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Aliabadi-Zuckermann A, Osorio-Jaramillo E, Knosalla C, Gummert J, Szabo G, Wittmann F, Yeter R, Schramm R, Goekler J, Hennig F, Morshuis M, Zuckermann A. Custodiol-N versus Custodiol: Results from a Prospective Randomised Single Blind, Multicenter Phase Iii Trial in Patients Undergoing Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.633] [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: 04/05/2023] Open
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Solowjowa N, Nemchyna O, Hrytsyna Y, Schönrath F, Knierim J, Falk V, Knosalla C. Computed Tomography and Speckle-Tracking Echocardiography as Multimodality Imaging Approach for Planning of Surgical Ventricular Restoration. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761703] [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: 03/22/2023]
Affiliation(s)
| | - O. Nemchyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Deutschland
| | - Y. Hrytsyna
- German Heart Institute Berlin, Berlin, Deutschland
| | - F. Schönrath
- German Heart Institute Berlin, Berlin, Deutschland
| | - J. Knierim
- Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | - V. Falk
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - C. Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Deutschland
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Kucherenko M, Kukucka M, Sang P, Hegemann N, Hennig F, Yeter R, Gransar T, Mladenow A, Emmerich A, Grune J, Falk V, Kübler WM, Knosalla C. Ultrasound Assessment of Pulmonary Artery Stiffness in Pulmonary Hypertension due to Left Heart Disease (PH-LHD). Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761774] [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: 03/22/2023]
Affiliation(s)
- M. Kucherenko
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
| | - M. Kukucka
- Department of Cardioanesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Deutschland
| | - P. Sang
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
| | - N. Hegemann
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - F. Hennig
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
| | - R. Yeter
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
| | - T. Gransar
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
| | - A. Mladenow
- Department of Cardioanesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Deutschland
| | - A. Emmerich
- Department of Cardioanesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Deutschland
| | - J. Grune
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - V. Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
| | - W. M. Kübler
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - C. Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin (DHZB), Berlin, Deutschland
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Nemchyna O, Solowjowa N, Dandel M, Hrytsyna Y, Stein J, Knierim J, Schoenrath F, Falk V, Knosalla C. The value of diastolic speckle-tracking parameters in predicting outcome after surgical ventricular restoration. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.176] [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 Institution(s). Main funding source(s): DZHK (German Centre for Cardiovascular Research) BMBF (German Ministry of Education and Research)
Background. Parameters of speckle-tracking echocardiography (STE) are incorporated into the integrative assessment of left ventricular (LV) diastolic function 1. In this study we aimed to evaluate both established and novel STE parameters of LV diastolic function and their prognostic role in patients with LV anteroapical aneurysm planned for surgical ventricular restoration (SVR).
Methods. We retrospectively examined data of 137 patients (60 ± 11 years, 25% women) with anteroapical LV aneurysm who underwent SVR and for whom preoperative echocardiography was available and feasible for STE and for conventional assessment of LV diastolic function by transmitral flow. STE parameters evaluated were: left atrial reservoir strain (LAS), early and late global diastolic strain rate (GLSRe and GLSRa), ratio of early-to-late diastolic strain rate (GLSRe/GLSRa), and ratio of early diastolic transmitral flow velocity (E) to GLSRe and to GLSRa. In 24 patients we evaluated an association of diastolic echocardiographic parameters with mean pulmonary artery pressure (PAPm) and mean pulmonary capillary wedge pressure (PCWPm) obtained invasively within 6 days of echocardiography. Preoperative echocardiographic parameters were assessed in whole cohort of patients for the association with an outcome, defined as all-cause mortality, LV assist device implantation, or heart transplantation.
Results. During a median follow-up of 4.7 years (IQR: 1.4-8.1 years) events occurred in 59 patients. GLSRa, E/GLSRa and LAS demonstrated significant correlation with PAPm and PCWPm (Table 1). GLSRa with optimal cut-off value of ≤ 0.41 s-1 was able to detect PAPm >30 mmHg with sensitivity of 0.8 and specificity of 0.8 (AUC 0.85; 95% CI 0.68-1.0; p = 0.008). E/GLSRa ≥1.24 m was able to detect PAPm >30 mmHg with sensitivity of 1.0 and specificity of 0.8 (AUC 0.87; 95%CI 0.7-1.0; p = 0.005). There was significant difference in event-free survival between groups stratified by cut-offs for GLSRa (Fig. 1A) and E/GLSRa (Fig. 1B). After adjustment for important clinical (age, sex, plasma creatinine, atrial fibrillation) and echocardiographic parameters (fractional shortening and LV end-systolic volume index) GLSRa and E/GLSRa remained an independent predictors of events (HR 0.16; 95% CI: 0.03-0.86; p = 0.032 and HR 1.22; 95% CI: 1.03-1.43; p = 0.018) and demonstrated higher prognostic value compared to LAS, other STE parameters and conventional parameters of LV diastolic function.
