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Mokhles MM, Siregar S, Versteegh MIM, Noyez L, van Putte B, Vonk ABA, Roos-Hesselink JW, Bogers AJJC, Takkenberg JJM. Male-female differences and survival in patients undergoing isolated mitral valve surgery: a nationwide cohort study in the Netherlands. Eur J Cardiothorac Surg 2016; 50:482-7. [PMID: 27174553 DOI: 10.1093/ejcts/ezw151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/08/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The objective of this study was to compare male-female differences with respect to baseline characteristics and short-term outcome in a contemporary nationwide cohort of patients who underwent isolated mitral valve (MV) surgery. METHODS All patients [N = 3411; 58% males (N = 1977)] who underwent isolated MV surgery (replacement: N = 1048, 31%; reconstruction: N = 2364, 69%) in the Netherlands between January 2007 and December 2011 were included in this study. Differences in patient and procedural characteristics and in-hospital outcome were compared between male and female patients. RESULTS Female patients were generally older (mean age, 64 vs 61 years, P < 0.001), presented more often with pulmonary hypertension (P = 0.03) and had higher logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) I (P < 0.001). Male patients presented more often with prior coronary artery bypass graft surgery (P < 0.001) and active endocarditis (P = 0.002). Female patients underwent MV replacement more often (P < 0.001) and, in case of replacement, received stented bioprostheses more often (P < 0.001). In-hospital mortality rates after MV replacement were 7% (n = 33) and 7% (n = 40) in male and female patients, respectively (OR 1.08, 95% CI 0.67-1.75; P = 0.75). In-hospital mortality rates after MV reconstruction were 1.4% (n = 21) and 1.3% (n = 11) in male and female patients, respectively (OR 0.88, 95% CI 0.42-1.84; P = 0.74). CONCLUSIONS There are substantial male-female differences in patient presentation and procedural aspects in isolated MV surgery in the Netherlands. Female patients are older, have more severe disease at the time of surgery and undergo valve repair less often. Future studies are needed to identify potentially modifiable patient factors to improve the outcome of female patients with MV disease.
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Kühlmann AYR, Etnel JRG, Roos-Hesselink JW, Jeekel J, Bogers AJJC, Takkenberg JJM. Systematic review and meta-analysis of music interventions in hypertension treatment: a quest for answers. BMC Cardiovasc Disord 2016; 16:69. [PMID: 27095510 PMCID: PMC4837643 DOI: 10.1186/s12872-016-0244-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/13/2016] [Indexed: 01/01/2023] Open
Abstract
Background Adverse effects, treatment resistance and high costs associated with pharmacological treatment of hypertension have led to growing interest in non-pharmacological complementary therapies such as music interventions. This meta-analysis aims to provide an overview of reported evidence on the efficacy of music interventions in the treatment of hypertension. Methods A systematic literature search was conducted for publications on the effect of music interventions on blood pressure in adult hypertensive subjects published between January 1990-June 2014. Randomized controlled trials with a follow-up duration ≥28 days were included. Blood pressure measures were pooled using inverse variance weighting. Results Of the 1689 abstracts reviewed, 10 randomized controlled trials were included. Random-effects pooling of the music intervention groups showed a trend toward a decrease in mean systolic blood pressure (SBP) from 144 mmHg(95 % CI:137–152) to 134 mmHg(95 % CI:124–144), and in mean diastolic blood pressure (DBP) from 84 mmHg(95 % CI:78–89) to 78 mmHg(95 % CI:73–84). Fixed-effect analysis of a subgroup of 3 trials with valid control groups showed a significant decrease in pooled mean SBP and DBP in both intervention and control groups. A comparison between music intervention groups and control groups was not possible due to unavailable measures of dispersion. Conclusions This systematic review and meta-analysis revealed a trend towards a decrease in blood pressure in hypertensive patients who received music interventions, but failed to establish a cause-effect relationship between music interventions and blood pressure reduction. Considering the potential value of this safe, low-cost intervention, well-designed, high quality and sufficiently powered randomized studies assessing the efficacy of music interventions in the treatment of hypertension are warranted. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0244-0) contains supplementary material, which is available to authorized users.
