1
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Becher PM, Gossling A, Fluschnik N, Schrage B, Seiffert M, Schofer N, Blankenberg S, Kirchhof PM, Westermann D, Kalbacher D. Temporal trends in incidence, patient characteristics, microbiology and in-hospital mortality in patients with infective endocarditis: a contemporary analysis of 86,469 cases between 2007 and 2019. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.375] [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
Infective endocarditis (IE) is characterized by high morbidity and mortality rates, despite recent improvements in diagnostics and treatment. We aimed to investigate incidence, clinical characteristics, and in-hospital mortality in a large-scale nationwide cohort.
Methods
Using data from the German Federal Bureau of Statistics, all IE cases in Germany between 2007 to 2019 were analyzed. Logistic regression models were fitted to assess associations between clinical factors and in-hospital mortality.
Results
In total, 86,469 patients were hospitalized with IE between 2007 and 2019. The mean age was 66.5±14.7 years and 31.8% (n=27,534/86,469) were female. Cardiovascular (CV) comorbidities were common. The incidence of IE in the German population increased from 6.3/100,000 to 10.2/100,000 between 2007 and 2019 (Figure 1). Staphylococcus (n=17,673/86,469; 20.4%) and streptococcus (n=17,618/86,469; 20.4%) were the most common IE-causing bacteria. The prevalence of staphylococcus gradually increased over time, whereas blood culture-negative IE (BCNIE) cases decreased (Figure 2). In-hospital mortality in patients with IE was 14.9%. Compared to BCNIE, staphylococcus and gram-negative pathogens were associated with higher in-hospital mortality. In multivariable analysis, factors associated with higher likelihood of in-hospital mortality were advanced age, female sex, CV comorbidities (e.g., heart failure, COPD, diabetes, stroke), need for dialysis or invasive ventilation, and sepsis.
Conclusions
In this contemporary cohort, incidence of IE increased over time and in-hospital mortality remained high (∼15%). While staphylococcus and streptococcus were the predominant microorganisms, bacteremia with staphylococcusand gram-negative pathogens were associated with higher likelihood of in-hospital mortality. Our results highlight the need for new preventive strategies and interventions in patients with IE.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P M Becher
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - A Gossling
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - N Fluschnik
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - M Seiffert
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P M Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg , Hamburg , Germany
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2
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Stolz L, Karam N, Von Bardeleben RS, Pfister R, Petronio A, Butter C, Melica B, Praz F, Massberg S, Kalbacher D, Lurz P, Adamo M, Metra M, Bax JJ, Hausleiter J. Staging heart failure patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2124] [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
Heart failure with reduced ejection fraction (HFrEF) and secondary mitral regurgitation (SMR) are closely related. Progression of HFrEF-SMR is associated with characteristic pathophysiological changes. Recently, staging of HFrEF-SMR patients showed prognostic value in a SMR cohort on medical therapy. Whether these stages are prognostic for SMR patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) in addition to drug therapy is unknown.
Purpose
The present study aimed at classifying HFrEF-SMR patients undergoing M-TEER into progressive disease stages based on cardiac and extracardiac involvement. We sought to evaluate the impact of the disease stages on survival outcome and symptomatic improvement after M-TEER
Methods
Based on echocardiographic transthoracic evaluation, patients were assigned into one of the following subsequent HFrEF-SMR stages representing disease progression (Figure 1): left ventricular (LV) dysfunction alone (Stage 1, LV end diastolic volume ≥159 ml and/or LV ejection fraction <50%); left atrial (LA) involvement (Stage 2, history of atrial fibrillation and/or indexed LA volume >34 ml/m2); right ventricular (RV) pressure/volume overload (Stage 3, tricuspid regurgitation ≥3+ and/or systolic pulmonary artery pressure >65 mmHg); biventricular failure (Stage 4, RV to pulmonary artery coupling <0.274 mm/mmHg). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on two-year all-cause mortality and symptomatic outcome was assessed with New York Heart Association (NYHA) functional class at follow-up.
Results
Among a total of 849 included patients who underwent M-TEER for symptomatic MR from 2008 until 2019, 9.5% (n=81) presented with LV dysfunction alone, 46% (n=393) with LA involvement, 15% (n=129) with pressure/volume overload and 29% (n=246) with biventricular failure. At baseline and follow-up, successive HFrEF-SMR stages were associated with more severe heart failure symptoms as expressed by NYHA functional class. An increase in HFrEF-SMR stage was associated with increased two-year all-cause mortality rates after M-TEER (Hazard ratio 1.39, confidence interval 1.23–1.58, p<0.01, Figure 2).