Conclusion. Late diastolic longitudinal strain rate and ratio of early diastolic transmitral flow velocity to late diastolic longitudinal strain rate demonstrated association with hemodynamic parameters in patients with LV anteropaical aneurysm and might be used for the evaluation of LV diastolic function. These parameters showed prognostic value for patients underwent SVR and could be implemented for preoperative evaluation of these patients. Abstract Table 1. Correlation data Abstract Figure 1. Survival curves
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Affiliation(s)
- O Nemchyna
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - N Solowjowa
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - M Dandel
- Cardio Centrum Berlin, Berlin, Germany
| | - Y Hrytsyna
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J Stein
- German Heart Center Berlin, Berlin, Germany
| | - J Knierim
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - F Schoenrath
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V Falk
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - C Knosalla
- German Heart Center Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
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Nemchyna O, Solowjowa N, Dandel M, Hrytsyna Y, Stein J, Knierim J, Schoenrath F, Falk V, Knosalla C. Left Ventricular Diastolic Function Assessed by Speckle Tracking Echocardiography in Patients with Left Ventricular Aneurysm. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742937] [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)
- O. Nemchyna
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
| | - N. Solowjowa
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
| | - M. Dandel
- Cardio Centrum Berlin, Berlin, Deutschland
| | - Y. Hrytsyna
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
| | - J. Stein
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
| | - J. Knierim
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
| | | | - V. Falk
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
| | - C. Knosalla
- Department of cardiovascular surgery, German Heart Institute Berlin, Berlin, Deutschland
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Just IA, Potapov E, Knosalla C, Schoenrath F. Mechanical unloading by miniature axial flow pumps in late cardiac allograft failure due to acute rejection. J Artif Organs 2021; 24:307-311. [PMID: 33846899 PMCID: PMC8380564 DOI: 10.1007/s10047-021-01266-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
Allograft failure secondary to rejection commonly requires a multimodal treatment, ultimately including mechanical circulatory support. A few case reports have demonstrated the use of Impella-devices due to its assumed favorable safety profile in this fragile cohort. However, this treatment option does not play a role in choice of anti-rejective therapy in clinical routine up to date. We summarize our institutional experiences and literature mini-review on Impella-based treatment strategies in allograft rejection after heart transplantation. In all seven cases, three from our institution and four reported in the literature, Impella-based therapies led to hemodynamic stabilization in allograft failure secondary to rejection. Adverse events included hemolysis, non-fatal bleeding and in one patient a relevant aortic valve insufficiency occurred. All patients showed an improvement of allograft function. Two patients died in context of severe immunosuppression or late secondary organ failure. Based on the limited available data, we propose that Impella-mediated mechanical unloading represents a valuable option for hemodynamic stabilization in severe allograft failure due to rejection, enabling an initiation of causal therapy and thereby potentially representing an opportunity to prevent mortality. Furthermore, we hypothesize it might add to the traditional therapeutic approaches by facilitating recovery by decompressing the myocardium in allograft rejection.
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Affiliation(s)
- I A Just
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - E Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - C Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie-Universität, Humboldt-Universität and Berlin-Institute-of-Health, Berlin, Germany
| | - F Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Nordmeyer S, Lee CB, Goubergrits L, Knosalla C, Berger F, Falk V, Ghorbani N, Hireche-Chikaoui H, Zhu M, Kelle S, Kuehne T, Kelm M. Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement. J Cardiovasc Magn Reson 2021; 23:15. [PMID: 33641670 PMCID: PMC7919094 DOI: 10.1186/s12968-020-00686-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Circulatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR. METHODS Circulatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n = 41) before and 4 months after AVR and in age and sex-matched healthy subjects (n = 10). RESULTS In patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9 ± 3% vs 12 ± 2%; p = 0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r = - 0.591, p < 0.001), myocardial fibrosis volume (r = - 0.427, p = 0.015), end systolic volume (r = - 0.609, p < 0.001) and NT-proBNP (r = - 0.444, p = 0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r = 0.704, p < 0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9 ± 3 vs 13 ± 5%; p < 0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR. CONCLUSION In our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered.
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Affiliation(s)
- S Nordmeyer
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany.
