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Mas-Peiro S, Faerber G, Herrmann E, Bauer T, Bleiziffer S, Bekeredjian R, Boening A, Frerker C, Beckmann A, Moellmann H, Ensminger S, Hamm C, Beyersdorf F, Fichtlscherer S, Walther T. TAVI versus SAVR in intermediate-risk patients with severe aortic stenosis and chronic kidney disease: a matched comparison in a subcohort from the GARY registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
According to American and recent European guidelines, both transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) may be used to treat severe aortic stenosis in a subgroup of patients with intermediate surgical risk, in spite of slight differences in recommended age limits (ACC/AHA: 65–80 years and ESC/EACTS: <75 years). A shared therapeutic decision is made with the patient, based on a heart team assessment. For this, individual factors should be taken into account. Concomitant chronic kidney disease (CKD) is a prognostic factor in such patients, and CKD stage ≥3a and ≥3b has been shown to be a significant independent risk factor for SAVR and TAVI, respectively.
Purpose
To compare TAVI vs. SAVR outcomes in a subgroup of patients for whom both therapies could possibly be considered according to current guidelines.
Methods
The large nation-wide German Aortic Valve Registry (GARY) includes data from patients treated with TAVI or SAVR. A subcohort of patients from GARY with intermediate surgical risk (age ≤80 years, STS-score 4–8) and moderate-to-severe chronic kidney disease (CKD stages 3a, 3b, and 4) was selected. A matched analysis of 704 patients undergoing TAVI and 374 undergoing SAVR was carried out using a propensity score method. Primary endpoint was 1-year survival. Clinical complications and specifically the need for postprocedural new-onset dialysis were secondary endpoints.
Results
TAVI and SAVR showed similar survival results at 1 year in a Kaplan-Meier analysis (HR [95% CI] for TAVI: 1.271 [0.795,2.031], p=0.316). Despite a numerically higher post-procedural short-term survival in TAVI patients and a numerically higher 1-year survival in SAVR patients, such differences did not reach statistical significance (96.4% vs. 94.2%, p=0.199, and 86.2% vs. 81.2%, p=0.316, respectively). In weighted analyses, need for permanent pacemaker, vascular complications, and moderate-to-severe valvular regurgitation were significantly more common with TAVI, whereas patients undergoing SAVR had significantly higher rates of myocardial infarction, and transient ischaemic attack, needed more transfusions for bleeding, and had a significantly longer intensive care unit stay and overall hospital stay. The need for new-onset dialysis for a limited time was more common after SAVR (p<0.0001); however, very few patients required chronic dialysis either after TAVI or after SAVR.
Conclusion
In a matched analysis of intermediate-risk patients with severe aortic stenosis and a concomitant moderate-to-severe CKD, for whom both TAVI and SAVR could possibly be considered, both approaches showed excellent and comparable results.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The registry receives financial support in the form of unrestricted grants by medical device companies (Edwards Lifesciences, JenaValve Technology, Medtronic, Sorin, St. Jude Medical, Symetis S.A.).In addition, there is unrestricted support by funding statisticians by the DZHK (Deutsches Zentrum für Herz-Kreislaufforschung).
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Affiliation(s)
- S Mas-Peiro
- Wolfgang Goethe University , Frankfurt am Main , Germany
| | - G Faerber
- University Hospital Jena , Jena , Germany
| | - E Herrmann
- Wolfgang Goethe University , Frankfurt am Main , Germany
| | - T Bauer
- Sana Clinic Offenbach , Offenbach , Germany
| | - S Bleiziffer
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum , Bad Oeynhausen , Germany
| | | | - A Boening
- University Hospital Giessen and Marburg , Giessen , Germany
| | - C Frerker
- Heart Center at the University of Cologne , Cologne , Germany
| | - A Beckmann
- German Society for Thoracic and Cardiovascular Surgery , Berlin , Germany
| | | | - S Ensminger
- Schleswig-Holstein University Clinic, Lubeck Campus , Luebeck , Germany
| | - C Hamm
- University Hospital Giessen and Marburg , Giessen , Germany
| | - F Beyersdorf
- University Heart Center Freiburg-Bad Krozingen , Freiburg , Germany
| | | | - T Walther
- Wolfgang Goethe University , Frankfurt am Main , Germany
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Vogt F, Santarpino G, Fujita B, Frerker C, Bauer T, Bekeredjian R, Bleiziffer S, Beckmann A, Möllmann H, Walther T, Beyersdorf F, Hamm C, Böning A, Baldus S, Ensminger S, Fischlein T, Eckner D. Surgical Aortic Valve Replacement in Patients Aged 50 to 69 Years: Insights from the German Aortic Valve Registry (GARY). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- F. Vogt
- Department of Cardiac Surgery, Nürnberg, Deutschland
| | - G. Santarpino
- Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecche, Italy
| | - B. Fujita
- Department of Thoracic and Cardiaovascular Surgery, Lübeck, Deutschland
| | - C. Frerker
- Department of Cardiology, Ratzeburger Allee 160, Lübeck, Deutschland
| | - T. Bauer
- Department of Cardiology, Offenbach, Deutschland
| | | | - S. Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Deutschland
| | - A. Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie e.V., Berlin, Deutschland
| | - H. Möllmann
- Department of Internal Medicine, Dortmund, Deutschland
| | - T. Walther
- Department of Cardiac, Thoracic and Thoracic Vascular Surgery, Frankfurt, Deutschland
| | - F. Beyersdorf
- Department of Cardiovascular Surgery, Freiburg, Deutschland
| | - C. Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Deutschland
| | - A. Böning
- Department of Cardiothoracic Surgery, Gießen, Deutschland
| | - S. Baldus
- Department of Internal Medicine III, Heart Center Cologne, Köln, Deutschland
| | - S. Ensminger
- Clinic for Heart and Thoracic Vessel Surgery, Lübeck, Deutschland
| | - T. Fischlein
- Department of Cardiac Surgery, Nürnberg, Deutschland
| | - D. Eckner
- Department of Cardiology, Nürnberg, Deutschland
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3
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Leha A, Huber C, Friede T, Bauer T, Beckmann A, Bekeredjian R, Bleiziffer S, Herrmann E, Moellmann H, Walther T, Kutschka I, Hasenfuss G, Ensminger S, Frerker C, Seidler T. Refined prediction and validation of individual risk using machine learning in transcatheter aortic valve implantation: TAVI Risk Machine (TRIM) scores. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Given the recent option for treatment using TAVI irrespective of surgical risk, general surgical risk scores have become less relevant, while TAVI-specific scores require refinement. Additionally, post-TAVI risk models are lacking; however, such risk models can support decision between post-TAVI treatment approaches, such as early discharge or close surveillance.