Conclusions
Classifying HFrEF-SMR patients undergoing M-TEER into subsequent disease stages provides prognostic value regarding heart failure symptoms and survival.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Stolz
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - N Karam
- European Hospital Georges Pompidou, Department of Cardiology , Paris , France
| | - R S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology , Mainz , Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department of Cardiology , Cologne , Germany
| | - A Petronio
- University of Pisa, Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department , Pisa , Italy
| | - C Butter
- Brandenburg Heart Center, Department of Cardiology , Bernau bei Berlin , Germany
| | - B Melica
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology , Vila Nova de Gaia , Portugal
| | - F Praz
- Inselspital - University of Bern, Department of Cardiology , Bern , Switzerland
| | - S Massberg
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - P Lurz
- Heart Center of Leipzig, Department of Cardiology , Leipzig , Germany
| | - M Adamo
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology , Brescia , Italy
| | - M Metra
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology , Brescia , Italy
| | - J J Bax
- Leiden University Medical Center, Department of Cardiology , Leiden , The Netherlands
| | - J Hausleiter
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
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3
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Koell B, Ludwig S, Weimann J, Waldschmidt L, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schofer N, Kalbacher D. C-Reactive Protein to Albumin Ratio offers superior risk prediction in patients undergoing mitral valve edge-to-edge repair: a comparison to established surgical risk scores. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1641] [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
The population of patients with relevant mitral regurgitation (MR) who stand to gain optimal benefit from mitral valve transcatheter edge-to-edge repair (TEER) remains to be determined. Prior to TEER, a heart-team approach with interdisciplinary decision-making is mandatory integrating both the patient profile and relevant co-morbidities. In addition, the application of established surgical risk scores is recommended by current guidelines. Whether alternative risk prediction is more suitable for this fragile patient cohort burdened with various co-morbidities has not been examined in detail. A simplified approach may be achieved by using the C-Reactive Protein to Albumin Ratio (CAR), but its value in TEER is unclear.
Methods
This single-center, retrospective study thought to determine long-term prognostic accuracy of different risk scores in patients with relevant MR undergoing TEER. For this analysis, 316 patients with a median follow-up time of 5.81 years were included. The primary outcome measure was defined as all-cause mortality. ROC analysis was conducted for the identification of the optimal CAR threshold, subsequently dichotomizing patients into two groups (CAR ≤0.4 and CAR >0.4) estimating their long-term event rate using the Kaplan-Meier method. In addition, we evaluated the prognostic value of CAR compared to two conventional surgical risk scores (logistic EuroSCORE and Society of Thoracic Surgeons [STS] risk score) using C-Index analysis.
Results
Among 316 high-risk patients undergoing TEER (mean age 75.6±8.2 years, 61.7% male, median logistic EuroSCORE 19.9% [11.7; 31.6], median STS Score 3.8% [2.2; 5.7]), 176 (55.7%) patients had a CAR value ≤0.4. Patients with an elevated CAR (>0.4) predominantly suffered from a higher burden of co-morbidities, such as peripheral artery disease (p=0.001), chronic obstructive pulmonary disease (p=0.044), and chronic kidney disease (p=0.015). Consequently, these patients had significantly higher logistic EuroSCORE and STS Score than patients with CAR ≤0.4 (logistic EuroSCORE p=0.002; STS Score p<0.001). Stratification according to the CAR threshold of 0.4 led to significant differences in the Cumulative Incidence curves (p<0.001). In addition, log-rank test revealed a superior risk stratification of the simplified CAR approach compared to established surgical risk scores (Figure 1). This effect consequently reflects in a higher adjusted C-Index for CAR (0.608) compared to logistic EuroSCORE (0.502; p<0.001) and STS Score (0.498; p<0.001).
Conclusions
Our data provide first evidence that alternative risk prediction using CAR allows for a feasible and easy-to-use risk prediction in a real-word TEER cohort presenting with advanced age, a high proportion of frailty and numerous co-morbidities. Alternative risk prediction in TEER patients should be investigated in more detail as the established surgical risk scores seem to demonstrate limited applicability in patients scheduled for TEER.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Affiliation(s)
- B Koell
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - S Ludwig
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - J Weimann
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - L Waldschmidt
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - J Schirmer
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery , Hamburg , Germany
| | - H Reichenspurner
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - L Conradi
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery , Hamburg , Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
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4
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Ludwig S, Sedighian S, Weimann J, Koell B, Waldschmidt L, Schaefer A, Seiffert M, Westermann D, Reichenspurner H, Blankenberg S, Schofer N, Lubos E, Conradi L, Kalbacher D. Outcomes of patients with severe mitral regurgitation treated with transcatheter mitral valve implantation or medical therapy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.363] [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: None.
Background
Patients with severe mitral regurgitation (MR) unsuitable for standard therapy (i.e., open-heart surgery and transcatheter edge-to-edge repair [TEER]), often remain on medical therapy (MT) alone. Transcatheter mitral valve implantation (TMVI) may represent an alternative treatment option for these patients.