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Huygens SA, Mokhles MM, Hanif M, Bekkers JA, Bogers AJJC, Rutten-van Mölken MPMH, Takkenberg JJM. Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2016; 50:605-616. [PMID: 27026750 PMCID: PMC5052462 DOI: 10.1093/ejcts/ezw101] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
Abstract
Many observational studies have reported outcomes after surgical aortic valve replacement (AVR), but there are no recent systematic reviews and meta-analyses including all available bioprostheses and allografts. The objective of this study is to provide a comprehensive and up-to-date overview of the outcomes after AVR with bioprostheses and allografts reported in the last 15 years. We conducted a systematic literature review (PROSPERO register: CRD42015017041) of studies published between 2000–15. Inclusion criteria were observational studies or randomized controlled trials reporting on outcomes of AVR with bioprostheses (stented or stentless) or allografts, with or without coronary artery bypass grafting (CABG) or valve repair procedure, with study population size n ≥ 30 and mean follow-up length ≥5 years. Fifty-four bioprosthesis studies and 14 allograft studies were included, encompassing 55 712 and 3872 patients and 349 840 and 32 419 patient-years, respectively. We pooled early mortality risk and linearized occurrence rates of valve-related events, reintervention and late mortality in a random-effects model. Sensitivity, meta-regression and subgroup analyses were performed to investigate the influence of outliers on the pooled estimates and to explore sources of heterogeneity. Funnel plots were used to investigate publication bias. Pooled early mortality risks for bioprostheses and allografts were 4.99% (95% confidence interval [CI], 4.44–5.62) and 5.03% (95% CI, 3.61–7.01), respectively. The late mortality rate was 5.70%/patient-year (95% CI, 4.99–5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23–2.28) for allografts. Pooled reintervention rates for bioprostheses and allografts were 0.75%/patient-year (95% CI, 0.61–0.91) and 1.87%/patient-year (95% CI, 1.52–2.31), respectively. There was substantial heterogeneity in most outcomes. Meta-regression analyses identified covariates that could explain the heterogeneity: implantation period, valve type, patient age, gender, pre-intervention New York Heart Association class III/IV, concomitant CABG, study design and follow-up length. There is possible publication bias in all outcomes. This comprehensive systematic review and meta-analysis provides an overview of the outcomes after AVR with bioprostheses and allografts reported during the last 15 years. The results of this study can support patients and doctors in the prosthetic valve choice and can be used in microsimulation models to predict patient outcomes and estimate the cost-effectiveness of AVR with bioprostheses or allografts compared with current and future heart valve prostheses.
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Siregar S, Nieboer D, Vergouwe Y, Versteegh MIM, Noyez L, Vonk ABA, Steyerberg EW, Takkenberg JJM. Improved Prediction by Dynamic Modeling: An Exploratory Study in the Adult Cardiac Surgery Database of the Netherlands Association for Cardio-Thoracic Surgery. Circ Cardiovasc Qual Outcomes 2016; 9:171-81. [PMID: 26933048 DOI: 10.1161/circoutcomes.114.001645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The predictive performance of static risk prediction models such as EuroSCORE deteriorates over time. We aimed to explore different methods for continuous updating of EuroSCORE (dynamic modeling) to improve risk prediction. METHODS AND RESULTS Data on adult cardiac surgery from 2007 to 2012 (n=95 240) were extracted from the Netherlands Association for Cardio-Thoracic Surgery database. The logistic EuroSCORE predicting in-hospital death was updated using 6 methods: recalibrating the intercept of the logistic regression model; recalibrating the intercept and joint effects of the prognostic factors; re-estimating all prognostic factor effects, re-estimating all prognostic factor effects, and applying shrinkage of the estimates; applying a test procedure to select either of these; and a Bayesian learning strategy. Models were updated with 1 or 3 years of data, in all cardiac surgery or within operation subgroups. Performance was tested in the subsequent year according to discrimination (area under the receiver operating curve, area under the curve) and calibration (calibration slope and calibration-in-the-large). Compared with the original EuroSCORE, all updating methods resulted in improved calibration-in-the-large (range -0.17 to 0.04 versus -1.13 to -0.97, ideally 0.0). Calibration slope (range 0.92-1.15) and discrimination (area under the curve range 0.83-0.87) were similar across methods. In small subgroups, such as aortic valve replacement and aortic valve replacement+coronary artery bypass grafting, extensive updating using 1 year of data led to poorer performance than using the original EuroSCORE. The choice of updating method had little effect on benchmarking results of all cardiac surgery. CONCLUSIONS Several methods for dynamic modeling may result in good discrimination and superior calibration compared with the original EuroSCORE. For large populations, all methods are appropriate. For smaller subgroups, it is recommended to use data from multiple years or a Bayesian approach.
