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Murana G, Cefarelli M, Kloppenburg G, Morshuis WJ, Heijmen RH. Surgical exclusion of a saccular aneurysm within a patent ductus arteriosus in an adult patient with Ortner's syndrome. Future Cardiol 2016; 12:613-616. [PMID: 27759427 DOI: 10.2217/fca-2016-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In adult the patent ductus arteriosus is a rare condition associated sometimes with lethal complications. We describe the case of a 44-year-old woman with a history of systemic lupus erythematosus admitted to our hospital with hoarseness and severe dyspnea. Clinical imaging examinations indicated a saccular aneurysm within a persistent ductus arteriosus with signs of impending rupture. Patient was not considered suitable for transcatheter closure and therefore she underwent open aortic repair. The procedure was uneventful and any significant complications occurred during postoperative course.
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Zipfel B, Zaefferer P, Riambau V, Szeberin Z, Weigang E, Menéndez M, Funovics M, Hamady M, Zipfel B, Zaefferer P, Riambau V, Szeberin Z, Weigang E, Menéndez M, Funovics M, Hamady M, Rousseau H, Mariné L, Kiskinis D, Bonneville JF, Kratimenos T, Nano G, Kato M, Gasparini D, Teebken O, Mangialardi N, Coppi G, Hoksbergen A, Heijmen RH. Worldwide results from the RESTORE II on elective endografting of thoracic aneurysms and dissections. J Vasc Surg 2016; 63:1466-75. [DOI: 10.1016/j.jvs.2015.12.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/10/2015] [Indexed: 10/21/2022]
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Kamman AV, de Beaufort HWL, van Bogerijen GHW, Nauta FJH, Heijmen RH, Moll FL, van Herwaarden JA, Trimarchi S. Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review. PLoS One 2016; 11:e0154930. [PMID: 27144723 PMCID: PMC4856408 DOI: 10.1371/journal.pone.0154930] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/21/2016] [Indexed: 01/16/2023] Open
Abstract
Background Currently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR (BEVAR/FEVAR) for CBAD. Methods EMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015. Studies describing outcomes of OSR, TEVAR, B/FEVAR, or all, for CBAD patients initially treated with medical therapy, were included. Primary endpoints were early mortality, and one-year and five-year survival. Secondary endpoints included occurrence of complications. Furthermore, a Time until Treatment Equipoise (TUTE) graph was constructed. Results Thirty-five articles were selected for systematic review. A total of 1081 OSR patients, 1397 TEVAR patients and 61 B/FEVAR patients were identified. Early mortality ranged from 5.6% to 21.0% for OSR, 0.0% to 13.7% for TEVAR, and 0.0% to 9.7% for B/FEVAR. For OSR, one-year and five-year survival ranged 72.0%-92.0% and 53.0%-86.7%, respectively. For TEVAR, one-year survival was 82.9%-100.0% and five-year survival 70.0%-88.9%. For B/FEVAR only one-year survival was available, ranging between 76.4% and 100.0%. Most common postoperative complications included stroke (OSR 0.0%-13.3%, TEVAR 0.0%-11.8%), spinal cord ischemia (OSR 0.0%-16.4%, TEVAR 0.0%-12.5%, B/FEVAR 0.0%-12.9%) and acute renal failure (OSR 0.0%-33.3%, TEVAR 0.0%-34.4%, B/FEVAR 0.0%-3.2%). Most common long-term complications after OSR included aneurysm formation (5.8%-20.0%) and new type A dissection (1.7–2.2%). Early complications after TEVAR included retrograde dissection (0.0%-7.1%), malperfusion (1.3%–9.4%), cardiac complications (0.0%–5.9%) and rupture (0.5%–5.0%). Most common long-term complications after TEVAR were rupture (0.5%–7.1%), endoleaks (0.0%–15.8%) and cardiac complications (5.9%-7.1%). No short-term aortic rupture or malperfusion was observed after B/FEVAR. Long-term complications included malperfusion (6.5%) and endoleaks (0.0%-66.7%). Reintervention rates after OSR, TEVAR and B/FEVAR were 5.8%-29.0%, 4.3%-47.4% and 0.0%-53.3%, respectively. TUTE for OSR was 2.7 years, for TEVAR 9.9 months and for B/FEVAR 10.3 months. Conclusion We found a limited early survival benefit of standard TEVAR over OSR for CBAD. Complication rates after TEVAR are higher, but complications after OSR are usually more serious. Initial experiences with B/FEVAR show its feasibility, but long-term results are needed to compare it to OSR and standard TEVAR. We conclude that optimal treatment of CBAD remains debatable and merits a patient specific decision. TUTE seems a feasible and useful tool to better understand management outcomes of CBAD.
