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Fox H, Gyoten T, Rojas SV, Lauenroth V, Günther S, Schramm R, Gummert JF, Morshuis M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6540697. [PMID: 35234899 PMCID: PMC9252132 DOI: 10.1093/icvts/ivac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 02/01/2022] [Accepted: 02/17/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Corresponding author. Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Georgstrasse 11, Bad Oeynhausen 32545, Germany. Tel: +49-5731-971331; fax: +49-5731-971820; e-mail: (H. Fox)
| | - Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Lauenroth
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Sabina Günther
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Safety, Mortality, and Hemodynamic Impact of Patients with MitraClip Undergoing Left Ventricular Assist Device Implantation. J Cardiovasc Transl Res 2021; 15:676-686. [PMID: 34713397 PMCID: PMC9213377 DOI: 10.1007/s12265-021-10178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/11/2021] [Indexed: 10/29/2022]
Abstract
The interactions and hemodynamic impact of transcatheter percutaneous mitral valve repair (TMR) have not yet been investigated in patients undergoing left ventricular assist device (LVAD) implantation, but hemodynamic adverse effects are feared in the combination of TMR and LVAD for altered mitral valve flow. This study investigated the hemodynamic interplay in combination of TMR and LVAD in 119 patients, and propensity score match analysis revealed no difference in both perioperative mortality and 2-year follow-up survival (p = 0.84). Nonetheless, postoperatively mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac index improved, and multivariable cox regression analysis at 2 years identified preoperative total bilirubin and temporary right ventricular mechanical circulatory support as independent risk factors for all-cause mortality but not TMR. Prior TMR has no impact on mortality or cardiovascular complications in patients with LVAD.
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Sohns C, Marrouche NF, Costard‐Jäckle A, Sossalla S, Bergau L, Schramm R, Fuchs U, Omran H, Rubarth K, Dumitrescu D, Konietschke F, Rudolph V, Gummert J, Sommer P, Fox H. Catheter ablation for atrial fibrillation in patients with end-stage heart failure and eligibility for heart transplantation. ESC Heart Fail 2021; 8:1666-1674. [PMID: 33314690 PMCID: PMC8006697 DOI: 10.1002/ehf2.13150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/13/2020] [Accepted: 11/15/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Timely referrals for transplantation and left ventricular assist device (LVAD) play a key role in favourable outcomes in patients with advanced heart failure (HF). The purpose of the Catheter Ablation for atrial fibrillation in patientS with end-sTage heart faiLure and Eligibility for Heart Transplantation (CASTLE-HTx) trial is to test the hypothesis that atrial fibrillation (AF) ablation has beneficial effects on mortality and morbidity during 'waiting time' for heart transplantation (HTx) or to prolong the time span until LVAD implantation. METHODS AND RESULTS CASTLE-HTx is a randomized evaluation of ablative treatment of AF in patients with severe left ventricular dysfunction who are candidates and eligible for HTx. The primary endpoint is the composite of all-cause mortality, worsening of HF requiring a high urgent transplantation, or LVAD implantation. The secondary study endpoints are all-cause mortality, cardiovascular mortality, cerebrovascular accidents, worsening of HF requiring unplanned hospitalization, AF burden reduction, unplanned hospitalization due to cardiovascular reason, all-cause hospitalization, quality of life, number of delivered implantable cardioverter defibrillator therapies, time to first implantable cardioverter defibrillator therapy, number of device-detected ventricular tachycardia/ventricular fibrillation episodes, left ventricular function, exercise tolerance, and percentage of right ventricular pacing. Ventricular myocardial tissue will be obtained from patients who will undergo LVAD implantation or HTx to assess the effect of catheter ablation on human HF myocardium. CASTLE-HTx will randomize 194 patients over a minimum time period of 2 years. CONCLUSIONS CASTLE-HTx will determine if AF ablation has beneficial effects on mortality in patients with end-stage HF who are eligible for HTx.