Purpose
We aimed to investigate differences in anatomical baseline characteristics and echocardiographic outcomes between MR patients unsuitable for standard therapy, that were either treated with TMVI or remained on MT.
Methods
Between 05/2016-02/2021, 121 high-risk patients with severe MR were evaluated for TMVI. Clinical, echocardiographic and functional outcomes between the subgroups of patients treated with TMVI and MT were compared. The primary combined endpoint was all-cause death or heart failure (HF) hospitalization at 1 year. Subgroup analyses were performed to define specific patient subsets favouring either TMVI or MT.
Results
At baseline, there were no differences between the TMVI group (n = 38) and the MT group (n = 44) regarding age (all TMVI vs. MT: 77.0 years [IQR 72.9, 80.1] vs. 79.0 [IQR 76.0, 81.7], p = 0.13), gender (42.1% female vs. 56.8% female, p = 0.27) and estimated surgical risk (EuroSCORE II 4.4% [IQR 2.8, 13.6] vs. 6.4 [IQR 3.4, 10.1], p = 0.72). Patients undergoing TMVI were more frequently treated for secondary MR (68.4%), while primary MR was the most prevalent MR etiology in patients remaining on medical therapy (50.0%). Left ventricular (LV) end-diastolic diameters (LVEDD) were larger and LV ejection fraction (LVEF) was lower in the TMVI group (LVEDD 58.0mm [IQR 51.4, 65.0], LVEF 37.0% [IQR 31.4, 51.2]) compared to the MT group (LVEDD 52.0mm [IQR 46.2, 58.8], LVEF 54.5% [IQR 40.8, 60.0]) (p = 0.02 for LVEDD, p < 0.001 for LVEF). MR was effectively reduced to ≤ mild MR in all patients undergoing TMVI. In the MT group, MR remained severe in 90% of patients after 1 year. The primary composite endpoint occurred numerically more often in the MT group (72.2%) compared to the TMVI group (51.6%, p = 0.061). Regarding the primary endpoint, the subgroups of patients with LVEF 30-49% (HR 0.28 [95%-CI 0.11-0.67], p = 0.004), effective regurgitant orifice area (EROA) <0.4 cm2 (HR 0.30 [95%-CI 0.13-0.71], p = 0.006), tricuspid annular plane systolic excursion (TAPSE) ≥17mm (HR 0.27 [95%-CI 0.11-0.67], p = 0.005) and New York Heart Association functional class III (HR 0.38 [95%-CI 0.18-0.81], p = 0.012) were more likely to benefit from TMVI compared to MT.
Conclusions
In patients with severe MR unsuitable for standard therapy, TMVI represents a reasonable therapeutic alternative yielding effective elimination of MR. While most patients eligible for TMVI suffer from secondary MR, the majority of patients remaining on MT has primary MR. The primary endpoint occurred numerically, yet not statistically, more often in patients on MT. Baseline echocardiography was able to identify subgroups of patients with beneficial outcome after TMVI.
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Affiliation(s)
- S Ludwig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Sedighian
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Weimann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Koell
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Waldschmidt
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Schaefer
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Seiffert
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | - S Blankenberg
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - E Lubos
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Conradi
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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5
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Stolz L, Orban M, Karam N, Lubos E, Wild M, Praz F, Braun D, Doldi P, Tence N, Hagl C, Mayerle J, Naebauer M, Kalbacher D, Massberg S, Hausleiter J. Impact of the cardio-hepatic syndrome on outcomes after transcatheter mitral valve edge-to-edge repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2217] [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
The prognostic value of impaired liver function in the presence of moderate-to-severe and severe mitral regurgitation (MR), also called cardio-hepatic syndrome (CHS), for outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) has not been studied yet.
Purpose
In this work, we aimed at identifying the prognostic impact of the CHS on two-year all-cause mortality in patients undergoing TEER compared to established risk factors. Furthermore, we evaluated the change in hepatic function after TEER.
Methods
Hepatic function was assessed by laboratory parameters of liver function (bilirubin, gamma glutamyl transferase [GGT], alkaline phosphatase [AP], aspartate and alanine aminotransferase [AST and ALT]). We defined CHS as elevation of at least two out of three laboratory parameters of hepatic cholestasis (bilirubin, GGT, AP). The impact of CHS on two-year mortality was evaluated using a proportional hazards Cox model. The change in hepatic function after TEER was evaluated by repeat laboratory testing at follow-up.