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Kamman AV, van Herwaarden JA, Orrico M, Nauta FJH, Heijmen RH, Moll FL, Trimarchi S. Standardized Protocol to Analyze Computed Tomography Imaging of Type B Aortic Dissections. J Endovasc Ther 2016; 23:472-82. [DOI: 10.1177/1526602816642591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose: To propose a standard measuring protocol for type B aortic dissections so as to improve comparability between studies reporting aortic dimensions. Methods: Fifteen computed tomography (CT) scans of type B aortic dissections were measured with a standard protocol by 2 independent observers using postprocessing software. The following parameters were assessed: true, false, and total lumen diameter; true and false lumen volume; and entry tear size, location, and number. Diameters were measured in a perpendicular plane at 2, 10, and 20 cm from the left subclavian artery and 5 cm from the most distal renal artery. True lumen volume was assessed from the left subclavian artery to the aortic bifurcation, while the false lumen volume was from the start to end up to the aortic bifurcation. Entry tear location was assessed in relation to the left subclavian artery. Intra- and interobserver repeatability and agreement were evaluated using the Bland-Altman method, an a priori set of acceptable differences, and Lin’s concordance correlation coefficient (LCCC). Results: Intra- and interobserver mean differences for aortic diameter and true and false lumen volumes were generally within the limits of agreement and the a priori differences; the LCCC showed excellent agreement. Entry tear location, size, and number were difficult to measure in a repeatable manner, with inconsistent correlation coefficients, especially between the 2 observers. Conclusion: This protocol showed acceptable repeatability for aortic diameter and aortic volume measurements. Assessment of entry tears proved challenging and associated with less favorable results. Additionally, investigators are urged to be more transparent regarding the measurement methodology used in studies describing aortic dimensions.
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Van Der Weijde E, Bakker OJ, Heijmen RH. A custom-made scalloped stentgraft to preserve left subclavian artery flow in descending thoracic aortic disease with a short neck. Expert Rev Med Devices 2016; 13:487-96. [PMID: 27018248 DOI: 10.1586/17434440.2016.1171710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In thoracic stentgrafting, a short proximal landing zone may necessitate intentional occlusion of the left subclavian artery, which may lead to brain, spinal cord, and left arm malperfusion. A scalloped stentgraft is designed for adequate proximal sealing and preserving the left subclavian artery flow. We performed a systematic review, describe the required pre-operative planning and details of the perioperative technique used and report our own experience. In literature, only 29 patients were reported so far using a proximal scalloped stentgraft. Results show a high technical success rate and low complication rate. These results are comparable to the results from our own institution. From these first small series the scalloped thoracic endovascular aortic repair appears to be a safe and relatively simple solution for thoracic aortic disease involving the left subclavian artery.
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Liebregts M, Bol GM, Groen JW, Lieuw-a-Fa M, Heijmen RH, ten Berg JM. FOLFOX chemotherapy as a cause of ventricular septal rupture after alcohol septal ablation for obstructive hypertrophic cardiomyopathy? Int J Cardiol 2016; 207:208-10. [DOI: 10.1016/j.ijcard.2016.01.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/26/2022]
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Reineke DC, Kaya A, Heinisch PP, Oezdemir B, Winkler B, Huber C, Heijmen RH, Morshuis W, Carrel TP, Englberger L. Long-term follow-up after implantation of the Shelhigh® No-React® complete biological aortic valved conduit. Eur J Cardiothorac Surg 2015; 50:98-104. [DOI: 10.1093/ejcts/ezv452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/26/2015] [Indexed: 11/12/2022] Open
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Ibrahim K, Quick S, Kappert U, Strasser RH, Heijmen RH, Wendler O. How should I treat a partially released JenaValve™ in the ascending aorta, whose feelers cannot be positioned inside the corresponding aortic sinus? EUROINTERVENTION 2015. [PMID: 26196755 DOI: 10.4244/eijv11i3a69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rettig TC, Rigter S, Nijenhuis VJ, van Kuijk JP, ten Berg JM, Heijmen RH, van de Garde EM, Noordzij PG. The Systemic Inflammatory Response Syndrome Predicts Short-Term Outcome After Transapical Transcatheter Aortic Valve Implantation. J Cardiothorac Vasc Anesth 2015; 29:283-7. [DOI: 10.1053/j.jvca.2014.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Indexed: 11/11/2022]
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Castrovinci S, Murana G, de Maat GE, Smith T, Schepens MA, Heijmen RH, Morshuis WJ. The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results. J Thorac Cardiovasc Surg 2015; 149:416-22. [DOI: 10.1016/j.jtcvs.2014.09.078] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/04/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
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Michiels V, Swaans MJ, Sorgdrager BJ, Veldkamp RF, Heijmen RH, Ten Berg JM. When collateral damage does matter: iatrogenic ventricular septal rupture after percutaneous coronary intervention of the left anterior descending artery. JACC Cardiovasc Interv 2015; 8:367-368. [PMID: 25596788 DOI: 10.1016/j.jcin.2014.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/29/2014] [Indexed: 11/18/2022]
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Nijenhuis VJ, Swaans MJ, Michiels V, de Kroon T, Heijmen RH, Ten Berg JM. "First experience with JenaValve™: a single-centre cohort". Neth Heart J 2014; 23:35-41. [PMID: 25326104 PMCID: PMC4268214 DOI: 10.1007/s12471-014-0619-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims Since the introduction of transcatheter aortic valve implantation (TAVI), newer generation and novel devices such as the retrievable JenaValve™ have been developed. We evaluated the procedural and 6-month results of our first experience with implantation of the JenaValve™. Methods and results From June 2012 to December 2013, 24 consecutive patients (mean age 80 ± 7 years, 42 % male) underwent an elective transapical TAVI with the JenaValve™. Device success was 88 %. The mortality rate was 4 % at 30 days and 31 % at 6 months. TAVI reduced the mean transvalvular gradient (44.2 ± 11.1 mmHg vs. 12.3 ± 4.3 mmHg, p < 0.001) and increased the mean aortic valve area (0.8 3 ± 0.23 to 1.70 ± 0.44 cm2). A mild paravalvular leakage (PVL) occurred in 4 patients (18 %) and a moderate PVL in 1 patient (4 %). Mean New York Heart Association Functional Class improved from 2.9 ± 0.5 to 2.0 ± 0.8 at 30 days. Conclusion TAVI using the JenaValve™ prosthesis seems adequate and safe in this first experience cohort.
