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Ludwig S, Koell B, Weimann J, Donal E, Patel D, Stolz L, Tanaka T, Scotti A, Trenkwalder T, Rudolph F, Samim D, von Stein P, Giannini C, Dreyfus J, Paradis JM, Adamo M, Karam N, Bohbot Y, Bernard A, Melica B, Quagliana A, Lavie Badie Y, Kessler M, Chehab O, Redwood S, Lubos E, Søndergaard L, Metra M, Primerano C, Iliadis C, Praz F, Gerçek M, Xhepa E, Nickenig G, Latib A, Schofer N, Makkar R, Granada JF, Modine T, Hausleiter J, Kalbacher D, Coisne A. Impact of Intraprocedural Mitral Regurgitation and Gradient Following Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation. JACC Cardiovasc Interv 2024; 17:1559-1573. [PMID: 38986655 DOI: 10.1016/j.jcin.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The impact of intraprocedural results following transcatheter edge-to-edge repair (TEER) in primary mitral regurgitation (MR) is controversial. OBJECTIVES This study sought to investigate the prognostic impact of intraprocedural residual mitral regurgitation (rMR) and mean mitral valve gradient (MPG) in patients with primary MR undergoing TEER. METHODS The PRIME-MR (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation) registry included consecutive patients with primary MR undergoing TEER from 2008 to 2022 at 27 international sites. Clinical outcomes were assessed according to intraprocedural rMR and mean MPG. Patients were categorized according to rMR (optimal result: ≤1+, suboptimal result: ≥2+) and MPG (low gradient: ≤5 mm Hg, high gradient: > 5 mm Hg). The prognostic impact of rMR and MPG was evaluated in a Cox regression analysis. The primary endpoint was 2-year all-cause mortality or heart failure hospitalization. RESULTS Intraprocedural rMR and mean MPG were available in 1,509 patients (median age = 82 years [Q1-Q3: 76.0-86.0 years], 55.1% male). Kaplan-Meier analysis according to rMR severity showed significant differences for the primary endpoint between rMR ≤1+ (29.1%), 2+ (41.7%), and ≥3+ (58.0%; P < 0.001), whereas there was no difference between patients with a low (32.4%) and high gradient (42.1%; P = 0.12). An optimal result/low gradient was achieved in most patients (n = 1,039). The worst outcomes were observed in patients with a suboptimal result/high gradient. After adjustment, rMR ≥2+ was independently linked to the primary endpoint (HR: 1.87; 95% CI: 1.32-2.65; P < 0.001), whereas MPG >5 mm Hg was not (HR: 0.78; 95% CI: 0.47-1.31; P = 0.35). CONCLUSIONS Intraprocedural rMR but not MPG independently predicted clinical outcomes following TEER for primary MR. When performing TEER in primary MR, optimal MR reduction seems to outweigh the impact of high transvalvular gradients.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Cardiovascular Research Foundation, New York, NY, USA
| | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erwan Donal
- Université de Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Teresa Trenkwalder
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Felix Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia (NRW), Bad Oeynhausen, Germany
| | - Daryoush Samim
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp von Stein
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Cristina Giannini
- SD Emodinamica, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Paris, France
| | | | - Marianna Adamo
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Anne Bernard
- INSERM UMR1327 ISCHEMIA, University of Tours, Tours University Hospital, Cardiology Department, Tours, France
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Angelo Quagliana
- Rigshospitalet, Copenhagen University Hospital Copenhagen, Copenhagen, Denmark
| | - Yoan Lavie Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Mirjam Kessler
- Department of Internal Medicine II, Ulm University Heart Center, Ulm, Germany
| | - Omar Chehab
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom
| | | | - Lars Søndergaard
- Rigshospitalet, Copenhagen University Hospital Copenhagen, Copenhagen, Denmark
| | - Marco Metra
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy
| | - Chiara Primerano
- SD Emodinamica, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Christos Iliadis
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia (NRW), Bad Oeynhausen, Germany
| | - Erion Xhepa
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Thomas Modine
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Centre Hospitalier Universitaire Bordeaux, Bordaux, France
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY, USA; Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, CHU Lille, Lille, France.