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - C B Lee
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - L Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Knosalla
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - F Berger
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - V Falk
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - N Ghorbani
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - H Hireche-Chikaoui
- Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - M Zhu
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Kuehne
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - M Kelm
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Nemchyna O, Solowjowa N, Dandel M, Hrytsyna Y, Knierim J, Soltani S, Schoenrath F, Falk V, Knosalla C. Two-dimensional echocardiography compared to cardiac computed tomography for assessment of left ventricular volume and function in patients with anteroapical aneurysm. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.357] [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: None.
Background. Two-dimensional (2D) echocardiography is widely accepted method for the assessment of left ventricular (LV) morphology and function after myocardial infarction and for initial preoperative evaluation of patients planned for surgical ventricular repair (SVR). Magnetic resonance imaging and cardiac computer tomography (CT) provide more accurate measurements, but not always available.
Purpose. The aim of this study was to compare 2D-echocardiography and CT for preoperative assessment of patients with LV aneurysm in order to optimize the perioperative management in SVR.
Methods. Patients (n = 179, mean age 62.6 ± 11 years, 23.5% women) with LV anteroapical aneurysm due to myocardial infarction were examined by echocardiography and CT before SVR. LV end-diastolic and end-systolic volumes (LVEDV and LVESV) and ejection fraction (EF) obtained by two methods were compared pairwise. Prognostic role for the prediction of all-cause death was assessed for preoperative parameters in multivariate Cox regression model adjusted for patient age, sex, NYHA class, diabetes mellitus, renal failure, atrial fibrillation and arterial hypertension.
Results. There was a strong correlation for preoperative LVEDV and LVESV measured by echocardiography and CT (r = 0.85, r = 0.87, p < 0.0001), however volumes obtained by echocardiography were smaller compared to those by CT (Table) with higher difference in patients with more dilated LV, as demonstrated by Bland-Altman analysis (Fig.). No significant difference in mean preoperative EF was observed with moderate correlation between two methods (r = 0.67, p < 0.0001). In total 68 patients died during median follow up of 5.3 years (IQR: 1.7-8.7 years) after SVR. Comparable predictive value was demonstrated for LVEDV measured by CT and echocardiography (for 10 ml increase HR = 1.04, p = 0.004 and HR = 1.06, p = 0.0001), as well as for LVESV (for 10 ml increase HR = 1.04, p = 0.001 and HR = 1.07, p = 0.0001) and for EF (for 5% increase HR = 0.83, p = 0.004 and HR = 0.81, p = 0.004).
Conclusion. In patients with LV aneurysm 2D-echocardiography may be used for the assessment of LV volumes and function and have similar prognostic role compared to CT in patients evaluated for SVR. Underestimation of LV volumes by echocardiography must be considered, especially in patients with more dilated LV.
Comparison of CT and echocardiography Parameter CT Echo Mean difference p-value LVEDV, ml LVESV, ml EF, % 289 ± 104 198 ± 97 34 ± 12 222 ± 81 149 ± 67 35 ± 9 67 ± 56 49 ± 51 -0.9 ± 9.2 <0.0001 <0.0001 0.215 Abstract Figure. Bland-Altman plots for LVEDV and LVESV
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Affiliation(s)
- O Nemchyna
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - N Solowjowa
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - M Dandel
- Independent Scholar, Berlin, Germany
| | - Y Hrytsyna
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J Knierim
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - S Soltani
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - F Schoenrath
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V Falk
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - C Knosalla
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
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Nemchyna O, Solowjowa N, Dandel M, Hrytsyna Y, Stein J, Soltani S, Knierim J, Schoenrath F, Falk V, Knosalla C. Prognostic role of left ventricular diastolic function assessed by speckle tracking echocardiography in patients after surgical ventricular repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0144] [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
Assessment of left ventricular (LV) diastolic function brings important prognostic information for patients with heart failure and could be evaluated by speckle tracking echocardiography (STE). Less known about its role in patients planned for surgical ventricular repair due to LV aneurysm.
Purpose
The aim of this study was to evaluate the prognostic role of STE parameters of LV diastolic function for prediction of all-cause mortality in patients after surgical ventricular repair.
Methods
We retrospectively evaluated data of 163 consecutive pts (mean age 62.3±11.5 years, 74.8% males) with anteroapical LV aneurysm who underwent surgical ventricular repair combined with coronary artery bypass surgery (71.8%) Prognostic role for prediction of all-cause mortality was assessed for various STE parameters, including left atrial strain (LAS) measured as peak reservoir strain and for the ratio of early to late global longitudinal strain rate (GLSRe/GLSRa).