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Patterson BO, Holt PJ, Nienaber C, Fairman RM, Heijmen RH, Thompson MM. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg 2014; 60:1491-7.e1. [DOI: 10.1016/j.jvs.2014.08.114] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/27/2014] [Indexed: 11/28/2022]
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Nijenhuis VJ, Swaans MJ, Post MC, Heijmen RH, de Kroon TL, ten Berg JM. Open Transapical Approach to Transcatheter Paravalvular Leakage Closure. Circ Cardiovasc Interv 2014; 7:611-20. [DOI: 10.1161/circinterventions.113.001171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Swaans MJ, Michiels V, Nijenhuis VJ, Heijmen RH, Ten Berg JM. Transcatheter mitral paravalvular leakage closure: A beautiful last resort. J Cardiol Cases 2014; 10:147-149. [PMID: 30534228 DOI: 10.1016/j.jccase.2014.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/05/2014] [Accepted: 06/22/2014] [Indexed: 11/25/2022] Open
Abstract
We describe a case of a 54-year-old patient with rheumatic heart valve disease who was treated with double valve replacement (both aortic and mitral) twice. Two months after the second operation she developed a severe mitral paravalvular leakage (PVL) leading to cardiogenic shock for which she was hospitalized in the intensive care unit. Multiple weaning efforts proved to be unsuccessful because of persistent hemodynamic instability caused by the severe PVL. Since re-redo cardiac surgery would have meant an unacceptable high peri-operative risk it was decided in the heart team to close the PVL by a transcatheter technique. This was done successfully and led to a spectacular hemodynamic improvement. Just 24 h after closure of the PVL she could be discharged from the intensive care unit and the day after the procedure she came walking into the echocardiography laboratory for an echocardiographic evaluation. This case demonstrates not only the feasibility of transcatheter closure of a PVL but also that this can be a true life-saving act. <Learning objective: This case emphasizes that refractory heart failure can be a hard indication for closure of a PVL given the fast and complete clinical recovery after closure of the defect. Furthermore, it demonstrates the feasibility and the efficacy of transcatheter PVL closure, even when multiple devices have to be used to close the leak properly avoiding the risks inherent to redo cardiac surgery.>.
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Saouti N, Hindori V, Morshuis WJ, Heijmen RH. Left subclavian artery revascularization as part of thoracic stent grafting†. Eur J Cardiothorac Surg 2014; 47:120-5; discussion 125. [DOI: 10.1093/ejcts/ezu130] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Toggweiler S, Leipsic J, Binder RK, Freeman M, Barbanti M, Heijmen RH, Wood DA, Webb JG. Management of Vascular Access in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:643-53. [DOI: 10.1016/j.jcin.2013.04.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/29/2013] [Accepted: 04/11/2013] [Indexed: 12/17/2022]
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Hindori VG, Heijmen RH, Morshuis WJ. Open Repair of Long-Standing Thoracic Stent Graft Collapse Resulting in Pseudocoarctation and Aneurysm Formation. Ann Thorac Surg 2013; 95:2164-6. [DOI: 10.1016/j.athoracsur.2012.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 10/21/2012] [Accepted: 10/23/2012] [Indexed: 11/29/2022]
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Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MA, Morshuis WJ. Reoperation After Acute Type A Aortic Dissection Repair: A Series of 104 Patients. Ann Thorac Surg 2013; 95:922-7. [DOI: 10.1016/j.athoracsur.2012.11.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/09/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
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Teebken OE, Thompson MM, Fattori R, Heijmen RH, Gogtay Y, Orend KH. One-year outcomes of Valiant-Captivia. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332536] [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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Heijmen RH, Thompson MM, Fattori R, Goktay Y, Teebken OE, Orend KH. Valiant Thoracic Stent-Graft Deployed With the New Captivia Delivery System:Procedural and 30-Day Results of the Valiant Captivia Registry. J Endovasc Ther 2012; 19:213-25. [DOI: 10.1583/11-3652mr.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Swaans MJ, Post MC, van der Ven HAJ, Heijmen RH, Budts W, ten Berg JM. Transapical treatment of paravalvular leaks in patients with a logistic euroscore of more than 15%. Catheter Cardiovasc Interv 2012; 79:741-7. [DOI: 10.1002/ccd.23264] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 05/27/2011] [Indexed: 12/23/2022]
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van Putte BP, Ozturk S, Siddiqi S, Schepens MAAM, Heijmen RH, Morshuis WJ. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg 2011; 93:503-9. [PMID: 22200369 DOI: 10.1016/j.athoracsur.2011.07.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/26/2011] [Accepted: 07/29/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Aortic root replacement with a mechanical valve prosthesis is a widely accepted surgical technique. This study aims to evaluate short-term and long-term outcomes of this approach and to identify predictors of 30-day mortality. METHODS We retrospectively analyzed a consecutive series of 528 patients (mean age, 54±13 years) who underwent aortic root replacement for aneurysm (83%), acute type A dissection (15%), or endocarditis (2%) in the period between 1974 and 2008. The mean time of follow-up was 9.0±7.0 years (range, 0 to 36 years). Concomitant aortic surgery was performed in 71%, coronary revascularization in 18%, and mitral valve surgery in 3%. Selective antegrade cerebral perfusion was applied in 25% and deep hypothermic circulatory arrest in 28% of patients. RESULTS Overall 30-day mortality was 3.2% to 2.5% for elective surgery and 6.5% for urgent surgery. Morbidity included resternotomy for bleeding or tamponade (19%), pacemaker implantation (3.6%), myocardial infarction (4.0%), and neurologic damage (4.2%). Multivariate analysis revealed myocardial infarction (p<0.001) and the lack of glue use (p=0.018) as independent predictors of 30-day mortality. Subanalysis of the selective antegrade cerebral perfusion patients and the deep hypothermic circulatory arrest patients revealed infarction (p=0.005) and coronary artery disease (p=0.45) for selective antegrade cerebral perfusion and wrapping (p=0.035) for deep hypothermic circulatory arrest as independent risk factors. The survival rate was 87%, 73%, and 29% after 5, 10, and 25 years, respectively. CONCLUSIONS Aortic root replacement with a mechanical valve prosthesis can be performed safely with low mortality and acceptable morbidity. Perioperative myocardial infarction is the strongest independent risk factor of 30-day mortality.
