker D, Hegazy Y, Ahmadi D, Ehrlich W, Knaut M, Reichenspurner H, Butter C, Hakmi S. The German Laser Lead Extraction Registry: GALLERY. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pecha S, Petersen J, Alassar Y, Hakmi S, Meyer C, Willems S, Reichenspurner H. Outcome Predictors for Surgical Atrial Fibrillation Ablation Concomitant to Mitral Valve Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Castro L, Pecha S, Amin S, Linder M, Gosau N, Willems S, Reichenspurner H, Hakmi S. Up to 5-Year Follow-up after Transvenous Lead Extraction Procedures. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Demal J, Pecha S, Castro L, Vogler J, Gosau N, Linder M, Willems S, Reichenspurner H, Hakmi S. In-Hospital Mortality after Transvenous Lead Extraction. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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