Results
During a median follow-up of 4.7 years (IQR: 1.6–8.9 years) there were 65 deaths, 5 year survival rate was 73.8 (95% CI 67–79%). Baseline ejection fraction, end-diastolic and end-systolic volumes of LV did not differ between pts who died and survived at 5 year after the surgery, whereas LAS was significantly higher and GLSRe/GLSRa was significantly lower in survivors. Cox proportional hazard model adjusted to demographic and clinical variables demonstrated that LAS and GLSRe/GLSRa were independent predictors of all-cause death, with HR of 0.79 (95% CI 0.66–0.95, p=0.012) for each 5% increase of LAS and HR of 1.24 (95% CI 1.1–1.4, p=0.001) for each 0.5 increase of GLSRe/GLSRa. Moreover, GLSRe/GLSRa remained an independent predictor after additional adjustment for LV end-systolic volume, sphericity index and presence of mitral insufficiency of grade 2 and higher. A significant difference in median survival time was demonstrated according to the following cut-offs: LAS ≥16.7% (12.1 vs. 6.4 years, p=0.01), GLSRe/GLSRa ratio ≥2.3 (3.3 years vs. 10.2 years, p=0.0005) (Figure). The classification and regression tree analysis with the application of all two-dimensional, Doppler and various speckle-tracking echocardiographic parameters revealed that GLSRe/GLSRa and LAS were the most important echocardiographic variables for risk stratification for 5-year mortality.
Conclusion
This study demonstrates that STE parameters of LV diastolic function are important predictors of all-cause mortality after surgical ventricular repair due to anteroapical aneurysm of LV and could be used in the preoperative decision-making process.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Nemchyna
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - N Solowjowa
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - M Dandel
- German Center for Cardiovascular Research, Partner Site Berlin, Germany, Berlin, Germany
| | - Y Hrytsyna
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J Stein
- German Heart Institute Berlin, Berlin, Germany
| | - S Soltani
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J Knierim
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - F Schoenrath
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V Falk
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - C Knosalla
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
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Nemchyna O, Solowjowa N, Dandel M, Stein J, Hrytsyna Y, Knierim J, Soltani S, Schoenrath F, Falk V, Knosalla C. 1036 Prognostic role of left ventricle longitudinal strain for the prediction of survival after surgical ventricular repair. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.628] [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
Surgical ventricular repair (SVR) in patients with ischemic cardiomyopathy is aimed to reshape left ventricle (LV) and reduce its volume in order to improve prognosis and quality of life. There are controversies regarding benefit of SVR, especially in patients with severely enlarged LV.
Purpose
Our purpose was to investigate prognostic value of LV longitudinal strain for survival and for the improvement of LV function after SVR in patients with anteroapical LV aneurysm.
Methods
218 pts (2005-2018, mean age 63.6 ± 11.2y, 73.9% males) with anteroapical LV aneurysm due to myocardial infarction underwent SVR combined with coronary bypass grafting (77.5%), mitral valve repair (18.3%) and LV thrombectomy (22.0%). Preoperative strain analysis was done retrospectively for 146 patients. Prognostic value of strain was tested in pts according to the LV end systolic volume index (LVESVI) with the cut-off value of 60ml/m². In 17 pts 1-year follow-up with strain quantification was done.
Results
During a median follow-up of 3.9 years (IQR: 1.0-6.8 years) there were 68 deaths and 1 patient was lost to follow-up. 30-days survival rate was 93.5% (95%CI: 90.3; 96.9%), 5 year survival – 72.5% (95%CI: 66.0-79.6%). Pts who died were significantly older, with higher proportion of diabetes (DM), peripheral artery disease, renal failure (RF) and atrial fibrillation (AF). Baseline ejection fraction (EF) and global longitudinal strain (GLS) did not differ significantly. Whereas basal longitudinal strain (BLS) was higher (more negative) in pts who survived (-11.4 ± 3% vs. -10.1 ± 4%, p = 0.027). Risk stratification by tertiles revealed that BLS was a significant predictor of survival. The risk of dying was 3 times higher for pts in the lowest tertile compared to those in the highest tertile (HR: 2.94, 95%CI:1.37-6.25, p = 0.013). When adjusted to age, AF, DM, RF, and previous heart surgery, BLS was an independent predictor of death (HR = 1.14, 95%CI:1.03;1.26, p = 0.032). At 1-year follow-up (12.7 ± 5.1 months) there was significant decrease of LV end-diastolic and end-systolic volume indices, from 102.8 ± 24.1 ml/m² to 77.9 ± 24 ml/m² (p < 0.001) and from 67 ± 23.2 ml/m² to 44.3 ± 7.6 ml/m² (p < 0.001), correspondingly, and increase of EF from 36.3 ± 9.4% to 44.4 ± 7.6% (p = 0.001). The mean systolic GLS improved from -6.6 ± 2.6% to -8.7 ± 3.2%, p = 0.008. Among 81 segments with baseline hypokinesia, 44 segments (54.3%) recovered their contractility, 36 segments (44.4%) remained hypokinetic and 1 segment deteriorated to akinesia. Mean systolic strain of segments which showed recovery was -6.6 ± 4.0% compared to -3.8 ± 4.5% with no improvement (p = 0.005). Cut-off value of systolic strain for prediction of recovery was -5.4 % (AUC = 0.69, p = 0.004; PPV = 0.73, NPV = 0.61).