Purpose
This study aimed to predict 30-day mortality following transcatheter aortic valve implantation (TAVI) based on machine learning (ML) using data from the German Aortic Valve Registry.
Methods
Mortality risk was determined using a random forest ML model that was condensed in the newly developed TAVI Risk Machine (TRIM) scores, designed to represent clinically meaningful risk modelling before (TRIMpre) and after (TRIMpost) TAVI. Algorithm was trained and cross-validated on data of 24,452 patients and generalisation was examined on data of 5,889 patients.
Results
TRIMpost demonstrated significantly better performance than traditional scores (C-statistics value, 0.79; 95% confidence interval [CI] [0.74; 0.83]). An abridged TRIMpost score comprising 25 features (calculated using a web interface) exhibited significantly higher performance than traditional scores (C-statistics value, 0.74; 95% CI [0.70; 0.78]).
Conclusion
TRIM scores have high performance for risk estimation before and after TAVI. Together with clinical judgement, they may support standardised and objective decision-making before and after TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Leha
- University Medical Center of Göttingen (UMG), Göttingen, Germany
| | - C Huber
- University Medical Center of Göttingen (UMG), Göttingen, Germany
| | - T Friede
- University Medical Center of Göttingen (UMG), Göttingen, Germany
| | - T Bauer
- Sana Klinikum Offenbach, Offenbach, Germany
| | - A Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Berlin, Germany
| | | | - S Bleiziffer
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - E Herrmann
- Johann Wolfgang Goethe University, Frankfurt, Germany
| | | | - T Walther
- Johann Wolfgang Goethe University, Frankfurt, Germany
| | - I Kutschka
- University Medical Center of Göttingen (UMG), Göttingen, Germany
| | - G Hasenfuss
- University Medical Center of Göttingen (UMG), Göttingen, Germany
| | - S Ensminger
- University Medical Center of Schleswig-Holstein, Luebeck, Germany
| | - C Frerker
- University Medical Center of Schleswig-Holstein, Luebeck, Germany
| | - T Seidler
- University Medical Center of Göttingen (UMG), Göttingen, Germany
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4
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Alushi B, Ensminger S, Balaban U, Frerker C, Falk V, Lauten A. Low-gradient aortic stenosis in patients with concomitant mitral regurgitation - a subgroup analysis from the German aortic valve registry (GARY). Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by German Cardiac Society, German Society for Thoracic and Cardiovascular Surgery, and German Heart Foundation. Statistical funding support by the German Center for Cardiovascular Research/Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK).
Background
Patients with severe aortic stenosis (AS) frequently present concomitant mitral regurgitation (MR), which may interfere with echocardiographic measurement of mean pressure gradient (MPG), maximal flow velocity and aortic valve area (AVA).
Purpose
We therefore, aimed to investigate the impact of different grades of MR on parameters of AS severity in a large cohort of all-comer patients with severe AS, prospectively included in the national German Aortic Registry (GARY).
Methods
All patients undergoing transcatheter or surgical aortic valve replacement for severe AS enrolled in GARY between 2011 and 2017 were considered for this analysis. After excluding cases with mitral stenosis and unknown causes of MR, 119,641 patients were considered for the present study. Based on LVEF, the study population was divided into the following subgroups: group 1 (LVEF < 30%, n = 7545), group 2 (LVEF 30-50%, n = 30,116), and group 3 (LVEF > 50%, n = 81,980). Differences in the values of the mPG were explored in each group and in relation to the decremental values of aortic valve area (AVA).
Results
Overall, 37,489 (31.3%) patients had no MR, 77,890 (65.1%) had MR grade I-II, and 4262 (3.6%) had MR grade III-IV.