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Affiliation(s)
- Christian Sohns
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Nassir F. Marrouche
- Tulane Research Innovation for Arrhythmia Discoveries (TRIAD), Heart and Vascular InstituteTulane University School of MedicineNew OrleansLAUSA
| | - Angelika Costard‐Jäckle
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Samuel Sossalla
- Department of Internal Medicine II, Cardiology, Pneumology, Intensive CareUniversity Hospital RegensburgRegensburgGermany
| | - Leonard Bergau
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Rene Schramm
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Uwe Fuchs
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Hazem Omran
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Kerstin Rubarth
- Department of Biometry and Clinical EpidemiologyUniversity Medical Center Berlin CharitéBerlinGermany
| | - Daniel Dumitrescu
- Clinic for General and Interventional Cardiology/AngiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Frank Konietschke
- Department of Biometry and Clinical EpidemiologyUniversity Medical Center Berlin CharitéBerlinGermany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/AngiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Philipp Sommer
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRW, Ruhr‐Universität BochumBad OeynhausenGermany
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Flottmann C, Dumitrescu D, Sohns C, Rudolph V, Fox H. Addition of levosimendan to overcome acute cardiogenic shock-Paving the way for later heart transplantation-A first case report. Clin Case Rep 2021; 9:856-860. [PMID: 33598259 PMCID: PMC7869361 DOI: 10.1002/ccr3.3672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/08/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022] Open
Abstract
Treatment of refractory cardiogenic shock has poor outcome. Levosimendan addition may help to achieve hemodynamic stabilization and improve conditions to where further treatment options such as listing for heart transplantation may become possible.
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Affiliation(s)
- Christian Flottmann
- Clinic for General and Interventional Cardiology/AngiologyHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
| | - Daniel Dumitrescu
- Clinic for General and Interventional Cardiology/AngiologyHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
| | - Christian Sohns
- Clinic for ElectrophysiologyHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/AngiologyHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
| | - Henrik Fox
- Heart Failure DepartmentHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
- Clinic for Thoracic and Cardiovascular SurgeryHerz‐ und Diabeteszentrum NRWRuhr‐Universität BochumBad OeynhausenGermany
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Gyoten T, Rojas SV, Irimie A, Schramm R, Morshuis M, Gummert JF, Sitzer M, Fox H. Patients with ventricular assist device and cerebral entrapment-Supporting skullcap reimplantation. Artif Organs 2020; 45:473-478. [PMID: 33141976 DOI: 10.1111/aor.13856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Effects of cranioplasty (CP) and skullcap reimplantation after decompressive craniectomy (DC) for cerebral hemorrhage or malignant brain infarction in patients with left ventricular assist device (LVAD) support as bridge to transplantation has not been surveyed yet. The aim of this study was to evaluate outcome and management after CP when aiming for transplantation. Data were collected from our prospective institutional database including all patients undergoing LVAD implantation between 2010 and 2019. Six patients needed CP procedures and were included. Our analysis focused on postoperative outcome, survival, and facilitation of heart transplantation. Study endpoints included also all-cause mortality. From a total of 1010 LVAD implantations during analysis period in our center, six bridge-to-transplantation LVAD patients [median age at LVAD implantation: 32.5 years (IQR: 24.8-39.5 years); four male, HVAD, n = 3; HM II, n = 1; HM 3, n = 2] underwent CP with imminent entrapment secondary to cerebral hemorrhage or malignant infarction. Primary heart failure etiology was myocarditis (n = 2), dilated (n = 2), or ischemic (n = 2). Median INTERMACS class was 1.5 (IQR; 1.0-2.8). Median time on LVAD support to DC procedure was 33 months (IQR: 16-48 months). The indication for DC was intraparenchymal hemorrhage (n = 4), subdural hematoma (n = 1), and malignant middle cerebral artery infarction (n = 1). After a median time of 4 months (IQR: 3.3-4.0 months, range; 2.0-10 months) post DC procedure, CP was subsequently performed without profound neurologic disabilities in all patients. After median time of 26 months (IQR: 21-42 months) follow-up, three patients successfully received heart transplantation, one patient could undergo LVAD explantation for myocardial recovery, and the remaining two patients are still on the list awaiting heart transplantation. CP procedure with skullcap reimplantation is feasible and can be safely performed in LVAD patients, which subsequently may even be eligible for heart transplantation with beneficial prognosis.
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Affiliation(s)
- Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Anca Irimie
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Department of Neurology, Klinikum Herford, Herford, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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