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Korteland NM, Top D, Borsboom GJJM, Roos-Hesselink JW, Bogers AJJC, Takkenberg JJM. Quality of life and prosthetic aortic valve selection in non-elderly adult patients. Interact Cardiovasc Thorac Surg 2016; 22:723-8. [PMID: 26920724 DOI: 10.1093/icvts/ivw021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/08/2016] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study assesses quality of life in relation to prosthetic aortic valve selection and preferences for shared decision-making among non-elderly adult patients after aortic valve replacement (AVR). METHODS A single-centre consecutive cohort of 497 AVR patients who underwent AVR between the age of 18 and 60 years was cross-sectionally surveyed 1-10 years after AVR. Health-related quality of life (Short-Form Health Survey, SF-36), valve-specific quality of life, patient experience with and preferences for involvement and final decision in prosthetic valve selection were investigated. RESULTS Two-hundred and forty patients (48%) responded. The median age was 57 years (range 26-70). Compared with the general age-matched Dutch population, AVR patients reported worse physical health, but better mental health. Biological valve recipients reported lower general health than mechanical valve recipients. Mechanical valve recipients had more doubts about the decision to undergo surgery, were more bothered by valve sound, the frequency of doctor visits and blood tests, and possible bleeding, but were less afraid of a possible reoperation. Eighty-nine percent were of the opinion that it is important to be involved in prosthetic valve selection, whereas 64% agreed that they actually had been involved. A better patient experience with involvement in prosthetic valve selection was associated with better mental health (P = 0.036). CONCLUSIONS Given the observed suboptimal patient involvement in prosthetic valve selection, the broad patient support for shared decision-making, and the positive association between patient involvement in prosthetic valve selection and mental health, tools to support shared decision-making would be useful in the setting of heart valve replacement.
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Treasure T, Takkenberg JJM, Pepper J. Republished review: Surgical management of aortic root disease in Marfan syndrome and other congenital disorders associated with aortic root aneurysms. Postgrad Med J 2016; 92:112-7. [PMID: 26811510 PMCID: PMC4752614 DOI: 10.1136/postgradmedj-2013-305132rep] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Elective root replacement in Marfan syndrome has improved life expectancy in affected patients. Three forms of surgery are now available: total root replacement (TRR) with a valved conduit, valve sparing root replacement (VSRR) and personalised external aortic root support (PEARS) with a macroporous mesh sleeve. TRR can be performed irrespective of aortic dimensions and a mechanical replacement valve is a secure and near certain means of correcting aortic valve regurgitation but has thromboembolic and bleeding risks. VSRR offers freedom from anticoagulation and attendant risks of bleeding but reoperation for aortic regurgitation runs at 1.3% per annum. A prospective multi-institutional study has found this to be an underestimate of the true rate of valve-related adverse events. PEARS conserves the aortic root anatomy and optimises the chance of maintaining valve function but average follow-up is under 5 years and so the long-term results are yet to be determined. Patients are on average in their 30s and so the cumulative lifetime need for reoperation, and of any valve-related complications, are consequently substantial. With lowering surgical risk of prophylactic root replacement, the threshold for intervention has reduced progressively over 30 years to 4.5 cm and so an increasing number of patients who are not destined to have a dissection are now having root replacement. In evaluation of these three forms of surgery, the number needed to treat to prevent dissection and the balance of net benefit and harm in future patients must be considered.
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Maat APWM, Cornelissen R, Bogers AJJC, Takkenberg JJM. Is the patient with mesothelioma without hope? Future Oncol 2015; 11:11-4. [PMID: 26638916 DOI: 10.2217/fon.15.184] [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: 12/25/2022] Open
Abstract
Hope is a very important mindset for malignant pleural mesothelioma patients as their cancer has a grim prognosis and limited therapeutic options. In this paper, we briefly discuss what hope means for a patient and how hope can help to cope with this disease. In addition, we discuss false hope. We also briefly touch on a few of the new therapies currently under development.