In group 1, 2 and 3, no MR was reported in 1339 (17.7%), 7612 (25.3%) and 28,538 (34.8%) patients respectively. MR grade I-II was more frequently observed (group 1 5621 [74.5%] vs. group 2 20,972 [69.6%] vs. group 3 51,297 [62.6%]), whereas MR grade III-IV was observed less frequently and present only in 585 (7.7%), 1532 (5.1%) and 2145 (2.6%) patients in subgroups 1, 2 and 3, respectively.
The aortic mPG was significantly lower in subgroup 1 compared to 2 and 3 (33.74 ± 14.93 versus 41.4 ± 16.47 and 46 ± 16.19mmHg respectively, p < 0.001). With increasing severity of MR, there was a significant reduction of the aortic mPG in each LVEF subgroup (Figure 1). This pattern was maintained irrespective of the AVA value.
Conclusions
In patients with severe AS, concomitant MR may potentially affect diagnostic accuracy of echocardiographic AS evaluation. In this first GARY analysis of patients with severe AS and concomitant MR, we observed that increasing MR severity affects transvalvular aortic mPG and results in a low-gradient AS pattern. In contrast, AVA is a robust diagnostic parameter for the diagnosis of true severe AS that maintains its validity independently of LVEF and severity of concomitant MR.
Abstract Figure 1
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Affiliation(s)
- B Alushi
- Helios Klinikum Erfurt, General and Interventional Cardiology, Erfurt, Germany
| | - S Ensminger
- University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
| | - U Balaban
- Goethe University Hospital, Institute of Biostatistics and Mathematical Modelling, Frankfurt, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - V Falk
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - A Lauten
- Helios Klinikum Erfurt, General and Interventional Cardiology, Erfurt, Germany
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Mas-Peiro S, Faerber G, Bauer T, Bleiziffer S, Bekeredjian R, Boening A, Frerker C, Beckmann A, Moellmann H, Vasa-Nicotera M, Ensminger S, Hamm C, Beyersdorf F, Walther T, Fichtlscherer S. Clinical outcomes after surgical or transcatheter aortic valve replacement in patients with chronic kidney disease: an analysis in 29 893 patients from the German Aortic Valve Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).
Purpose
We analyzed the impact of eGFR and different stages of chronic kidney disease (CKD), on short- and mid-term survival in patients undergoing TAVI or SAVR.
Methods
Data from 29893 patients enrolled in the German Aortic Valve registry (GARY) from January 2011 to December 2015 receiving TAVI (n=12834) or SAVR (n=17059) at 88 sites were included. The impact of renal impairment, as measured by eGFR and CKD stages, was investigated. The primary endpoint was 1-year cumulative all-cause mortality. A propensity score method was used to compare TAVI vs. SAVR in patients with intermediate risk and mild-to-moderate renal disease being eligible for both therapies.
Results
Higher CKD stages were significantly associated to lower in-hospital, 30-day- and 1-year survival rates. Both TAVI- and SAVR-treated patients in CKD 3a, 3b, 4, and 5 stages showed significant and gradually increasing HR values for 1-year all-cause mortality. The same trend persisted in multivariable analysis, although HR values for CKD 3a and 5 did not reach significance in TAVI patients, whereas CKD 4+5 did not reach statistical significance in SAVR. Likewise, eGFR as a continuous variable was a significant predictor for 1-year mortality, with the best cut-off points being 47.4 mL/min/1.73 m2 for TAVI and 59.8 mL/min/1.73 m2 for SAVR. Significant 8.6% and 9.0% increases in 1-year mortality were observed for every 5-mL reduction in eGFR for TAVI and SAVR, respectively. No significant differences in survival were found between TAVI and SAVR in a matched group of intermediate-risk patients potentially eligible for both therapies (HR [(95% CI] for TAVI vs SAVR 1.24 [0.76, 2.02], p=0.240).
Conclusions
CKD≥3b and CKD≥3a is an independent major risk factor for mortality in patients undergoing TAVI and SAVR, respectively. In the overall population of patients with severe aortic stenosis, an appropriate stratification based on CKD substage may contribute to a better selection of patients suitable for such therapies. TAVI and SAVR appear to achieve similar survival rates in intermediate-risk patients with moderate-to-severe renal dysfunction.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grants by medical device companies (Edwards Lifesciences, JenaValve Technology, Medtronic, Sorin, St. Jude Medical, Symetis S.A.). Unrestricted support by funding statisticians by the DZHK (Deutsches Zentrum für Herz-Kreislaufforschung).
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Affiliation(s)
- S Mas-Peiro
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - G Faerber
- University Hospital Jena, Jena, Germany
| | - T Bauer
- Sana Klinikum Offenbach, Offenbach, Germany
| | | | | | - A Boening
- University hospital Giessen and Marburg, Giessen, Germany
| | - C Frerker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - A Beckmann
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | | | | | - S Ensminger
- University hospital Schleswig-Holstein Campus Lübeck, Luebeck, Germany
| | - C.W Hamm
- University hospital Giessen and Marburg, Giessen, Germany
| | - F Beyersdorf
- University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - T Walther
- Wolfgang Goethe University, Frankfurt am Main, Germany
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Armario X, Rosseel L, Banning A, Khogali S, Blackman D, Abdel-Wahab M, Tchetche D, Hildick-Smith D, Van Mieghem N, Spence M, Frerker C, Nickenig G, Pilgrim T, Sondergaard L, Mylotte D. Transcatheter aortic valve implantation with the LOTUS Edge system: early European experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
To evaluate the clinical outcomes of transcatheter aortic valve implantation (TAVI) with the recently commercialised LOTUS EdgeTM system.