Conclusion
Our study demonstrates that BLS is an independent predictor of survival after SVR in patients with LV anteroapical aneurysm. Furthermore, higher systolic strain predicts recovery of LV regional function at 1-year after SVR.
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Affiliation(s)
- O Nemchyna
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - N Solowjowa
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - M Dandel
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J Stein
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - Y Hrytsyna
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J Knierim
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - S Soltani
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - F Schoenrath
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V Falk
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - C Knosalla
- German Heart Institute of Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
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Solowjowa N, Nemchyna O, Hrytsyna Y, Meyer A, Pasic M, Falk V, Knosalla C. Repair of Anteroapical Left Ventricular Aneurysms Guided by Use of Cardiac Computed Tomography: Assessment of Aneurysm Volume and of Anticipated Residual Left Ventricular Volume. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705399] [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: 10/24/2022]
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12
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Nemchyna O, Dandel M, Solowjowa N, Hrytsyna Y, Stein J, Soltani S, Knierim J, Felix S, Falk V, Knosalla C. Strain Study in Patients after Surgical Ventricular Repair: Prognostic Role of Strain Parameters and Evaluation of Left-Ventricle Remodeling. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705327] [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: 10/24/2022]
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13
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Hennig F, Kemper D, Felix S, Yeter R, Potapov E, Starck C, Falk V, Knosalla C. Evolving Results in Post-VAD Heart Transplantation. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705374] [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: 10/24/2022]
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14
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Nemchyna O, Solowjowa N, Hrytsyna Y, Soltani S, Knierim J, Dandel M, Falk V, Knosalla C. Prognostic Value of Strain Echocardiography for the Prediction of Survival after Left Ventricular Aneurysmectomy. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679020] [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)
- O. Nemchyna
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - N. Solowjowa
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - Y. Hrytsyna
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - S. Soltani
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J. Knierim
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - M. Dandel
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V. Falk
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C. Knosalla
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Berlin, Germany
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15
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Nemchyna O, Solowjowa N, Hrytsyna Y, Soltani S, Knierim J, Dandel M, Falk V, Knosalla C. Assessment of Left Ventricular Reverse Remodeling and Functional Improvement after Surgical Ventricular Repair by Two-Dimensional Speckle-Tracking Echocardiography. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678777] [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)
- O. Nemchyna
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - N. Solowjowa
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - Y. Hrytsyna
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - S. Soltani
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - J. Knierim
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - M. Dandel
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V. Falk
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiothoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C. Knosalla
- Deutsches Herzzentrum Berlin, Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK, German Centre for Cardiovascular Research, Berlin, Germany
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16
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Siegel G, Berkholz J, Klüßendorf D, Knosalla C, Zakrzewicz A, Ermilov E, Malmsten M, Lindman B. Atherogenesis and plaque rupture, surface/interface-related phenomena. Colloids Surf A Physicochem Eng Asp 2018. [DOI: 10.1016/j.colsurfa.2018.05.080] [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: 11/29/2022]
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17
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Ardehali A, Van Raemdonck D, Kukreja J, Smith M, Loor G, Rea F, Massard G, De Robertis F, Nagendran J, Moradiellos J, Dhital K, Knosalla C, Bermudez C, Tsui S, Madsen J, Wang I, McCurry K, Deuse T, Thomas P, Tudorache I, Wiegmann B, Schiavon M, Calabrese F, Santelmo N, Olland A, Falcoz P, Varela A, Hertz M, Simon A, Resichenspurner H, Haverich A, Warnecke G. Negative Impact of Primary Graft Dysfunction Grade 3 within the Initial 72 Hours on Short and Long Term Clinical Outcomes in Standard Criteria Double Lung Transplants: Prospective Evidence from the OCS Lung INSPIRE International Trial Results. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1195] [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: 11/24/2022] Open
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18