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van der Lienden BT, Swinkels BM, Heijmen RH, Mast EG, De Kroon TL, ten Berg JM. First Valve-in-Valve Direct Transaortic CoreValve Implantation in an Insufficient Sapien Valve. JACC Cardiovasc Interv 2011; 4:1049-50. [DOI: 10.1016/j.jcin.2011.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/02/2011] [Indexed: 11/28/2022]
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Kaya A, Heijmen RH, Kelder J, Schepens MA, Morshuis WJ. Stentless biological valved conduit for aortic root replacement: Initial experience with the Shelhigh BioConduit model NR-2000C. J Thorac Cardiovasc Surg 2011; 141:1157-62. [DOI: 10.1016/j.jtcvs.2010.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 06/01/2010] [Accepted: 07/05/2010] [Indexed: 11/30/2022]
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Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Atamneh H, Rampoldi V, Muhs BE. Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. J Vasc Surg 2011; 53:1210-6. [DOI: 10.1016/j.jvs.2010.10.135] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/27/2010] [Accepted: 10/31/2010] [Indexed: 11/30/2022]
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Malvindi PG, van Putte BP, Leone A, Heijmen RH, Schepens MAAM, Morshuis WJ. Aortic reoperation after freestanding homograft and pulmonary autograft root replacement. Ann Thorac Surg 2011; 91:1135-40. [PMID: 21353201 DOI: 10.1016/j.athoracsur.2011.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/03/2011] [Accepted: 01/04/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human allografts and pulmonary autografts offer many advantages as an aortic valve and root substitute. The progressive degeneration of the aortic allograft and the pulmonary autograft has been seen as an important disadvantage, and the need for a reoperation has been perceived as challenging and risky for the patients. METHODS Between March 1992 and October 2009, 53 consecutive patients (mean age 50 ± 13 years; 38 male), who had a previous aortic root replacement, underwent redo surgery for failure of the aortic homograft (n = 42) or the pulmonary autograft (n = 11). The median follow-up (available for 47 of 51 patients) was 44 months. RESULTS Structural valve deterioration was the main indication for reoperation on the homograft (86%), with an earlier presentation in patients who received homografts from donors more than 55 years old. Failure of the pulmonary autograft occurred primarily because of severe aortic regurgitation predominantly due to dilation of the autograft (n = 5) and autograft valve prolapse (n = 5). The total in-hospital mortality was 3.8% (n = 2). No deaths occurred among patients who previously underwent a Ross procedure. The course was complicated in 25 cases (48%). The cumulative 1-year, 5-year, and 8-year survival rates were 92%, 90%, and 77%, respectively. No late deaths were encountered after reoperation on the pulmonary autograft (maximum follow-up 218 months). Freedom from reoperation (excluding early in-hospital operation) for recurrent aortic valve or root pathology was 97% at 8 years. CONCLUSIONS Reoperation after freestanding homograft and pulmonary autograft root replacement can be accomplished safely. The total postoperative morbidity rate is still high.
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Schaap J, Brinkman EB, Heijmen RH. Left ventricular outflow tract pseudoaneurysm compromising blood flow through the left main coronary artery after mechanical aortic valve implantation. Eur Heart J 2011; 32:1508. [DOI: 10.1093/eurheartj/ehr010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Malvindi PG, van Putte BP, Heijmen RH, Schepens MAAM, Morshuis WJ. Reoperations for aortic false aneurysms after cardiac surgery. Ann Thorac Surg 2010; 90:1437-43. [PMID: 20971235 DOI: 10.1016/j.athoracsur.2010.06.103] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/17/2010] [Accepted: 06/22/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases. METHODS We retrospectively reviewed our experience in 43 patients who received a reoperation for postsurgical aortic false aneurysm in the last 14 years. Thirty-three patients were male. The mean age was 60 ± 12 years. Most of the patients received prior aortic surgery on the aortic root, the ascending aorta, the aortic arch, and the descending thoracic aorta (38 patients). False aneurysm was diagnosed during follow-up evaluation in the absence of any symptoms in 23 cases. Univariate and multivariate analyses on 18 perioperative variables were performed. RESULTS In-hospital mortality was 6.9% (3 patients). The postoperative course was complicated in 17 cases (39%). At multivariate analysis, a preoperative history of coronary artery disease and postoperative sepsis were independent risk factors for hospital mortality. Survival rates at 1, 5, and 10 years were 94%, 79%, and 68%, respectively. Freedom from reoperation was 86% at 1 year and 72% at 5 and 10 years. CONCLUSIONS Despite a high postoperative complication rate, a reoperation for postsurgical aortic false aneurysm can be performed with acceptable mortality and good mid-term and long-term outcomes.
