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Hanke T, Charitos EI, Stierle U, Robinson DR, Hemmer W, Moritz A, Lange R, Sievers HH. The Ross operation - a feasible and safe option in the setting of a bicuspid aortic valve? Eur J Cardiothorac Surg 2010; 38:333-9. [PMID: 20359904 DOI: 10.1016/j.ejcts.2010.01.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 01/21/2010] [Accepted: 01/26/2010] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The Ross operation in the setting of a bicuspid aortic valve (BAV) remains controversial. Using data from the German Ross Registry, we sought to investigate the effect of the presence of a BAV on autograft function and diameters over time after the Ross operation compared with the presence of a tricuspid aortic valve (TAV). METHODS A total of 1277 patients (mean age 42.2 + or - 15.3 years) with intra-operatively documented aortic valve morphology during the Ross operation were analysed in the present study (sub-coronary technique, n=648, root replacement technique, n=629 patients). A BAV was present in 70.9% of patients. Clinical and echocardiographic follow-up was performed preoperatively and at pre-specified intervals (mean follow-up 5.7 + or - 3.8 years, 6806 patient-years). Hierarchical multilevel modelling techniques were used for the statistical analysis of serial measurements and comparisons among groups. RESULTS Initial neo-aortic regurgitation was lower in the BAV group (0.52 vs 0.62 aortic insufficiency (AI) grades, p=0.008), whereas the annual increase of it did not differ among groups. In both surgical techniques, no significant development of neo-aortic regurgitation (<0.02 AI grades per year) could be detected. Initial aortic annulus and sinus dimensions did not differ in the presence of a BAV. However, BAV patients developed a higher degree of annulus and sinus dilatation over time (0.20mm per year vs 0.06 mm per year, p=0.003; 0.24 vs 0.11 mm per year, p=0.013). This effect persisted when allowing for the two different surgical techniques. Baseline sinotubular junction (STJ) diameters did not differ among groups and annual increase thereof was similar (29.15 mm vs 28.9 mm, p=0.69; 0.44 mm vs 0.35 mm, p=0.15). CONCLUSIONS For the observed time period, postoperative neo-aortic regurgitation after the Ross procedure did not differ between patients with a BAV or a TAV. Root dimensions, although clinically not relevant, increased in both valve entities supporting surgical reinforcement strategies. We cannot consider a BAV as a contraindication for the Ross operation.
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Mohamed SA, Meyer A, Stegen I, Radtke A, Richardt D, Nimzyk R, Nigam V, Bullerdiek J, Belge G, Sievers HH. Upregulation of the high mobility group AT-hook 2 gene in acute aortic dissection. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246645] [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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Richardt D, Sievers HH, Richardt HG. Neurohumoral activation in acute aortic dissection typ A. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247034] [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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Mohamed SA, Nigam V, Jensen B, Sier H, Simpson P, Srivastava D, Sievers HH. Micrornas in bicuspid aortic valve: a comparison between stenosis and insufficiency aortic valve. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246793] [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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Kallenbach K, Karck M, Beller C, Moritz A, Mohr FW, Beyersdorf F, Carrel T, Beyer M, Vahl CF, Harringer W, Ziemer G, Dapunt O, Reichenspurner H, Laufer G, Reichart B, Jakob H, Matschke K, Diegeler A, Sievers HH, Klövekorn W, Schäfers HJ, Däbritz S, Warnecke H, Sons H, Scheld HH, Gummert J, Autschbach R, Welz A, Rieß FC, Leyh R, Posival H, van Ingen G, Ennker J, Weinhold C, Steinhoff G, Cremer J, Franke U, Dörge HC, Kuntze T, Fischlein T, Hausmann H, Wimmer-Greinecker G, Silber RE, Hekmat K, Rein J, Hammel D, Weigang E. Aortic root surgery in acute aortic dissection type-A – new insights from GERAADA (German Registry for Acute Aortic Dissection type-A) after three years. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hanke T, Stierle U, Charitos EI, Gorski A, Bogers AJJC, Bechtel M, Boehm J, Botha C, Lange R, Hörer J, Moritz A, Wahlers T, Franke U, Hemmer W, Ferrari-Kuehne K, Hetzer R, Hübler M, Ziemer G, Takkenberg JJM, Robinson D, Misfeld M, Sievers HH. Major adverse cardiac events after the Ross operation in 1620 patients – current status of the German-Dutch Ross Registry with up to 20 years follow-up. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karluß A, Charitos EI, Stierle U, Sievers HH. In regurgitant bicuspid aortic valves the anterior mitral leaflet is enlarged. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246993] [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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Hanke T, Käbler J, Anderson I, Garbers C, Schön J, Bechtel M, Berger KU, Sievers HH, Heringlake M. The relation between preoperative cerebral oxygen saturation and variables of cardiopulmonary function in cardiac surgery patients. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246670] [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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Weigang E, Kallenbach K, Moritz A, Mohr FW, Beyersdorf F, Carrel T, Beyer M, Vahl CF, Harringer W, Ziemer G, Dapunt O, Reichenspurner H, Laufer G, Reichart B, Jakob H, Matschke K, Diegeler A, Sievers HH, Klövekorn W, Schäfers HJ, Däbritz S, Warnecke H, Sons H, Scheld HH, Gummert J, Autschbach R, Welz A, Rieß FC, Leyh R, Posival H, van Ingen G, Ennker J, Weinhold C, Steinhoff G, Cremer J, Franke U, Dörge HC, Kuntze T, Fischlein T, Hausmann H, Wimmer-Greinecker G, Silber RE, Hekmat K, Rein J, Hammel D, Karck M. German Registry for Acute Aortic Dissections type-A (GERAADA) – trends after three years. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246768] [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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Misfeld M, Charitos EI, Richardt D, Robinson D, Borgers AJJC, Hemmer W, Franke U, Boehm J, Rein J, Botha C, Lange R, Hörer J, Moritz A, Wahlers T, Breuer M, Ferrari-Kuehne K, Hetzer R, Hübler M, Gorski A, Ziemer G, Takkenberg JJM, Hanke T, Sievers HH, Stierle U. What happens to patients in the second decade after the Ross operation? Results from the German-Dutch Ross registry. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Karluß A, Stierle U, Schmidtke C, Sievers HH, Charitos EI. Midterm evaluation of aortic valve repair: results from a single center's aortic valve repair registry. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Guldner NW, Hellenbroich Y, Rumpf PM, Hardel T, Kruse C, Sievers HH. Sex-chromosomal verified differentiation from human glandular stem cells to cardiomyocyte- like cells in co-culture with human myocardial biopsies. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bechtel M, Müller-Steinhardt M, Stierle U, Schmidtke C, Sievers HH. Does histocompatibility affect homograft valve function? An update. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Guldner NW, Weigel G, Bastian F, Scharfschwerdt M, Zimmermann H, Girndt B, Flüß F, Sievers HH. Nano- coating with titanium reduces the immunologic response to glutardialdehyde-fixed bovine pericardium – a new technique to improve durability of biologic heart valve prostheses? Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hanke T, Gatz N, Beilharz A, Holz D, Schön J, Beilharz M, Berger KU, Sievers HH, Heringlake M. The perioperative course of plasma growth differentiation factor 15 (GDF15) in cardiac surgery patients and its relation to postoperative renal dysfunction. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246671] [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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Charitos EI, Hanke T, Robinson D, Misfeld M, Bogers AJJC, Hemmer W, Bechtel M, Boehm J, Botha C, Lange R, Hörer J, Moritz A, Wahlers T, Franke U, Breuer M, Ferrari-Kuehne K, Hetzer R, Hübler M, Ziemer G, Takkenberg JJM, Gorski A, Stierle U, Sievers HH. After the Ross procedure the patients' survival is similar to that of the normal population: results from the German-Dutch Ross Registry in 1623 patients. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247052] [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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Guldner NW, Klapproth P, Margaritoff PRJ, Noel R, Sievers HH, Grossherr M. Impact of valves in a biomechanical heart model assisting failing hearts. Asian Cardiovasc Thorac Ann 2009; 17:592-7. [PMID: 20026534 DOI: 10.1177/0218492309349066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Experimental valveless muscular blood pumps (biomechanical hearts) in goats can pump more than 1 L.min(-1), but due to a high pendulum volume, no significant flow contribution to the circulation is gained. Thus valved and valveless biomechanical hearts were compared for efficacy. Heart failure was induced in 5 adult Bore goats by repeated intracoronary embolization. A valved and balloon-equipped pumping chamber was integrated into the descending aorta, simulating standard biomechanical circulatory support. The valveless biomechanical heart supported a failing heart with a baseline cardiac output of 2,670 +/- 710 mL.min(-1) by contributing additional flow of 113 +/- 37 mL.min(-1). The biomechanical heart model incorporating an outlet valve offered an additional 304 +/- 126 mL.min(-1), and the use of 2 valves significantly enhanced pulmonary blood flow by 1,235 +/- 526 mL.min(-1). The use of 2 valves in biomechanical hearts seems to be essential to achieve adequate circulatory support. Double-valved biomechanical hearts driven by an appropriate skeletal muscle ventricle may contribute to the therapy of heart failure.
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Hörer J, Hanke T, Stierle U, Takkenberg JJM, Bogers AJJC, Hemmer W, Rein JG, Hetzer R, Hübler M, Robinson DR, Sievers HH, Lange R. Neoaortic root diameters and aortic regurgitation in children after the Ross operation. Ann Thorac Surg 2009; 88:594-600; discussion 600. [PMID: 19632419 DOI: 10.1016/j.athoracsur.2009.04.077] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/20/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND For children who require aortic valve replacement, the Ross operation provides a unique advantage of growth potential of the pulmonary autograft in the aortic position. This study assessed the progression of autograft root diameters and its effect on aortic regurgitation (AR). METHODS Neoaortic echo dimensions from 48 children (<16 years) undergoing Ross operation who had follow-up echocardiograms before age 20 were analyzed (mean follow-up, 5.1 +/- 3.3 years). RESULTS The mean age at the time of the Ross operation was 10.0 +/- 4.3 years. Mean z values of the neoaortic annulus (1.5 +/- 0.4), sinus (2.5 +/- 0.4), and sinotubular junction (2.6 +/- 0.9) when the autograft was implanted were significantly larger compared with normal values (p < 0.001, all). The mean z values significantly increased with follow-up at the level of the sinus (0.5 +/- 0.1/year, p < 0.001) and the sinotubular junction (0.7 +/- 0.2, p < 0.001), but not at the level of the annulus (0.1 +/- 0.1, p = 0.59). AR increased with follow-up time (0.07 +/- 0.02 grade/year, p < 0.001). AR increased with sinotubular junction diameter (p = 0.028), but there was not significant evidence of an association with annulus diameter (p = 0.25) or sinus diameter (p = 0.40). CONCLUSIONS Children undergoing Ross operation have larger neoaortic root dimensions than healthy children. Growth of the annulus matches somatic growth. The diameters of the sinus and the sinotubular junction increase significantly relative to somatic growth. The latter may explain the development of AR.