Methods and results
We performed a multicentre, single-arm, retrospective registry to generate early information on patients undergoing TAVI with the LOTUS EdgeTM system following its commercial release in July 2019. Novel features of this second-generation device include increased flexibility of the delivery catheter, enhanced visualisation of the locking mechanism and the depth guard technology to reduce left ventricular outflow tract interaction and, potentially, reduce the risk of permanent pacemaker (PPM) implantation. All endpoints were defined according to the VARC-2 definitions and were reported by the treating site.
A total of 286 consecutive patients from 18 participating centres were included. The mean age and STS score were 81.2±6.9 years and 5.2±5.4%, respectively. Most procedures were performed under local anaesthesia (97.2%) via transfemoral access (98.6%).
Successful vascular access, valve delivery and deployment and system retrieval were achieved in 97.6% of cases. 30-day rates of all-cause mortality (2.1%, N=6) and stroke (3.5%, N=10) were acceptable. Disabling, life-threatening or major bleeding occurred in 3.8% and major vascular complications in 2.1%. The incidence of new PPM implantation was 27.1% among all patients and 32.2% among pacemaker-naive patients. After TAVI, the mean transvalvular pressure gradient was 11.9±5.6 mmHg and the mean aortic valve area was 1.9±0.9 cm2. The rate of moderate paravalvular leak was 2.1% with no cases of severe paravalvular leak.
Conclusions
Early experience with the LOTUS EdgeTM system demonstrated acceptable 30-day clinical outcomes with impressively low rates of paravalvular leak. The requirement for new PPM remained high in this early experience. Further study is required to understand if improving operator experience with the device can reduce PPM rates.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- X Armario
- Galway University Hospital, Galway, Ireland
| | - L Rosseel
- Galway University Hospital, Galway, Ireland
| | - A Banning
- John Radcliffe Hospital, Oxford, United Kingdom
| | - S.S Khogali
- New Cross Hospital, Wolverhampton, United Kingdom
| | - D.J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | | | - N.M Van Mieghem
- Erasmus University Medical Centre, Rotterdam, Netherlands (The)
| | - M.S Spence
- Belfast City Hospital Trust, Belfast, United Kingdom
| | - C Frerker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | | | - T Pilgrim
- University of Bern, Bern, Switzerland
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - D Mylotte
- Galway University Hospital, Galway, Ireland
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Macherey S, Meertens M, Eichel S, Schipper J, Mauri V, Frerker C, Adam M, Kuhn E, Wahlers T, Lee S, Baldus S, Schmidt T. Stroke and mortality rates after valve-in-valve TAVR and comparison with data from redo SAVR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Early registry data described a potentially increased risk for cerebrovascular events and mortality in patients undergoing transcatheter aortic valve replacement (TAVR) as valve-in-valve (viv) procedures. Further data of small patient cohorts described divergent results for cerebrovascular events and mortality in patients undergoing TAVR as viv procedures for failed surgical bioprotheses in comparison with patients on redo surgical aortic valve replacement (SAVR). We performed a meta-analysis of stroke rates and mortality for viv TAVR procedures basing on the current literature.
Methods
We included all case series (≥10 patients), case-control studies and randomized controlled trials comparing viv TAVR and redo SAVR procedures with respect to cerebrovascular events and mortality rates. Additionally, we included all case series and registries with patients undergoing viv TAVR. After a structured literature research, 17 studies were eligible. For statistical analysis risk ratios and confidence intervals using Mantel-Haenszel test and the I-statistic to quantify possible heterogeneity were calculated. A P-value <0.05 was defined as statistical significant difference.
Results
Eleven case series and registries reporting on stroke and mortality in 8,509 patients undergoing viv TAVR were eligible for analysis. The quantitative analysis of non-comparative studies showed a calculated 30-day stroke rate of 2.2% and 30-day mortality rate of 4.2% after viv TAVR. Data on the 1-year rates were sporadically reported, therefore meta analysis was not appropriately feasible.
Six studies reporting on 498 participants undergoing viv TAVR (N=254) and redo SAVR (N=244) were eligible. The median age ranged from 72.3 to 80.2 years for viv TAVR and from 66.2 to 78.8 years for redo SAVR patients. The STS score was 7.2–7.4% (viv TAVR) and 5.8–7.7% (redo SAVR), respectively. A total of 3/226 participants treated with viv TAVR and 4/214 patients undergoing redo SAVR experienced a stroke during the first 30 postoperative days (N=4 trials, RR 0.86, 95% CI 0.20 to 3.59, p=0.83, I2 = 0%). None of the studies reported sufficient data on the 1-year stroke incidence. The 30-day mortality was 4.3% for viv TAVR and 4.5% for redo SAVR patients. This difference was not significantly different (N=6 trials, RR 0.90, 95% CI 0.40 to 2.05, p=0.80, I2 = 0%). The 1-year mortality rates were 13.3% and 13.6%, respectively (N=2 trials, RR 0.98, 95% CI 0.49 to 1.94, p=0.94, I2 = 0%).