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Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Athamneh H, Muhs BE. Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms. Circulation 2010; 121:2718-23. [PMID: 20547930 DOI: 10.1161/circulationaha.109.908871] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes.
Methods and Results—
We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8±12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5;
P
=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1;
P
=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%.
Conclusion—
Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.
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Swaans MJ, Braam RL, Heijmen RH, Plokker HWM, Jaarsma W. Three-dimensional transesophageal echocardiography in a patient with early failure of mitral valve repair: why are we still looking at a three-dimensional structure in 2 dimensions? Circ Cardiovasc Imaging 2009; 1:282-3. [PMID: 19808552 DOI: 10.1161/circimaging.108.793356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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82
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Saouti N, Morshuis WJ, Heijmen RH, Snijder RJ. Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience. Eur J Cardiothorac Surg 2009; 35:947-52; discussion 952. [DOI: 10.1016/j.ejcts.2009.01.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 01/09/2009] [Accepted: 01/13/2009] [Indexed: 11/30/2022] Open
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83
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Kaya A, Heijmen RH, Rousseau H, Nienaber CA, Ehrlich M, Amabile P, Beregi JP, Fattori R. Emergency treatment of the thoracic aorta: results in 113 consecutive acute patients (the Talent Thoracic Retrospective Registry)☆. Eur J Cardiothorac Surg 2009; 35:276-81. [PMID: 19109030 DOI: 10.1016/j.ejcts.2008.10.052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 10/20/2008] [Accepted: 10/27/2008] [Indexed: 11/28/2022] Open
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84
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Marcheix B, Rousseau H, Bongard V, Heijmen RH, Nienaber CA, Ehrlich M, Amabile P, Beregi JP, Fattori R. Stent Grafting of Dissected Descending Aorta in Patients With Marfan's Syndrome. JACC Cardiovasc Interv 2008; 1:673-80. [DOI: 10.1016/j.jcin.2008.10.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 10/06/2008] [Accepted: 10/17/2008] [Indexed: 11/26/2022]
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85
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Botta L, Sonker U, Heijmen RH. Diffuse atherosclerosis of thoracic aorta involving supraaortic and coronary arteries: single-stage surgical revascularization. Thorac Cardiovasc Surg 2008; 56:490-2. [PMID: 19012218 DOI: 10.1055/s-2007-965712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Arterial occlusive disease of supraaortic vessels, particularly the subclavian and innominate arteries, is infrequent. Hemodynamically significant proximal lesions of all supraaortic arteries are uncommon and the combination with coronary artery disease is even rarer. So far, the surgical management and operative timing of patients with coexisting severe disease of brachiocephalic and heart vessels is still a matter of debate. We report the case of a patient with severe polydistrectual atherosclerosis treated with single-stage aorto-carotid, carotid-subclavian and aortocoronary bypass.
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Brunnekreef GB, Heijmen RH, Gerritsen WB, Schepens MA, ter Beek HT, van Dongen EP. Measurements of Cerebrospinal Fluid Concentrations of S100β Protein During and After Thoracic Endovascular Stent Grafting. Eur J Vasc Endovasc Surg 2007; 34:169-72. [PMID: 17408991 DOI: 10.1016/j.ejvs.2007.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 01/20/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Thoracic endovascular aortic repair is associated with postoperative spinal cord ischemia in approximately 1 to 12.5% of all cases. S100beta is a protein that is released during acute damage of the central nervous system. This study was performed to determine the concentration of S100beta in cerebrospinal fluid during and after stenting of the thoracic aorta in patients at high risk for spinal cord ischemia. DESIGN Prospective clinical study. MATERIALS AND METHODS Eight patients who underwent elective thoracic aortic stent grafting underwent lumbar spinal fluid drainage. These patients were at high risk to develop spinal cord ischemia. METHODS CSF samples for analysis of S100beta protein were drawn after induction of anesthesia, during stenting, once every hour the following six hours and 20 hours after repair. RESULTS No significant increase in S100beta protein could be detected in CSF and no neurological deficits were detected postoperatively. CONCLUSIONS The results of this study show us that there is no significant release of S100beta protein in CSF during stenting of the thoracic aorta in this subgroup of patients at high risk for spinal cord ischemia, consistent with clinical exam that there was no significant damage to the central nervous system.