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Gottlieb J, Neurohr C, Müller-Quernheim J, Wirtz H, Sill B, Wilkens H, Besa V, Knosalla C, Junge M, Capusan C, Strüber M. Benefits of Early Everolimus-Based Quadruple Immunosuppression Early After Lung Transplantation - Results of 4EVERLUNG, a Prospective Randomized Multicenter Trial. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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19
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Solowjowa N, Hrytsyna Y, Meyer A, Pasic M, Falk V, Knosalla C. Survival Determinants and Improvement of Heart Failure Symptoms after Surgical Repair of Anteroapical Left Ventricular Aneurysms Guided with Multislice Computed Tomography. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628106] [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)
- N. Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Y. Hrytsyna
- Charité - University Medicine, Berlin, Germany
| | - A. Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - M. Pasic
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - V. Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - C. Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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20
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Gassner M, Kemper D, Schwarz C, Yeter R, Staab D, Henning F, Pille C, Menk M, Falk V, Weber-Carstens S, Knosalla C. Successful Bridging to Lung Transplantation in Patients with Need of ECMO and Invasive Mechanical Ventilation: Report of Mid-Term Outcomes. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598685] [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)
- M. Gassner
- Anesthesiology and operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - D. Kemper
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - C. Schwarz
- Division of Cystic Fibrosis, Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R. Yeter
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - D. Staab
- Division of Cystic Fibrosis, Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F. Henning
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - C. Pille
- Anesthesiology and operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M. Menk
- Anesthesiology and operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - V. Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S. Weber-Carstens
- Anesthesiology and operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C. Knosalla
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
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21
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Solowjowa N, Penkalla A, Hrytsyna Y, Pasic M, Falk V, Knosalla C. Reverse Remodeling of Mitral Valve Apparatus after Surgical Repair of Acquired Left Ventricular Aneurysms of Posterior versus Anterior Localization Assessed with Multislice Computed Tomography. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598851] [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)
- N. Solowjowa
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - A. Penkalla
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - Y. Hrytsyna
- Charité - University Medicine Berlin, Berlin, Germany
| | - M. Pasic
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - V. Falk
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - C. Knosalla
- Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
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22
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Warnecke G, Van Raemdonck D, Kukreja J, Smith M, Loor G, Rea F, Massard G, De Robertis F, Nagendran J, Moradiellos J, Dhital K, Knosalla C, Bermudez C, Tsui S, Madsen J, Wang I, McCurry K, Deuse T, Thomas P, Sommer W, Weigmann B, Khun C, Tudorache I, Avsar M, Schiavon M, Santelmo N, Olland A, Falcoz P, Varela A, Hertz M, Simon A, Resichenspurner H, Haverich A, Ardehali A. Mid and Long-Term Clinical Results of OCS Lung INSPIRE International Trial. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Solowjowa N, Musayeva L, Hrytsyna Y, Knosalla C, Falk V. Functional Anatomy of the Mitral Valve and Left Ventricle in Ischemic Mitral Regurgitation Assessed with Multislice Computed Tomography. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571662] [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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24
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Warnecke G, Van Raemdonck D, Smith M, Kukreja J, Loor G, Rea F, Massard G, De Robertis F, Nagendran J, Moradiellos J, Dhital K, Knosalla C, Bermudez C, Tsui S, Garcia J, Wang I, McCurry K, Wagner F, Leseche G, Thomas P, Weigmann B, Tudorache I, Kühn C, Avsar M, Sommer W, Schiavon M, Santelmo N, Falcoz P, Olland A, Deuse T, Varela A, Simon A, Madsen J, Hertz M, Reichenspurner H, Haverich A, Ardehali A. The Organ Care System (OCS™) Lung INSPIRE International Trial Results. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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25
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Deuse T, Bara C, Barten M, Hirt S, Doesch A, Knosalla C, Grinninger C, Stypmann J, Porstner M, Wimmer P, Schulz U. A Multi-Center, Randomized, Open-Label, Parallel Group Phase IV Trial Investigating the Outcome on Renal Function, Efficacy and Safety of CNI-Reduction or Elimination With Everolimus in De Novo Heart Transplant: Recipients: The MANDELA Study Design. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.228] [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: 10/23/2022] Open
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26