Conclusion
In the current literature favorable stroke and mortality rates at 30 days for patients undergoing viv TAVR are documented. Similar stroke and mortality rates comparing viv TAVR and redo SAVR patients at 30 days were found as well as similar 1-year mortality. A selection bias for the viv TAVR and redo SAVR patients may exist, but cannot be dissolved with this registry analysis, only showing a trend of younger and lower risk patients receiving a redo SAVR procedure.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Macherey
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Meertens
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - S Eichel
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - J Schipper
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - V Mauri
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - C Frerker
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Adam
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - E Kuhn
- Cologne University Hospital - Heart Center, Department of Cardiothoracic Surgery, Cologne, Germany
| | - T Wahlers
- Cologne University Hospital - Heart Center, Department of Cardiothoracic Surgery, Cologne, Germany
| | - S Lee
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - T Schmidt
- Cologne University Hospital - Heart Center, Cologne, Germany
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8
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Blumenstein J, Möllmann H, Bleiziffer S, Bauer T, Ensminger S, Bekeredjian R, Walther T, Frerker C, Beyersdorf F, Hamm C, Beckmann A. Transcatheter aortic valve implantation in nonagenarians: insights from the German Aortic Valve Registry (GARY). Clin Res Cardiol 2020; 109:1099-1106. [PMID: 31989251 DOI: 10.1007/s00392-020-01601-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the outcome of nonagenarians (≥ 90 years) with that of younger (< 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice. METHODS Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients. RESULTS Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p < 0.001), frail (38.7% vs. 34.7%, p < 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p < 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p > 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age ≥ 90 years could be identified as an isolated risk factor for mortality. CONCLUSION TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients-most probably due to the intrinsic higher risk profile of the very old patients-the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.
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Affiliation(s)
- J Blumenstein
- Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany
| | - H Möllmann
- Department of Internal Medicine I, St. Johannes Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany.
| | - S Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - T Bauer
- Department of Cardiology, Sana-Klinikum, Offenbach, Germany
| | - S Ensminger
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Lübeck, Germany
| | - R Bekeredjian
- Department of Cardiology, Robert-Bosch Hospital, Stuttgart, Germany
| | - T Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Frankfurt, Germany
| | - C Frerker
- Department of Cardiology, University Hospital, Heart Center, Cologne, Germany
| | - F Beyersdorf
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Heart Center, Freiburg, Germany
| | - C Hamm
- Department of Medical Clinic I, University Hospital, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - A Beckmann
- Deutsche Gesellschaft für Thorax, Herz- Und Gefäßchirurgie, Berlin, Germany
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9
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Tichelbäcker T, Dumitrescu D, Gerhardt F, Stern D, Wissmüller M, Adam M, Schmidt T, Frerker C, Pfister R, Halbach M, Baldus S, Rosenkranz S. Pulmonary hypertension and valvular heart disease. Herz 2019; 44:491-501. [PMID: 31312873 DOI: 10.1007/s00059-019-4823-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients with left-sided heart disease, including valvular heart disease. In this context, elevated left atrial pressure primarily leads to the development of post-capillary PH. Despite the fact that repair of left-sided valvular heart disease by surgical or interventional approaches will improve PH, recent studies have highlighted that PH (pre- or post-interventional) remains an important predictor of long-term outcome. Here, we review the current knowledge on PH in valvular heart disease taking into account new hemodynamic PH definitions, and the distinction between post- and pre-capillary components of PH. A specific focus is on the precise characterization of hemodynamics and cardiopulmonary interaction, and on potential strategies for the management of residual PH after mitral or aortic valve interventions. In addition, we highlight the clinical significance of tricuspid regurgitation, which may occur as a primary condition or as a consequence of PH and right heart dilatation (functional). In this context, proper patient selection for potential tricuspid valve interventions is crucial. Finally, the article highlights gaps in evidence, and points toward future perspectives.
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Affiliation(s)
- T Tichelbäcker
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Dumitrescu
- Klinik für Allgemeine und Interventionelle Kardiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - F Gerhardt
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Stern
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - M Wissmüller
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - M Adam
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - T Schmidt
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Frerker
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - R Pfister
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - M Halbach
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Baldus
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Rosenkranz
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany.
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10
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Kitamura M, Schmidt T, Schewel D, Alessandrini H, Kuck KH, Frerker C. P6491Predictive effect of mitral annular size on persistent mitral valve dysfunction after transcatheter edge-to-edge mitral valve repair for functional mitral regurgitation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with functional mitral regurgitation (FMR), deformation of the mitral valve (MV) apparatus leads to deteriorating coaptation of both leaflets. The MV geometry is essential to predict procedural success of using the MitraClip™ for FMR patients. Persistent such mitral regurgitation (MR) and post-procedural mitral stenosis (MS) are parameters for an increasing mortality rate after MitraClip implantation. The anterior-to-posterior mitral annulus diameter (MAD) is simple to evaluate with a high reproducibility rate. However, the predictive effect has not been determined to date.