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Kirov H, Caldonazo T, Mukharyamov M, Toshmatov S, Fischer J, Schneider U, Siemeni T, Doenst T. Cardiac Surgery 2023 Reviewed. Thorac Cardiovasc Surg 2024. [PMID: 38740368 DOI: 10.1055/s-0044-1786758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term "cardiac surgery AND 2023." We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Sultonbek Toshmatov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiac Surgery, Saarland University Medical Center, Homburg Saar, Germany
| | - Thierry Siemeni
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, University Hospital Jena, Jena, Germany
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Hatab T, Samimi S, Bou Chaaya RG, Qamar F, Kharsa C, Wessly P, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Nagueh SF, Zaid S, Goel SS. Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge-to-Edge Repair. J Am Heart Assoc 2024; 13:e032784. [PMID: 38390821 PMCID: PMC10944065 DOI: 10.1161/jaha.123.032784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER. METHODS AND RESULTS We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal: 0 risk factors, mixed: 1 risk factor, poor: ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile: hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile: HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile: HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile: HR, 3.39 [95% CI, 2.56-7.33], P=0.02). CONCLUSIONS The echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Fatima Qamar
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Marvin D Atkins
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Michael J Reardon
- Department of Cardiovascular Surgery Houston Methodist Hospital Houston TX
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Sherif F Nagueh
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Syed Zaid
- Department of Cardiology Baylor School of Medicine and the Michael E DeBakey VAMC Houston TX
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center Houston TX
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Noda A, Doi S, Kuwata S, Shiokawa N, Suzuki N, Kanamitsu Y, Sato Y, Tatsuro S, Okuno T, Kai T, Koga M, Tanabe Y, Izumo M, Ishibashi Y, Akashi YJ. Preprocedural Controlling Nutritional Status Score as a Predictor of Mortality in Patients Undergoing Transcatheter Mitral Valve Repair - A Single Center Experience in Japan. Circ Rep 2023; 5:442-449. [PMID: 38073869 PMCID: PMC10700033 DOI: 10.1253/circrep.cr-23-0055] [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: 05/28/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 03/12/2024] Open
Abstract
Background: A high score for controlling nutritional status (CONUT) due to poor nutritional status has been associated with adverse outcomes in patients with chronic heart failure. However, because little is known about the effect of CONUT score on mortality rates after transcatheter mitral valve repair, we evaluated nutrition screening tools for prognosis prediction in patients undergoing transcatheter mitral valve repair using the MitraClipTM system. Methods and Results: We retrospectively analyzed 148 patients with severe mitral regurgitation (MR) who underwent MitraClipTM implantation between April 2018 and April 2021. The preprocedural CONUT scores were assessed at the time of hospitalization, the primary outcome was all-cause death, and the analysis was of the mortality and incidence rates of cardiac events 1 year post-operation. Functional MR was of ischemic origin in the majority of patients (69.6%), with a mean left ventricular ejection fraction of 48.9±15.8%. Kaplan-Meier curves indicated that all-cause death was significantly worse in the high-CONUT score group than in the low-CONUT score group. Cox hazard analysis showed a significant association between all-cause death and CONUT score, as well as MitraScore. Conclusions: Preprocedural CONUT score, as well as MitraScore, in patients undergoing transcatheter edge-to-edge mitral valve repair may predict an increased risk of all-cause death. This knowledge should allow the heart team to accurately assess the clinical implications and prognostic benefits of the procedure in individual patients.
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Affiliation(s)
- Airi Noda
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Shunichi Doi
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Noriko Shiokawa
- Ultrasound Center, St. Marianna University School of Medicine Kawasaki Japan
| | - Norio Suzuki
- St. Marianna University Toyoko Hospital Kawasaki Japan
| | - Yoko Kanamitsu
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Shoji Tatsuro
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Taishi Okuno
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Takahiko Kai
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Masashi Koga
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Yasuhiro Tanabe
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Yuki Ishibashi
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
| | - Yoshihiro J Akashi
- Department of Cardiology, St. Marianna University School of Medicine Kawasaki Japan
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Kellermair J, Damian I, Grund M, Hagleitner G, Huber F, Resl M, Sulzbacher G, Clodi M, Steinwender C, Zierer A. Transapical electrosurgical laceration and stabilization of mitral clips followed by transcatheter mitral valve replacement-A one-stop shop. JTCVS Tech 2023; 22:189-196. [PMID: 38152237 PMCID: PMC10750474 DOI: 10.1016/j.xjtc.2023.07.028] [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: 05/06/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 12/29/2023] Open
Abstract
Objective Electrosurgical laceration and stabilization of mitral clips (ELASTA-CLIP) is a bail-out technique to recreate a single-orifice mitral valve after transcatheter edge-to-edge repair (TEER) with subsequent transcatheter mitral valve replacement (TMVR). This technique is a novel option for patients with significant residual mitral regurgitation after TEER with high risk for conventional surgery. The original ELASTA CLIP procedure features a transseptal approach, whereas the TMVR with the Tendyne bioprosthesis has a transapical access. Hereby we tested the hypothesis that a modified transapical ELASTA CLIP technique can be safely applied transapically allowing a straightforward one-stop shop access strategy. Methods We developed the procedural steps in a porcine passive-beating heart model and applied the modified technique with subsequent TMVR in 2 consecutive patients with severe mitral regurgitation after previous TEER. Patients were followed up to 30 days. Results The modified transapical ELASTA CLIP procedure was successful in both patients. The mean total procedure time was 118 minutes, and the mean fluoroscopy duration 22 minutes. At 30 days' follow-up, both patients were alive without bleeding complications, reintervention, or prosthetic valve dysfunction. Conclusions The modified transapical ELASTA CLIP procedure is technically feasible and safe at 30 days. Procedure times are lower compared with previous reports of the original transseptal approach.
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Affiliation(s)
- Joerg Kellermair
- Department of Cardiology and Internal Intensive Care Medicine, Kepler University Hospital Linz, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Ilinca Damian
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital Linz, Linz, Austria
| | - Michael Grund
- Department of Cardiology and Internal Intensive Care Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Georg Hagleitner
- Central Radiology Institute, Kepler University Hospital Linz, Linz, Austria
| | - Florian Huber
- Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital Linz, Linz, Austria
| | - Michael Resl
- Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
- Department of Medicine, St John of God Hospital Linz, Linz, Austria
| | - Gregor Sulzbacher
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital Linz, Linz, Austria
| | - Martin Clodi
- Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
- Department of Medicine, St John of God Hospital Linz, Linz, Austria
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care Medicine, Kepler University Hospital Linz, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Andreas Zierer
- Institute for Cardiovascular and Metabolic Research (ICMR), Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital Linz, Linz, Austria
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