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Baggen VJM, Spinelli L, Venner C, Tuohinen S, Konopka M, Santoro C, Wahi S, Krstic I, Duchateau N, Handoko ML, Driessen MMP, Post MC, Van Dijk AP, Roos-Hesselink JW, Van Den Bosch AE, Takkenberg JJM, Sieswerda GT, Giudice CA, Castaldo D, Pisani A, Trimarco B, Huttin O, Mandry D, Voilliot D, Chabot JF, Marie PY, Juilliere Y, Chaouat A, Selton-Suty C, Skytta T, Virtanen V, Kellokumpu-Lehtinen PL, Raatikainen P, Burkhard-Jagodzinska K, Krol W, Zdanowicz R, Starczewski M, Aniol-Strzyzewska K, Jakubiak A, Sitkowski D, Dluzniewski M, Braksator W, Buonauro A, Bocchino ML, Esposito R, Canora A, Vaccaro A, Castaldo S, Sanduzzi Zamparelli A, Trimarco B, Galderisi M, Chong A, Deljanin Ilic M, Vrbic S, Marinkovic D, Ilic S, Sermesant M, Gibelin P, Ferrari E, Moceri P, Di Pasqua MC, Spruijt OA, Oosterveer FPT, Marcus JT, Bogaard HJ, Vonk Noordegraaf A. Moderated Posters session: pulmonary hypertension and other conditionsP516Echocardiographic findings predicting mortality in pulmonary arterial hypertension: a systematic review and meta-analysisP517Impairment of endothelial-mediated coronary flow reserve in patients with Anderson Fabry diseaseP518Comparative evaluation of various echocardiography-based methods for the estimation of pulmonary vascular resistance in pulmonary hypertensionP519Detection of early radiotherapy-induced changes in myocardial cyclic variation in breast cancer patients - an ultrasound tissue characterization studyP520Right ventricle adaptation changes resulting from endurance training in the group of junior cyclists - sex is an important determinantP521Impact of pulmonary hypertension on the impairment of right ventricular longitudinal function in patients with obstructive sleep apnea syndromeP522Improvement of echocardiographic (TTE) estimation of pulmonary vascular resistance (PVR) in comparison with right heart catheter measurementsP523Assessment of left ventricular function in breast cancer patients with adjuvant treatment (combined anthracyclines and trastuzumab): two years follow upP5243D regional right ventricular function in pulmonary hypertensionP525Simple echocardiographic parameters to assess right ventricular systolic function in patients with precapillary pulmonary hypertension: a comparison with cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev251] [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: 11/12/2022] Open
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Mokhles S, Takkenberg JJM, Bogers AJJC. Surgery Versus Radiation Therapy in Stage I Lung Cancer. Ann Thorac Surg 2015; 100:1968. [PMID: 26522556 DOI: 10.1016/j.athoracsur.2015.04.142] [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: 04/29/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
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Rizopoulos D, Taylor JMG, Van Rosmalen J, Steyerberg EW, Takkenberg JJM. Personalized screening intervals for biomarkers using joint models for longitudinal and survival data. Biostatistics 2015; 17:149-64. [PMID: 26319700 DOI: 10.1093/biostatistics/kxv031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/02/2015] [Indexed: 11/13/2022] Open
Abstract
Screening and surveillance are routinely used in medicine for early detection of disease and close monitoring of progression. Motivated by a study of patients who received a human tissue valve in the aortic position, in this work we are interested in personalizing screening intervals for longitudinal biomarker measurements. Our aim in this paper is 2-fold: First, to appropriately select the model to use at the time point the patient was still event-free, and second, based on this model to select the optimal time point to plan the next measurement. To achieve these two goals, we combine information theory measures with optimal design concepts for the posterior predictive distribution of the survival process given the longitudinal history of the subject.