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Kaya A, Heijmen RH, Vreuls W, Seldenrijk CA, Schepens MA. Chronic type A dissection in a pulmonary autograft. THE JOURNAL OF HEART VALVE DISEASE 2007; 16:162-4. [PMID: 17484466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A 37-year-old patient presented with severe aortic valve insufficiency due to massive dilatation of the neo-aortic root (77 mm diameter) 14 years after a Ross procedure. Intraoperatively, the dilatation appeared to be caused by a localized chronic dissection of the pulmonary autograft. Surgery consisted of a modified Bentall procedure with a mechanical composite valve, with an uncomplicated postoperative course.
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Schepens MAAM, Kelder JC, Morshuis WJ, Heijmen RH, van Dongen EP, ter Beek HTM. Long-Term Follow-Up After Thoracoabdominal Aortic Aneurysm Repair. Ann Thorac Surg 2007; 83:S851-5; discussion S890-2. [PMID: 17257940 DOI: 10.1016/j.athoracsur.2006.10.087] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 10/10/2006] [Accepted: 10/23/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early mortality and morbidity after thoracoabdominal aortic aneurysm (TAAA) repair has been analyzed extensively; however, very few studies have examined the risk factors for late death. METHODS We analyzed 500 consecutive TAAA repairs performed at St. Antonius Hospital between 1981 and March 30, 2006. Survival and freedom from aortic reoperation were calculated using the Kaplan-Meier method, and the effects of preoperative, intraoperative, and postoperative risk factors were evaluated using Cox proportional hazard analysis. Survival was compared with a Dutch population matched for age, sex, and date of operation. RESULTS Patient survival with 95% confidence intervals (CI) was 83% (80% to 86%), 63% (58% to 67%), 34% (29% to 40%), 16% (9% to 20%), and 6% (2% to 11%) after 1, 5, 10, 15, and 20 years, respectively, compared with 100%, 99%, 85%, 36%, and 15% for the matched Dutch population. Hazard analysis showed an early phase of high hazard falling to low levels 9 months postoperatively and a late phase in which the hazard of death gradually increased. Incremental risk factors for late death were depressed left ventricular function (p < 0.001), increased age (p < 0.001), urgency (p = 0.007), postoperative dialysis (p < 0.001), and postoperative neurologic deficit (p = 0.016). Freedom from reoperation on the aorta with 95% CI was 98% (97% to 99%), 92% (89% to 94%), 86% (82% to 90%), 83% (78% to 87%), and 83% (78% to 87%) after 1, 5, 10, 15, and 20 years, respectively. CONCLUSIONS Survival remains suboptimal, especially in the early years after TAAA repair, compared with a matched population. Avoidance of postoperative problems such as dialysis and neurologic deficits and performing elective surgery on relative young patients with unimpaired ventricular function will increase the likelihood of late survival.
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Kaya A, Heijmen RH, Overtoom TT, Vos JA, Morshuis WJ, Schepens MA. Thoracic Stent Grafting for Acute Aortic Pathology. Ann Thorac Surg 2006; 82:560-5. [PMID: 16863763 DOI: 10.1016/j.athoracsur.2006.03.053] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 03/15/2006] [Accepted: 03/20/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Elective endovascular repair of the thoracic aorta has shown reduced morbidity and mortality when compared with open surgery. The number of studies describing the use of thoracic endovascular stent grafts for acute pathology is limited, however. The purpose of this study was to describe our increasing experience with stent grafting for acute thoracic aortic pathology. METHODS Since January 2002, 28 patients underwent endovascular stent graft treatment for various types of acute thoracic aorta diseases, including complicated Stanford type B dissection (n = 12), ruptured descending aorta aneurysms (n = 7), intramural hematoma (n = 4), traumatic rupture of the thoracic aorta (n = 2), aortopulmonary fistula (n = 2), and penetrating aortic ulcer (n = 1). These acute thoracic aortic syndromes were predominantly localized in the proximal descending thoracic aorta (75%). Talent stent grafts were used in 26 patients and Excluder stent grafts in 2 patients. RESULTS Stent graft deployment at the intended position was successful in all patients. There was 1 intraoperative death (3.6%), due to acute myocardial infarction, after successful exclusion of the lesion with a stent graft. Hospital mortality was 21.4% (n = 6). Four of 6 hospital deaths, however, were directly related to the severely compromised clinical status preoperatively, including extensive bowel ischemia and irreversible cerebral damage after resuscitation. New neurologic symptoms were seen in 4 patients. The majority of the neurologic symptoms improved and faded away during hospital stay. Mean follow-up was 11 months (range, 1 to 31), and all the hospital survivors (n = 22) were alive. There was 1 nonrelated stroke 4 months postoperatively. During follow-up, 2 patients required transposition of the left subclavian artery for malperfusion, and 2 patients required a second stent graft procedure for endoleak. Additionally, 2 patients with early type II endoleaks were treated conservatively, and 1 of them sealed spontaneously at 6 months. CONCLUSIONS Thoracic stent grafting for acute aortic pathology is feasible in critically ill patients. Postoperative morbidity and mortality is predominantly related to the compromised preoperative clinical status, illustrating its use as salvage strategy.
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90
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Milhous JGJ, Heijmen RH, Ball ET, Plokker HWT. Myocardial infarction with ventricular septal rupture complicating elective aortic valve replacement. THE JOURNAL OF HEART VALVE DISEASE 2006; 15:509-11. [PMID: 16901044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Herein is described the case of a 79-year-old woman who underwent elective aortic valve replacement. The procedure was complicated by a particulate embolism into the left anterior descending artery leading to a myocardial infarction, complicated by ventricular septal rupture. Subsequently, the patient was reoperated on and the septal defect closed successfully, with an uneventful recovery.