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Warnecke G, van Raemdonck D, Loor G, Smith M, Massard G, Rea F, Simon A, Moradiellos J, Varela A, Nagendran S, Santelmo N, Wiegmann B, Sommer W, Kuehn C, Tudorache I, Avsar M, Nicotra S, Knosalla C, Hetzer R, Tsui S, Bermudez C, Dhital K, Kukreja J, McCurry K, Hertz M, Ardehali A, Haverich A. The INSPIRE International Lung Trial with the Organ Care System Technology (OCS™) - Interim Report. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544388] [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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27
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Schmitt-Knosalla I, Kühl A, Brösel S, Wassilew K, Hetzer R, Volk HD, Knosalla C. Effect of CD4+ /CD8+ T-cell Depletion in Acute Lung Allograft Rejection in Mice. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544474] [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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28
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Schmitt-Knosalla I, Kühl A, Lahdou I, Bhagat C, Wassilew K, Brösel S, Kotnik K, Hetzer R, Volk HD, Bader M, Knosalla C. Indoleamine 2,3-Dioxygenase (IDO) Mediates Immune Tolerance through Catabolism of Platelet-Derived Serotonin. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544478] [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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29
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Schubert S, Miera O, Hetzer R, Knosalla C, Kemper D, Photiadis J, Berger F. Long term results after pediatric heart transplantation - improved treatment strategies increase survival. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1393997] [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: 10/24/2022]
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30
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Warnecke G, Haverich A, van Raemdonck D, Massard G, Santelmo N, Falcoz P, Olland A, Leseche G, Mal H, Thomas P, Rea F, Nicotra S, Schiavon M, Marulli G, Knosalla C, Hetzer R, Simon A, Tsui S, Kukreja J, Bermudez C, Moradiellos F, Varela A, Dhital K, Nagendran J, McCurry K, Ardehali A. The INSPIRE International Lung Trial With the Organ Care System Technology (OCSTM) - Interim Report. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00586] [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: 11/25/2022]
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31
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Dandel M, Knosalla C, Kemper D, Hetzer R. Assessment of Right Ventricular Adaptability to Loading Conditions Can Improve the Timing of Listing to Transplantation in Patients with Pulmonary Arterial Hypertension. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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32
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Dandel M, Wallukat G, Englert A, Knosalla C, Hetzer R. Immunoadsorption: A Treatment Alternative for Older Patients with β1-Autoantibody Positive Dilated Cardiomyopathy Who Are at Higher Risk for Transplantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.245] [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] Open
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33
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Warnecke G, Van Raemdonck D, Massard G, Rea F, Smith M, Kukreja J, De Robertis F, Dhital K, Nagendran J, Moradiellos J, Bermudez C, Tsui S, Leseche G, Knosalla C, McCurry K, Thomas P, Loor G, Garcia J, Wang I, Avsar M, Tudorache I, Kühn C, Wiegmann B, Sommer W, Santelmo N, Falcoz P, Olland A, Schiavon M, Marulli G, Di Gregorio G, Simon A, Hetzer R, Varela A, Madsen J, Hertz M, Haverich A, Ardehali A. The INSPIRE Lung International Trial Evaluating the Impact of Portable Ex-vivo Perfusion Using the Organ Care System (OCS™) Lung Technology on Routine Lung Transplant Outcomes. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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34
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Warnecke G, van Raemdonck D, Massard G, Santelmo N, Falcoz PE, Olland A, Leseche G, Mal H, Thomas P, Rea F, Nicotra S, Schiavon M, Marulli G, Knosalla C, Hetzer R, Simon A, Tsui S, Kukreja J, Bermudez C, Moradiellos F, Varela A, Dhital K, Nagendran J, Mc Curry K, Ardehali A, Haverich A. The INSPIRE international lung trial with the organ care system technology (OCS™) - interim report. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367139] [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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35
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Solowjowa N, Penkalla A, Dandel M, Pasic M, Weng Y, Hetzer R, Knosalla C. Mitral valve and left ventricular reverse remodeling after surgical repair of submitral left ventricular aneurysms assessed with multi-slice computed tomography. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367402] [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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36
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Yeter R, Pasic M, Hübler M, Dandel M, Hiemann N, Kemper D, Wellnhofer E, Hetzer R, Knosalla C. Extended donor criteria in heart transplantation: 4-year results of the experience with the Organ Care system. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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37
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Dandel M, Potapov E, Krabatsch T, Knosalla C, Hetzer R. Left ventricular vs biventricular assist device: Impact of load dependency of right ventricular performance on decision making before ventricular assist device implantation. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367164] [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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38