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Korteland NM, Bras FJ, van Hout FMA, Kluin J, Klautz RJM, Bogers AJJC, Takkenberg JJM. Prosthetic aortic valve selection: current patient experience, preferences and knowledge. Open Heart 2015; 2:e000237. [PMID: 25893105 PMCID: PMC4395830 DOI: 10.1136/openhrt-2015-000237] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/10/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Current clinical practice guidelines advocate shared decision-making (SDM) in prosthetic valve selection. This study assesses among adult patients accepted for aortic valve replacement (AVR): (1) experience with current clinical decision-making regarding prosthetic valve selection, (2) preferences for SDM and risk presentation and (3) prosthetic valve knowledge and numeracy. Methods In a prospective multicentre cohort study, AVR patients were surveyed preoperatively and 3 months postoperatively. Results 132 patients (89 males/43 females; mean age 67 years (range 23–86)) responded preoperatively. Decisional conflict was observed in 56% of patients, and in 25% to such an extent that it made them feel unsure about the decision. 68% wanted to be involved in decision-making, whereas 53% agreed that they actually were. 69% were able to answer three basic knowledge questions concerning prosthetic valves correctly. 56% were able to answer three basic numeracy questions correctly. Three months postsurgery, 90% (n=110) were satisfied with their aortic valve prosthesis, with no difference between mechanical and bioprosthetic valve recipients. Conclusions In current clinical practice, many AVR patients experience decisional conflict and suboptimal involvement in prosthetic valve selection, and exhibit impaired knowledge concerning prosthetic valves and numeracy. Given the broad support for SDM among AVR patients and the obvious need for understandable information, to-be-developed tools to support SDM in the setting of prosthetic valve selection will help to improve quality of decision-making, better inform and actively involve patients, and reduce decisional conflict. Trial registration number NTR3618.
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Sergeant P, Takkenberg JJM, Noyez L. The sequelae of misinterpretating surgical outcome data. Interact Cardiovasc Thorac Surg 2015; 20:691-3. [PMID: 25788579 DOI: 10.1093/icvts/ivv060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/12/2022] Open
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Boks RH, van Pelt C, Takkenberg JJM, Bogers AJJC. Minimizing the perfusion system by integration of the components. Does it affect the hematocrit drop and transfused red blood cells? A retrospective audit. Perfusion 2015; 30:127-31. [PMID: 25713163 DOI: 10.1177/0267659114536456] [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: 11/16/2022]
Abstract
BACKGROUND We evaluate the affect on the hematocrit (Hct) drop and the amount of transfused red blood cells (RBCs) during cardiopulmonary bypass (CPB) in adult cardiac surgery patients due to minimizing the CPB circuit by using integrated components. METHODS Two hundred and seventy-two patients were included in this retrospective audit. Patients were assigned to three cohorts: the first cohort consisted of patients operated on with a CPB circuit volume of 1630 ml in 2008; the second cohort of such patients in 2010, with 1380 ml; and the third cohort of such patients in 2011, with 1250 ml. RESULTS There were no significant differences with respect to patient demographics. The priming volume was consecutively significantly reduced; (1635 ± 84 ml, 1384 ± 72 ml and 1256 ± 130 ml, p<0.0001). A trend of decreased amount of RBCs during CPB was visible (cohort 1630: 98 ± 195 ml, cohort 1380: 35 ± 151 ml and cohort 1250: 48 ± 113 ml, p=0.02). Also, the amount of RBCs during the total CPB procedure shows a decreased trend (cohort 1630: 122 ± 230 ml, cohort 1380: 52 ± 180 ml and cohort 1250: 71 ± 156 ml, p=0.04). Blood loss during CPB was significantly lower in cohorts 1380 and 1250 (1630: 922 ± 378 ml, 1380: 706 ± 347 ml and 1250: 708 ± 418 ml, p<0.0001). The volume of diuresis was significantly larger in cohort 1630 (1630: 1166 ± 800 ml, 1380: 477 ± 530 ml and 1250: 523 ± 504 ml, p<0.0001). The Hct drop at the start and end of CPB was significantly reduced comparing cohort 1630 with cohort 1250 (1630: 32 ± 7%, 1380: 30 ± 7% and 1250: 28 ± 10%, p=0.002) at the start of CPB and (1630: 31 ± 7%, 1380: 29 ± 7% and 1250: 28 ± 8%, p=0.016) at the end of CPB. The Hct values at the start and end of CPB were significantly different between the cohorts (1680: 0.23 ± 0.03 L/L - 0.22 ± 0.02 L/L, 1380: 0.25 ± 0.03 L/L - 0.25 ± 0.03 L/L and 1250: 0.25 ± 0.03 L/L- 0.25 ± 0.03 L/L, p= 0.001 and 0.0001). CONCLUSIONS Minimizing our CPB circuit by using integrated components has affected the drop of Hct and the amount of transfused RBCs.