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91
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van de Garde EMW, Bras LJ, Heijmen RH, Knibbe CAJ, van Dongen EPA, Wiltink EHH, Biesma DH. Low-dose recombinant factor VIIa in the management of uncontrolled postoperative hemorrhage in cardiac surgery patients. J Cardiothorac Vasc Anesth 2006; 20:573-5. [PMID: 16884993 DOI: 10.1053/j.jvca.2005.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Indexed: 11/11/2022]
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92
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Kaya A, Schepens MA, Morshuis WJ, Heijmen RH, Brutel de la Riviere A, Dossche KM. Valve-Related Events After Aortic Root Replacement With Cryopreserved Aortic Homografts. Ann Thorac Surg 2005; 79:1491-5. [PMID: 15854921 DOI: 10.1016/j.athoracsur.2004.11.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic root replacement with aortic homografts for various pathologic conditions involving the aortic root has yielded good early results. To assess mid-term valve-related events, a follow-up study was conducted. METHODS From February 1989 through January 2003, 213 patients with a mean age of 51.3 +/- 11.8 years underwent aortic root replacement with a cryopreserved aortic homograft. Bacterial endocarditis (58.7%) was the predominant indication for surgery (native valve endocarditis, n = 73; prosthetic valve endocarditis, n = 52). Of the 197 hospital survivors, 194 were entered in the follow-up study (98.5% complete). Endpoints of the study were death, valve-related death, reoperation for valve failure, endocarditis, thromboembolic events, and anticoagulant-related bleeding events. Follow-up was conducted between February and April 2003. RESULTS Overall hospital mortality was 7.5% (n = 16; 70% confidence limits, 5.6% to 9.4%). Mean follow-up was 5.8 years (range, 0.3 to 14.3). In total, 20 late deaths occurred (10.3%); of these, 5 were valve-related. The overall survival at 5 and 10 years is 87.3% +/- 2.4% and 70.8% +/- 5.3%, respectively. Twenty-one patients (10.8%) required reoperation, either for structural valve deterioration (n = 12), false aneurysm (n = 3), endocarditis of the homograft (n = 3), or for other reason (n = 3). Mortality for reoperation was 28.6% (n = 6). Five-year and 10-year freedom from reoperation is 94.5% +/- 1.8% and 76.4% +/- 5.3%, respectively. Endocarditis of the homograft was reported in 4 patients (3.2%), of whom 1 patient was treated medically and 3 required reoperation. Thromboembolic events (n = 1) and anticoagulant-related bleeding events (n = 0) were rarely seen. A recent echocardiographic study was available in 124 patients (71.3%). Aortic regurgitation grade I to II was reported in 121 patients (97.6%). CONCLUSIONS Cryopreserved aortic homografts function well on mid-term evaluation. The incidence of structural valve failure is acceptable. Reoperations for homograft endocarditis carry a high mortality rate.
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Settepani F, Kaya A, Morshuis WJ, Schepens MA, Heijmen RH, Dossche KM. The Ross Operation: An Evaluation of a Single Institution's Experience. Ann Thorac Surg 2005; 79:499-504. [PMID: 15680823 DOI: 10.1016/j.athoracsur.2004.07.076] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pulmonary autograft aortic root replacement was used in adults. Risk factors for aortic valve incompetence (AI) and pulmonary homograft valve stenosis are identified. METHODS From February 1991 through May 2003, 103 patients, with a mean age of 35.2 +/- 9.5 years, underwent aortic root replacement with the pulmonary autograft. Annulus reinforcement (reduction annuloplasty or use of root ring) was carried out in 45 patients. In all but 1 patient, the right ventricular outflow tract was reconstructed with a cryopreserved pulmonary homograft. Mean follow-up duration was 6.0 +/- 2.8 years (range 0.3 to 11 years). RESULTS There were no hospital deaths. Overall patient survival was 98.9 +/- 1.0% at 1 year and 97.3 +/- 1.9% at 10 years. Autograft function follow-up resulted in 5 patients requiring reoperation for aortic incompetence. The univariate risk factors for aortic incompetence at discharge and during follow-up were respectively annulus reinforcement (p = 0.05) and bicuspic aortic valve (p = 0.05). Reoperation for homograft failure occurred in 1 patient. During follow-up, 24 patients (25.5%) developed homograft stenosis (gradient > 20 mm Hg). Univariate analysis indicated the diameter of the homograft (p = 0.001) as factor associated with stenosis during follow-up. Cox regression identified smaller diameter of the homograft (p = 0.001) and older age of donor (p = 0.002) as independent risk factor for the development of homograft stenosis. CONCLUSIONS The Ross operation can be performed with few complications. Although both the aortic autograft and the pulmonary homograft have limited durability, this has not yet resulted in considerable reoperation rates and associated morbidity and mortality.
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Sonker U, Peek DFPM, van der Meij JJC, Heijmen RH, Seldenrijk CA, Knaepen PJ. Primary lung tumor mimicking acute type A aortic dissection. Ann Thorac Surg 2004; 77:1841-3. [PMID: 15111207 DOI: 10.1016/s0003-4975(03)01167-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2003] [Indexed: 11/19/2022]
Abstract
A 64-year-old man presented with clinical features and echocardiographic diagnosis of an acute type A dissection. He underwent median sternotomy for definitive surgical treatment. On external examination of the aorta, other intrapericardial structures, and the right lung, it was evident that the patient had an advanced lung tumor. This was confirmed by frozen-section and histopathologic examinations. Epiaortic scanning showed beyond doubt the presence of a mobile intraaortic mass that had misled us in making the preoperative diagnosis of an acute type A dissection.