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Dandel M, Potapov E, Krabatsch T, Stepanenko A, Knosalla C, Hetzer R. Impact of load dependency of right ventricular performance on decision making before ventricular assist device implantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4396] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dandel M, Englert A, Lehmkuhl HB, Knosalla C, Hetzer R. Immunoadsorption is a safe and efficient therapeutic option for potential transplant candidates with non-ischemic chronic cardiomyopathy associated with diabetes mellitus. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4398] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dandel M, Kemper D, Knosalla C, Lehmkuhl H, Hetzer R. Predictive Value of Right Ventricular Function for Transplant-Free Survival with Pulmonary Arterial Hypertension. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Dandel M, Potapov E, Krabatsch T, Stepanenko A, Knosalla C, Hetzer R. Impact of Right Ventricular Performance Load Dependency on Preoperative Prediction of Postoperative Right Heart Function in Patients Who Need a Left Ventricular Assist Device. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.757] [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: 10/27/2022] Open
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Warnecke G, Weigmann B, Van Raemdonck D, Massard G, Santelmo N, Falcoz PE, Olland A, Leseche G, Mal H, Thomas P, Rea F, Marulli G, Knosalla C, Hetzer R, Ardehali A, Kukreja J, Bermudez C, Moradiellos F, Varela A, Dhital K, Nagendran J, McCurry K, Haverich A. The INSPIRE International Lung Trial with the Organ Care System Technology (OCS™). J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Eschborn J, Kemper D, Schönemann C, Knosalla C, Hetzer R, Hiemann N. Effects of Anti-HLA Antibodies Present before Heart Transplantation on Survival, Acute Cellular Rejection and Coronary Allograft Vasculopathy: A Single Center Experience. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.679] [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: 10/27/2022] Open
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Penkalla AJ, Solowjowa N, Dandel M, Pasic M, Weng Y, Hetzer R, Knosalla C. Assessment of left ventricular and mitral valve geometry and function after surgical repair of submitral left ventricular aneurysms with multi-slice computed tomography. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332726] [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: 10/27/2022]
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Sato K, Knosalla C, Yeter R, Tsuchida M, Hetzer R. The invasiveness of cardiopulmonary bypass to the whole body in lung transplantation. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332407] [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: 10/27/2022]
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Sidjuk VA, Solowjowa N, Röttgen R, Knosalla C. Nachweis von frühzeitigen Veränderungen der Herzbasis und der funktionellen Parameter nach Aneurysmektomie bei Herzspitzen-Aneurysma mit Computertomographie. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311443] [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: 10/28/2022]
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Hiemann N, Grimmer S, Kemper D, Knosalla C, Hetzer R. Tuberculous meningitis in a lung transplanted patient. Transpl Infect Dis 2012; 14:E19-22. [DOI: 10.1111/j.1399-3062.2012.00736.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 11/19/2011] [Accepted: 01/02/2012] [Indexed: 11/30/2022]
Affiliation(s)
- N.E. Hiemann
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin; Germany
| | - S. Grimmer
- Department of Anaesthesiology; Charité Universitätsmedizin Berlin; Berlin; Germany
| | - D. Kemper
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin; Germany
| | - C. Knosalla
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin; Germany
| | - R. Hetzer
- Department of Cardiothoracic and Vascular Surgery; Deutsches Herzzentrum Berlin; Berlin; Germany
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Lehmkuhl E, Kendel F, Gelbrich G, Dunkel A, Oertelt-Prigione S, Babitsch B, Knosalla C, Bairey-Merz N, Hetzer R, Regitz-Zagrosek V. Gender-specific predictors of early mortality after coronary artery bypass graft surgery. Clin Res Cardiol 2012; 101:745-51. [PMID: 22527091 DOI: 10.1007/s00392-012-0454-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained. OBJECTIVES To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors. METHODS A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005-2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality. RESULTS Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70-4.96, P < 0.001). Women were older than men (+4.7 years, P < 0.001), had lower self-assessed preoperative physical functioning (-16 points on a scale from 0 to 100, P < 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %, P = 0.01), respiratory insufficiency (9.4 vs. 5.3 %, P = 0.006) and resuscitation (5.2 vs. 1.8 %, P = 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77-2.41, P = 0.29). CONCLUSIONS Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.
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Affiliation(s)
- E Lehmkuhl
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
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Warnecke G, Haverich A, Massard G, Santelmo N, Rea F, Knosalla C, Hetzer R, Leseche G, Ardehali A, Simon A, Kukreja J, McCurrey K. 322 The INSPIRE International Lung Trial with the Organ Care System Technology (OCS™). J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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