Purpose
We evaluated the predictive effect of baseline anterior-to-posterior MAD on persistent MV dysfunctions after MitraClip™ implantation.
Methods
We investigated the prevalence of procedural failure (MR at discharge > grade 2+) and post-procedural MS (mean transmitral gradient (mTMG) at discharge ≥6 mmHg) in a patient cohort with FMR (n=190), who underwent MitraClip™ implantation. We measured the MV apparatus geometry on mid-systole using transoesophageal echocardiography before the index procedure. The MAD was stratified by interquartile ranges (IQR) in the comparison. (≤34 mm, 35 to 37 mm, 38 to 40 mm, and ≥41 mm, respectively)
Results
The mean age was 75±9 years, and 63 patients (33%) were female. The mean left ventricular ejection fraction was 34±14%. Moderate-to-severe (3+) or severe MR (4+) were documented in all patients before the procedure. Transthoracic echocardiography at discharge revealed residual MR (>2+) in 10 patients (5%) and post-procedural MS in 13 patients (7%), in which one patient presented with both residual MR and MS.
After stratification by the IQRs of MAD, there were significant differences in body weight (p<0.001), height (p<0.001), and body surface area (p<0.001), but no significant differences in the other baseline characteristics. Notably, significant differences in the prevalence of procedural failure (p=0.004) and post-procedural MS (p=0.022) were observed among the groups. (Figure) Specifically, in the cohort with the 4th IQR (MAD ≥41 mm, n=44), procedural failure was observed in 7 patients (16%), although the prevalence was only 2% in the other IQR groups. Moreover, the cohorts with the 1st and 2nd IQR presented with higher prevalence of post-procedural MS (6 of 46 patients (13%) in the 1st IQR group, and 6 of 51 (12%) in the 2nd IQR group) than those with the 3rd and 4th IQRs. (1 of 49 patients (2%) in the 3rd IQR, and none of 44 patients in the 4th IQR)
Figure 1
Conclusion
In this analysis we showed that the mitral annulus size affected MV dysfunction after MitraClip™. Anterior-to-posterior MAD was useful to predict the procedural result. For FMR candidates with dilated mitral annulus larger than 40 mm, new-generation MitraClip-XTR™ system or other therapeutic concept such as annuloplasty may be reasonable to obtain satisfactory MV function.
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Affiliation(s)
- M Kitamura
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - D Schewel
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - H Alessandrini
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - K.-H Kuck
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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Affiliation(s)
- C Frerker
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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12
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Frerker C, Schmidt T, Pfister R, Körber MI, Mauri V, Wösten M, Baldus S. [Cardioband®: Where do we stand, who are suitable patients?]. Herz 2019; 44:596-601. [PMID: 31372675 DOI: 10.1007/s00059-019-4839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Functional mitral regurgitation (FMR) is characterized by a dilatation of the mitral valve annulus resulting in an insufficient adaptation of the anterior and posterior mitral valve leaflets and/or severe tethering of the leaflets due to dilatation of the left ventricle. The Cardioband® system was introduced in 2015 and is a catheter-based direct mitral valve annuloplasty procedure for treatment of FMR. In the European CE approval study 60 patients with moderate or severe FMR were analyzed per protocol. There were no device or procedure-related deaths. The technical success rate of the procedure, defined as successful implantation and tightening was 97%. At 1 year, the overall survival and survival free of hospital readmission for heart failure were 87% and 66%, respectively. Currently, various interventional treatment procedures are available, such as the edge-to-edge technique as well as direct and indirect annuloplasty. In summary, patients with FMR as a result of a dilatation of the mitral valve annulus appear to be suitable for direct annuloplasty with the Cardioband® system.
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Affiliation(s)
- C Frerker
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Schmidt
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M I Körber
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - V Mauri
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M Wösten
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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13
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Fujita B, Schmidt T, Bleiziffer S, Bauer T, Beckmann A, Bekeredjian R, Möllmann H, Walther T, Landwehr S, Hamm C, Beyersdorf F, Katus H, Harringer W, Ensminger S, Frerker C. Incidence of new Permanent Pacemaker Implantation after Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Implantation and Its Impact on 1-Year Mortality—Insights from the German Aortic Valve Registry. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- B. Fujita
- Department of Heart and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
| | - T. Schmidt
- Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - T. Bauer
- Universität Gießen, Gießen, Germany
| | - A. Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
| | | | | | - T. Walther
- Universität Frankfurt, Frankfurt, Germany
| | - S. Landwehr
- BQS Institut für Qualität und Patientensicherheit, Düsseldorf, Germany
| | - C. Hamm
- Kerckhoff-Heart Center Bad Nauheim, Bad Nauheim, Germany
| | - F. Beyersdorf
- Universitäts Herzzentrum - Freiburg/Bad Krozingen, Freiburg, Germany
| | - H. Katus
- Universität Heidelberg, Heidelberg, Germany
| | | | - S. Ensminger
- Department of Heart and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
| | - C. Frerker
- Asklepios Klinik St. Georg, Hamburg, Germany
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14