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Schepens MA, van den Berg JC, Moll FL, Dossche KM, Heijmen RH. AneuRx Stent-Graft Failure Four Years After TAA Exclusion. J Endovasc Ther 2004. [DOI: 10.1583/1545-1550(2004)011<0049:asffya>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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96
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Zeebregts CJ, Heijmen RH, van den Dungen JJ, van Schilfgaarde R. Non-suture methods of vascular anastomosis. Br J Surg 2003; 90:261-71. [PMID: 12594661 DOI: 10.1002/bjs.4063] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The main aim of performing a vascular anastomosis is to achieve maximal patency rates. An important factor to achieve that goal is to minimize damage to the vessel walls. Sutures inevitably induce vascular wall damage, which influences the healing of the anastomosis. Over time, several alternatives to sutures have become available. METHODS A Medline literature search was performed to locate English, German and French language articles pertinent to non-suture methods of vascular anastomosis. Manual cross-referencing was also performed and many historical articles were included. RESULTS AND CONCLUSION The non-suture techniques can be categorized into five groups based on the materials used: rings, clips, adhesives, stents and laser welding. With all these techniques a faster and less traumatic anastomosis can be made compared with sutures. However, each device is associated with technique-related complications. As a consequence, suturing continues to be the standard approach. The disadvantages of the non-suture techniques include: rigidity and a non-compliant anastomosis with rings; toxicity, leakage and aneurysm formation with adhesives; early occlusion with stents; cost, reduced strength in larger-sized vessels and demand for surgical skills with laser welding. Further refinement is needed before widespread adoption of these techniques can occur. Clips, however, may be particularly promising but long-term evaluation is required.
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van Muiswinkel KW, Heijmen RH, van den Berg JC, Ernst SM, Schepens MA. Endovascular treatment of a saccular aortic arch aneurysm in a patient with a patent LIMA [correction of Lima] graft. Eur J Vasc Endovasc Surg 2003; 25:188-9. [PMID: 12552485 DOI: 10.1053/ejvs.2002.1784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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98
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Heijmen RH, van Haarlem SW, Morshuis WJ, Jansen EW, Jaarsma W, Snijder RJ. [Pulmonary thromboendarterectomy: an effective surgical treatment for cor pulmonale due to chronic pulmonary emboli]. NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE 2002; 146:2087-92. [PMID: 12448964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To evaluate the initial experience with pulmonary thromboendarterectomy for cor pulmonale due to chronic pulmonary embolism. METHOD In the period 1 April 1996 to 31 October 2001, 18 patients with right ventricular failure due to chronic thromboembolic pulmonary hypertension were operated on. Their mean age was 54 (SD: 14) years. Preoperatively, all of the patients were in functional New York Heart Association (NYHA) class III or IV. Pulmonary angiography revealed pulmonary hypertension with an increased pulmonary vascular resistance, as well as typical angiographic signs of unresolved chronic emboli. Pulmonary thromboendarterectomy was performed via median sternotomy, using extracorporeal circulation and intermittent deep hypothermic circulatory arrest. The patients were monitored via the outpatients' department. RESULTS From a technical viewpoint, the procedure was performed successfully in all of the patients. Initially the pulmonary thromboendarterectomy was performed unilaterally (n = 7), which did not decrease pulmonary artery pressure significantly. The following 11 patients were treated bilaterally; in them thromboendarterectomy required an average of circulatory arrest totalling 64 (SD: 30) min with 161 (SD: 35) min of myocardial ischemia. After bilateral pulmonary thromboendarterectomy, the pulmonary artery pressure decreased from 45 (SD: 13) to 28 (SD: 9) mmHg (p = 0.001). Reperfusion pulmonary oedema, requiring prolonged ventilation, occurred in 3 patients. There was no operative or later mortality. At a mean follow-up of 28 (SD: 19) months, all but one of the patients were in functional NYHA class I or II. Echocardiography revealed reduced right ventricular dimensions and pulmonary artery pressures. One patient, with mainly distally located obstructions, exhibited no substantial improvement. CONCLUSION The initial experience with pulmonary thromboendarterectomy for patients with cor pulmonale due to chronic pulmonary emboli demonstrated satisfactory mid-term follow-up data.
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100
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Peek DF, Heijmen RH, Ernst SM, Schepens MA. Extensive mediastinal lipomatosis in a patient with severe aortic valve stenosis. Eur J Cardiothorac Surg 2002; 21:564-5. [PMID: 11888787 DOI: 10.1016/s1010-7940(01)01171-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mediastinal lipomatosis is a rare benign condition characterized by a large amount of mature adipose tissue in the mediastinum. We present the case of an 86-year-old male who was admitted to the hospital for analysis of his progressive dyspnea. After careful examination, the patient was diagnosed with severe aortic valve stenosis and extensive mediastinal lipomatosis. This rare coincidence of aortic valve disease and mediastinal lipoma was treated by aortic valve replacement and an extensive debulking procedure.
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