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van der Wal MT, Boks RH, Wijers-Hille MJ, Hofland J, Takkenberg JJM, Bogers AJJC. The effect of pre-operative blood withdrawal, with or without sequestration, on allogeneic blood product requirements. Perfusion 2015; 30:643-9. [PMID: 25713053 DOI: 10.1177/0267659115573097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED A common effect of autologous blood withdrawal before cardiopulmonary bypass (CPB) is a decrease in haematocrit (Hct) and haemoglobin (Hb) content. A refinement of this technique is autologous blood withdrawal with the sequestration of platelet rich plasma (PRP) and red blood cells (RBCs). METHODS One hundred and four patients were included in a randomized study stratified into three groups: the autologous blood withdrawal group (Group 1), the autologous blood withdrawal group with blood loss sequestration (Group 2) and the control group (Control group). In Group 1, the amount of withdrawn blood was transfused after CPB. In Group 2, the RBCs were transfused immediately after sequestration and the PRP was transfused after the termination of CPB. In the Control group, no autologous blood withdrawal was employed. The following variables were analysed: blood loss, blood products transfusion, fluid transfusion, diuresis, haematological and coagulation data and the duration of the operation and intensive care unit stay. RESULTS We found no significant differences in peri-operative blood loss and transfused blood products among the three groups. There was a trend towards a lower amount of transfused fresh frozen plasma (FFP) for Group 1 (p =0.057) in the operation room (OR). The use of plasma expanders post-CPB was significantly higher in the Control group (p=0.024). RBCs coming from the auto-transfusion device were, for Group 1, significantly lower (p=0.007). The Hb and Hct values in Group 1, at start and end of CPB, were significantly lower (p=0.023-0.003 / 0.001-0.001, respectively). All other parameters were not significantly different. CONCLUSION there were no significant differences between the study groups. This randomized trial shows that, although sequestration immediately after autologous blood withdrawal has no added value, autologous blood withdrawal in patients with a normal pre-operative Hb and Hct is simple, inexpensive and allows for autologous blood transfusion.
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Rizopoulos D, Takkenberg JJM. Tools & techniques--statistics: Dealing with time-varying covariates in survival analysis--joint models versus Cox models. EUROINTERVENTION 2015; 10:285-8. [PMID: 24952063 DOI: 10.4244/eijv10i2a47] [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] [Indexed: 11/23/2022]
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Sievers HH, Stierle U, Charitos EI, Takkenberg JJM, Hörer J, Lange R, Franke U, Albert M, Gorski A, Leyh RG, Riso A, Sachweh J, Moritz A, Hetzer R, Hemmer W. A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry†. Eur J Cardiothorac Surg 2015; 49:212-8. [PMID: 25666469 DOI: 10.1093/ejcts/ezv001] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/29/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients. METHODS Between 1990-2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years. RESULTS The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years. CONCLUSION The autograft principle results in postoperative long-term survival comparable with that of the age- and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.
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Treasure T, Takkenberg JJM, Pepper J. Surgical management of aortic root disease in Marfan syndrome and other congenital disorders associated with aortic root aneurysms. Heart 2015; 100:1571-6. [PMID: 24986892 PMCID: PMC4215278 DOI: 10.1136/heartjnl-2013-305132] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Elective root replacement in Marfan syndrome has improved life expectancy in affected patients. Three forms of surgery are now available: total root replacement (TRR) with a valved conduit, valve sparing root replacement (VSRR) and personalised external aortic root support (PEARS) with a macroporous mesh sleeve. TRR can be performed irrespective of aortic dimensions and a mechanical replacement valve is a secure and near certain means of correcting aortic valve regurgitation but has thromboembolic and bleeding risks. VSRR offers freedom from anticoagulation and attendant risks of bleeding but reoperation for aortic regurgitation runs at 1.3% per annum. A prospective multi-institutional study has found this to be an underestimate of the true rate of valve-related adverse events. PEARS conserves the aortic root anatomy and optimises the chance of maintaining valve function but average follow-up is under 5 years and so the long-term results are yet to be determined. Patients are on average in their 30s and so the cumulative lifetime need for reoperation, and of any valve-related complications, are consequently substantial. With lowering surgical risk of prophylactic root replacement, the threshold for intervention has reduced progressively over 30 years to 4.5 cm and so an increasing number of patients who are not destined to have a dissection are now having root replacement. In evaluation of these three forms of surgery, the number needed to treat to prevent dissection and the balance of net benefit and harm in future patients must be considered.