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Heeger CH, Metzner A, Schlueter M, Rillig A, Mathew S, Fink T, Reissmann B, Lemes C, Maurer T, Santoro F, Schmidt T, Ghanem A, Frerker C, Kuck KH, Ouyang F. 2117Cerebral protection during catheter ablation of ventricular tachycardia in patients with ischemic heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - M Schlueter
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Ghanem
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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15
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Alessandrini H, Kreidel F, Wohlmuth P, Schlueter M, Schewel J, Schewel D, Schmidt T, Frerker C, Kuck KH. P1754Anatomical, morphological, and haemodynamic predictors of transmitral pressure gradient greater than or equal to 5 mmHg after MitraClip implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Alessandrini
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - F Kreidel
- University Medical Center of Mainz, Mainz, Germany
| | - P Wohlmuth
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Schlueter
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - J Schewel
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - D Schewel
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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Heeger CH, Metzner A, Rillig A, Mathew S, Fink T, Reissmann B, Lemes C, Maurer T, Santoro F, Schmidt T, Frerker C, Ghanem A, Kuck KH, Ouyang F. 997Embolic debris captured by a cerebral protection system during catheter ablation of ventricular tachycardia in patients with ischemic heart disease. Europace 2018. [DOI: 10.1093/europace/euy015.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Ghanem
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Rottner L, Schmidt T, Dotz I, Lemes C, Heeger CH, Fink T, Mathew S, Reissmann B, Rexha E, Riedl J, Frerker C, Ouyang F, Kuck KH, Metzner A, Maurer T. P1212The clip and the tip: Long-term clinical outcome after ablation of atrial fibrillation in patients with MitraClip. Europace 2018. [DOI: 10.1093/europace/euy015.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Rottner
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - I Dotz
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - E Rexha
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - J Riedl
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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Fujita B, Husser O, Hengstenberg C, Beckmann A, Möllmann H, Walther T, Bekeredjian R, Bleiziffer S, Mohr FW, Bauer T, Ensminger S, Frerker C. Conscious Sedation versus General Anesthesia in Transcatheter Aortic Valve Implantation: Insights from the German Aortic Valve Registry. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Fujita
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - O. Husser
- Klinik für Herz- und Kreislauferkrankungen, Technical University of Munich, München, Germany
| | - C. Hengstenberg
- Klinik für Herz- und Kreislauferkrankungen, Technical University of Munich, München, Germany
| | - A. Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
| | - H. Möllmann
- St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | | | | | - S. Bleiziffer
- Klinik für Herz- und Gefäßchirurgie, Technical University of Munich, München, Germany
| | | | - T. Bauer
- University of Giessen, Gießen, Germany
| | - S. Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - C. Frerker
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
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Ensminger S, Fujita B, Bauer T, Möllmann H, Beckmann A, Bekeredjian R, Bleiziffer S, Landwehr S, Hamm C, Mohr FW, Katus H, Harringer W, Walther T, Frerker C. Direct Comparison of Rapid Deployment Valves and Conventional Biological Valves for Treatment of Aortic Stenosis: Insights from the German Aortic Valve Registry. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - B. Fujita
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - T. Bauer
- University of Giessen, Gießen, Germany
| | - H. Möllmann
- St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - A. Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
| | | | | | - S. Landwehr
- BQS Institute for Quality and Patient Safety, Düsseldorf, Germany
| | - C. Hamm
- Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - H. Katus
- University of Heidelberg, Heidelberg, Germany
| | | | | | - C. Frerker
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
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Abstract
BACKGROUND The tricuspid valve can be considered the "forgotten" valve because in the past hardly any research has been conducted in this field and as a result only few therapeutic options existed. The prognosis of untreated tricuspid regurgitation (TR) is poor and mortality is high for patients with severe TR. Patients frequently return to medical practices and hospitals because of cardiac decompensation, with shortness of breath and leg edema. OBJECTIVE Recent years have seen more development in catheter-based treatment options. Currently, several devices are in clinical evaluation, which are presented in this article. MATERIAL AND METHODS A web-based literature search was carried out and information was gathered at international cardiology meetings (TCT 2016 in Washington, DGK 2017 in Mannheim, EuroPCR 2017 in Paris). RESULTS AND CONCLUSION There are various options for interventional catheter procedures for TR, which are being investigated within the scope of clinical studies. Most aim at reducing the tricuspid annular diameter and optimizing leaflet coaptation. Because of these new therapy options patients can now be treated who were considered untreatable in the past because of the high perioperative mortality.
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Affiliation(s)
- T Wißt
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland
| | - F Kreidel
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland
| | - M Schlüter
- Asklepios Proresearch, Hamburg, Deutschland
| | - K-H Kuck
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland
| | - C Frerker
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland.