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Hörer J, Hanke T, Stierle U, Takkenberg JJ, Bogers AJ, Hemmer W, Rein JG, Hetzer R, Hübler M, Robinson DR, Sievers HH, Lange R. Homograft Performance in Children After the Ross Operation. Ann Thorac Surg 2009; 88:609-15. [DOI: 10.1016/j.athoracsur.2009.04.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 04/22/2009] [Accepted: 04/24/2009] [Indexed: 11/15/2022]
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Guldner NW, Jasmund I, Zimmermann H, Heinlein M, Girndt B, Großherr M, Klinger M, Sievers HH. The first self-endothelialized titanium-coated glutaraldehyde-fixed heart valve prosthesis within systemic circulation. J Thorac Cardiovasc Surg 2009; 138:248-50. [DOI: 10.1016/j.jtcvs.2008.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 11/05/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
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Bechtel JFM, Wellhöner P, Charitos EI, Bucsky B, Morshuis M, Sievers HH. Localizing an occult gastrointestinal bleeding by wireless PillCam SB capsule videoendoscopy in a patient with the HeartMate II left ventricular assist device. J Thorac Cardiovasc Surg 2009; 139:e73-4. [PMID: 19660366 DOI: 10.1016/j.jtcvs.2008.08.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 08/16/2008] [Accepted: 08/16/2008] [Indexed: 01/08/2023]
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Mohamed SA, Sievers HH, Hanke T, Richardt D, Schmidtke C, Charitos EI, Belge G, Bullerdiek J. Pathway analysis of differentially expressed genes in patients with acute aortic dissection. Biomark Insights 2009; 4:81-90. [PMID: 19652764 PMCID: PMC2716678 DOI: 10.4137/bmi.s2530] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Acute aortic dissection (AAD) is a life-threatening condition with high mortality and a relatively unclarified pathophysiological mechanism. Although differentially expressed genes in AAD have been recognized, interactions between these genes remain poorly defined. This study was conducted to gain a better understanding of the molecular mechanisms underlying AAD and to support the future development of a clinical test for monitoring patients at high risk. Materials and Methods Aortic tissue was collected from 19 patients with AAD (mean age 61.7 ± 13.1 years), and from eight other patients (mean age 32.9 ± 12.2 years) who carried the mutated gene for Marfan syndrome (MS). Six patients (mean age 56.7 ± 12.3 years) served as the control group. The PIQORTM Immunology microarray with 1076 probes in quadruplicates was utilized; the differentially expressed genes were analysed in a MedScan search using Pathway Assist software. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and protein analysis were performed. Results Interactions of MS fibrillin-1 (FBN1) in the MedScan pathway analysis showed four genes, fibulin-1 (FBLN1), fibulin-2 (FBLN2), decorin (DCN) and microfibrillar associated protein 5 (MFAP5), which were differentially expressed in all tissue from AAD. The validation of these genes by qRT-PCR revealed a minimum of three-fold downregulation of FBLN1 (0.5 ± 0.4 vs. 6.1 ± 2.3 fold, p = 0.003) and of DCN (2.5 ± 1.0 vs. 8.5 ± 4.7 fold, p = 0.04) in AAD compared to MS and control samples. Conclusions Downregulation of fibrillin-1 (FBN1) may weaken extracellular components in the aorta and/or interfer with the transmission of cellular signals and eventually cause AAD. Additional research on these four identified genes can be a starting point to develop a diagnostic tool.
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Hanke T, Misfeld M, Karluss A, Charitos EI, Neumeier I, Hagemann A, Graf B, Stierle U, Sievers HH. New insights into surgical atrial fibrillation ablation therapy: Initial experience with a novel permanently implantable heart rhythm monitor device. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191709] [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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Charitos EI, Babin-Ebell J, Kraatz EG, Sier HA, Wagner KF, Sievers HH. Transmyocardial laser revascularization combined with intramyocardial endothelial progenitor cell transplantation in patients with intractable ischemic heart disease ineligible for conventional revascularization: preliminary results in a highly selected small patient cohort. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191714] [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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Hanke T, Charitos EI, Stierle U, Hemmer W, Lange R, Hörer J, Hübler M, Takkenberg J, Bogers AJJC, Sievers HH. Effect of autograft reinforcement techniques on autograft durability and function after the Ross procedure: Results from the German-Dutch Ross Registry. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191410] [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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