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Rizopoulos D, Hatfield LA, Carlin BP, Takkenberg JJM. Combining Dynamic Predictions From Joint Models for Longitudinal and Time-to-Event Data Using Bayesian Model Averaging. J Am Stat Assoc 2014. [DOI: 10.1080/01621459.2014.931236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yacoub MH, El-Hamamsy I, Sievers HH, Carabello BA, Bonow RO, Stelzer P, da Costa FDA, Schäfers HJ, Skillington P, Charitos EI, Luciani GB, Takkenberg JJM. Under-use of the Ross operation--a lost opportunity. Lancet 2014; 384:559-560. [PMID: 25131967 DOI: 10.1016/s0140-6736(14)61090-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Golab HD, Kissler J, de Jong PL, van de Woestijne PC, Takkenberg JJM, Bogers AJJC. Clinical outcome and blood transfusion after infant cardiac surgery with a routine use of conventional ultrafiltration. Perfusion 2014; 30:323-31. [PMID: 25122118 DOI: 10.1177/0267659114546946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Priming-related hemodilution is the culprit behind excessive body water accumulation, postoperative coagulopathy and enhanced blood transfusion in infant cardiac surgery patients. In this retrospective, observational study, clinical data were analyzed to assess the effect of conventional ultrafiltration on allogenic blood transfusion and patient clinical outcome. METHODS All infants with a bodyweight up to 10 kg who underwent consequent cardiac surgery in 2011 and 2012 were eligible for the audit. Seventy patients, operated in accordance with existing pediatric protocol, enrolled in the control group. The study group consisted of 55 patients who were operated employing conventional ultrafiltration during bypass and recently adjusted hematocrit targets. The following variables were primarily investigated: hematocrit and colloid osmotic pressure value, total volume of blood products transfused and duration of postoperative mechanical ventilation. Secondary outcome measures were: postoperative urine production, postoperative blood loss, length of stay at the intensive care unit and hospital stay. RESULTS There were no significant differences between the groups in relation to demographics or hematological and cardiopulmonary bypass data. The ultrafiltration volume removed from circulation during bypass in the study group was 171 ± 99 ml. No significant difference between the groups was found with regard to the total allogenic blood transfusion (study group 216 ± 92 ml versus control group 191 ±93 ml; p = 0.136). All recorded clinical end points, duration of mechanical ventilation, duration of chest tube in situ, stay in ICU and stay in hospital, were similar between the groups. CONCLUSIONS Routine use of conventional ultrafiltration during the cardiac surgery for patients with a bodyweight less than 10 kg was a safe technique that allowed us to achieve higher hematocrit levels at the end of the operation without additional transfusions of allogenic blood. On the other hand, ultrafiltration did not improve the clinical end points.