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Schäfer U, Deuschl F, Schofer N, Frerker C, Schmidt T, Kuck K, Kreidel F, Schirmer J, Mizote I, Reichenspurner H, Blankenberg S, Treede H, Conradi L. Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients. Int J Cardiol 2017; 232:247-254. [DOI: 10.1016/j.ijcard.2017.01.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/25/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Schirmer J, Holzhey D, Sinning J, Bauernschmitt R, Schröfel H, Oertel F, Bleiziffer S, Unbehaun A, Holinski S, Lauten A, Frerker C, Kaminski A, Blankenberg S, Reichenspurner H, Conradi L, Schäfer U. Treatment of Native Calcific Mitral Stenosis using Commercially Available Transcatheter Heart Valves (THV): Results from the First German THV Mitral Stenosis Registry. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J. Schirmer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - D. Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - J.M. Sinning
- Department of Medicine II, University Medical Center Bonn, Bonn, Germany
| | - R. Bauernschmitt
- Department of Cardiothoracic and Vascular Surgery, University Medical Center Ulm, Ulm, Germany
| | - H. Schröfel
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - F. Oertel
- Department of Cardiothoracic Surgery, Augsburg Medical Center, Augsburg, Germany
| | - S. Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - A. Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - S. Holinski
- Department of Cardiovascular Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - A. Lauten
- Department of Cardiology, Charité - University Medicine Berlin, Berlin, Germany
| | - C. Frerker
- Department of Cardiology, Asklepios Medical Center St. Georg, Hamburg, Germany
| | - A. Kaminski
- Department of Cardiac Surgery, University Medical Center Rostock, Rostock, Germany
| | - S. Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - L. Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - U. Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
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23
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Ensminger S, Fujita B, Landwehr S, Bauer T, Möllmann H, Beckmann A, Welz A, Kuck KH, Hamm C, Mohr F, Walther T, Frerker C. Current Trends in Practice and Outcomes after Surgical Aortic Valve Replacement in Germany: Update of the GARY Registry. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Ensminger
- Heart and Diabetes Center NRW, Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - B. Fujita
- Heart and Diabetes Center NRW, Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - S. Landwehr
- BQS Institute for Quality and Patient Safety, Düsseldorf, Germany
| | - T. Bauer
- Cardiology, University Gießen, Gießen, Germany
| | - H. Möllmann
- Internal Medicine, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - A. Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Berlin, Germany
| | - A. Welz
- Cardiac Surgery, University of Bonn, Bonn, Germany
| | - K.-H. Kuck
- Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - C. Hamm
- Cardiology, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
| | - F.W. Mohr
- Herzchirurgie, Herzzentrum Leipzig, Leipzig, Germany
| | - T. Walther
- Herzchirurgie, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
| | - C. Frerker
- Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
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Thielsen T, Frerker C, Schmidt T, Schlüter M, Kreidel F, Alessandrini H, Kuck KH. [Future interventional procedures for valve diseases]. Internist (Berl) 2016; 57:341-8. [PMID: 26907869 DOI: 10.1007/s00108-016-0029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous valve therapies represent one of the most innovative areas within interventional cardiology in the past 10 years. AIM The aim of this work is to give an overview of current and upcoming therapeutic options. MATERIALS AND METHODS In this manuscript, the results of a retro- and prospective literature research are summarized. RESULTS AND DISCUSSION With the introduction of percutaneous therapies for valvular heart disease, patients who were previously considered too ill for surgery can now be treated. The percutaneous treatment of aortic or mitral valve disease has become standard therapy. Likewise, promising results have been obtained for percutaneous treatment options for pathologies of the tricuspid valve, which are still under intense investigation.
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Affiliation(s)
- T Thielsen
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - C Frerker
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - T Schmidt
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - M Schlüter
- Asklepios proresearch, Hamburg, Deutschland
| | - F Kreidel
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - H Alessandrini
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - K-H Kuck
- Abteilung für Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
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Deuschl F, Schofer N, Vogel B, Seiffert M, Frerker C, Conradi L, Treede H, Lubos E, Schirmer J, Schewel D, Kuck KH, Reichenspurner H, Blankenberg S, Schäfer U. Use of Endovascular Dual Filtration System for Cerebral Protection in Transcatheter Heart Valve Implantation Procedures. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schlingloff F, Frerker C, Schäfer U, Schmoeckel M, Bader R. Combined Total Arterial Off-Pump Revascularization and Direct Aortictranscatheter Valve Implantation in High-Risk Patients with Coronary Artery Disease and Aortic Stenosis. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Linke A, Wenaweser P, Gerckens U, Tamburino C, Bosmans J, Bleiziffer S, Blackman D, Schafer U, Muller R, Sievert H, Sondergaard L, Klugmann S, Hoffmann R, Tchetche D, Colombo A, Legrand VM, Bedogni F, lePrince P, Schuler G, Mazzitelli D, Eftychiou C, Frerker C, Boekstegers P, Windecker S, Mohr FW, Woitek F, Lange R, Bauernschmitt R, Brecker S. Treatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study. Eur Heart J 2014; 35:2672-84. [DOI: 10.1093/eurheartj/ehu162] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schlingloff F, Frerker C, Schäfer U, Schmoeckel M, Bader R. Hybrid TAVR procedures for complex pathologies. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Schlingloff F, Frerker C, Thielsen T, Schaefer U, Bader R. 154-I * TRANSAPICAL AORTIC VALVE (JENAVALVE) IMPLANTATION FOR SEVERE AORTIC INSUFFICIENCY AND AORTIC ANEURYSM. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Frerker C, Schäfer U, Kuck KH. [Mitral valve regurgitation in advanced heart failure: interventional or surgical treatment? For interventional treatment]. Dtsch Med Wochenschr 2010; 135:624. [PMID: 20333598 DOI: 10.1055/s-0030-1251907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C Frerker
- Hanseatisches Herzzentrum Asklepios Klinik St. Georg II Medizinische Klinik, 20099 Hamburg.
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