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Mokhles S, Nuyttens JJ, Maat APWM, Birim Ö, Aerts JGJV, Bogers AJJC, Takkenberg JJM. Survival and Treatment of Non-small Cell Lung Cancer Stage I–II Treated Surgically or with Stereotactic Body Radiotherapy: Patient and Tumor-Specific Factors Affect the Prognosis. Ann Surg Oncol 2014; 22:316-23. [DOI: 10.1245/s10434-014-3860-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Indexed: 11/18/2022]
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Andrinopoulou ER, Rizopoulos D, Takkenberg JJM, Lesaffre E. Joint modeling of two longitudinal outcomes and competing risk data. Stat Med 2014; 33:3167-78. [PMID: 24676841 DOI: 10.1002/sim.6158] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 01/23/2014] [Accepted: 03/02/2014] [Indexed: 02/01/2023]
Abstract
Aortic gradient and aortic regurgitation are echocardiographic markers of aortic valve function. Both are biomarkers repeatedly measured in patients with valve abnormalities, and thus, it is expected that they are biologically interrelated. Loss of follow-up could be caused by multiple reasons, including valve progression related, such as an intervention or even the death of the patient. In that case, it would be of interest and appropriate to analyze these outcomes jointly. Joint models have recently received much attention because they cover a wide range of clinical applications and have promising results. We propose a joint model consisting of two longitudinal outcomes, one continuous (aortic gradient) and one ordinal (aortic regurgitation), and two time-to-events (death and reoperation). Moreover, we allow for more flexibility for the average evolution and the subject-specific profiles of the continuous repeated outcome by using B-splines. A disadvantage, however, is that when adopting a non-linear structure for the model, we may have difficulties when interpreting the results. To overcome this problem, we propose a graphical approach. In this paper, we apply the proposed joint models under the Bayesian framework, using a data set including serial echocardiographic measurements of aortic gradient and aortic regurgitation and measurements of the occurrence of death and reoperation in patients who received a human tissue valve in the aortic position. The interpretation of the results will be discussed.
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Yap SC, Takkenberg JJM, Witsenburg M, Meijboom FJ, Roos-Hesselink JW. Aortic stenosis at young adult age. Expert Rev Cardiovasc Ther 2014; 3:1087-98. [PMID: 16292999 DOI: 10.1586/14779072.3.6.1087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aortic stenosis at young adult age is usually the result of a stenotic bicuspid aortic valve, which is the most common cardiac congenital anomaly. In clinical practice, exercise and pregnancy are important topics. Furthermore, the timing of intervention is under debate, as little information is available on the natural history and outcome after aortic valve replacement in these young adults. In older patients, there is a trend towards earlier intervention. With the increased knowledge of the pathophysiology of aortic stenosis, studies have focused on the dilatation of the ascending aorta with risk of dissection. Recently, it has been suggested that pharmacologic treatment of aortic stenosis could be beneficial for these young adults.
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Abstract
Allografts were introduced in the early 1960s for the replacement of the aortic valve and regarded at the time as a close-to-perfect valve substitute. However, over the past 40 years it has become evident that not all of the high expectations could be met. This review summarizes the past 40 years of clinical experience with allografts for aortic valve replacement, describes the advantages and disadvantages of allografts compared with other aortic valve substitutes and their impact on patient prognosis, and discusses the future role of allografts for the replacement of the aortic valve or root.
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Treasure T, Takkenberg JJM, Golesworthy T, Rega F, Petrou M, Rosendahl U, Mohiaddin R, Rubens M, Thornton W, Lees B, Pepper J. Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1-9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement. Heart 2014; 100:969-75. [PMID: 24395977 PMCID: PMC4033204 DOI: 10.1136/heartjnl-2013-304913] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Among people with Marfan syndrome who have a typical aortic root aneurysm, dissection is a characteristic cause of premature death. To pre-empt Type A dissection, composite root replacement with a mechanical valve became the standard of care in the 1980s and 1990s. This is being superseded by valve-sparing aortic root replacement to avoid lifelong anticoagulation. In 2004, a total root and valve-sparing procedure, personalised external aortic support, was introduced. We report here results among the first 30 recipients. METHODS From cross-sectional digital images, the patient's own aorta is modelled by computer aided design and a replica is made in thermoplastic by rapid prototyping. On this, a personalised support of a macroporous polymer mesh is manufactured. The mesh is positioned around the aorta, closely applied from the aortoventricular junction to beyond the brachiocephalic artery. The operation is performed with a beating heart and usually without cardiopulmonary bypass. RESULTS Between 2004 and 2011, 30 patients, median age 28 years (IQR 20-44) had this operation and have been prospectively followed for 1.4-8.8 years by February 2013. During a total of 133 patient-years there were no deaths or cerebrovascular, aortic or valve-related events. These early outcomes are better than published results for the more radical extirpative root replacement operations. CONCLUSIONS The aortic valve, the root architecture, and the blood/endothelia interface are conserved. The perioperative burden is less and there has been freedom from aortic and valvular events. A prospective comparative study is planned.
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