Results
We included 1083 patients who underwent TEER for highly symptomatic primary or secondary MR at four high volume academic European centers between 2008 and 2019. In 66.4% of patients, we observed elevated levels of either bilirubin, GGT or AP. CHS was present in 23% of patients and showed strong association with a reduced two-year survival (52.9% vs. 87.0% in patients without CHS, p<0.01). In a multivariate Cox regression model, CHS was identified as a strong and independent predictor of increased two-year mortality (hazard ratio 1.49, p=0.03). In patients with successful MR reduction ≤2+ (90.7% of patients), parameters of hepatic function significantly improved from baseline to follow-up (−0.2 mg/dl for bilirubin; −21 U/l for GGT, respectively, p<0.01), while they did not in case of residual postprocedural MR >2+.
Conclusions
CHS can be observed in up to 25% of patients undergoing TEER and is associated with impaired two-year survival rates. Successful TEER is associated with decreased levels of hepatic enzymes at follow-up evaluation.
Funding Acknowledgement
Type of funding sources: None. Cardio-hepatic syndrome TEER
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Affiliation(s)
- L Stolz
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - M Orban
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - N Karam
- European Hospital Georges Pompidou, Paris, France
| | - E Lubos
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Wild
- Inselspital - University of Bern, Bern, Switzerland
| | - F Praz
- Inselspital - University of Bern, Bern, Switzerland
| | - D Braun
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - P Doldi
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - N Tence
- European Hospital Georges Pompidou, Paris, France
| | - C Hagl
- Clinic of the University of Munich Großhadern, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - J Mayerle
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik II, Munich, Germany
| | - M Naebauer
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - D Kalbacher
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Massberg
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - J Hausleiter
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
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6
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Koell B, Ludwig S, Weimann J, Waldschmidt L, Schofer N, Seiffert M, Schirmer J, Westermann D, Reichenspurner H, Blankenberg S, Lubos E, Conradi L, Kalbacher D. Long-Term survival and functional status in patients with elevated mitral valve pressure gradient after transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1641] [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
A growing number of patients are currently treated for severe mitral regurgitation (MR) using a transcatheter mitral valve repair (TMVr). In clinical routine, the potential risk of elevated post-procedural mitral valve pressure gradient (MPG) may prohibit optimal MR reduction driven by the avoidance of additional clip implantations. Thus, the unfavorable impact on survival and functional outcome of increased MPG in patients undergoing TMVr is currently debatable.
Methods
In this single-center, prospective study, survival and functional outcome of 780 consecutive patients with severe MR undergoing TMVr between September 2008 and January 2020 were investigated. After exclusion of patients with unsuccessful procedure and those lost to follow-up, data of 676 patients with a median follow-up time of 5.26 (5.11, 5.51) years were analyzed. MPG was determined by transthoracic echocardiography at discharge and considered elevated in excess of 4.5 mmHg. Kaplan-Meier analysis as well as multivariable Cox regression models were performed for the impact on elevated MPG on 5-year outcomes for the subgroups of functional MR (FMR) and degenerative MR (DMR). The primary outcome measure was a combined endpoint of death or rehospitalization for congestive heart failure.
Results
Among 676 patients undergoing TMVr (mean age 74.6±8.5 years, 59.0% male, median STS Score 3.9 [interquartile range 2.5; 6.0]), 179 (26.4%) patients had elevated MPG >4.5 mmHg. FMR was present in 426 (63.0%) patients. In the overall patient cohort, Kaplan-Meier and Cox Regression analyses could not demonstrate significant differences for the combined endpoint (p=0.99). In contrast, subgroup analysis according to MR etiology indicated a significant adverse influence of elevated MPG on the combined endpoint as well as functional outcome in patients with DMR, but not with FMR (Figure 1). After adjustment, multivariate Cox Regression analysis showed an inferior prognosis in patients with DMR and elevated MVPG >4.5 mmHg (hazard ratio 1.79 [1.17, 2.72], p=0.0069, Figure 2).
Conclusions
TMVr-patients with DMR and measurable elevated post-procedural MVPG face an inferior prognosis and reduced functional outcomes compared to patients with FMR.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- B Koell
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - S Ludwig
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - J Weimann
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - L Waldschmidt
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - M Seiffert
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - J Schirmer
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - H Reichenspurner
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - E Lubos
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - L Conradi
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
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7
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Iliadis C, Kalbacher D, Lurz P, Petrescu A, Orban M, Karam N, Lubos E, Thiele H, Von Bardeleben S, Hausleiter J, Pfister R. Association of left atrial volume index with outcomes after transcatheter mitral valve repair for secondary mitral regurgitation: results from the EuroSMR registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1695] [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
The benefit of transcatheter edge-to-edge mitral valve repair (TMVr) in heart failure patients with secondary mitral regurgitation (SMR) shows large heterogeneity. A potential explanation might be the burden and chronicity of left-ventricular backward failure which is reflected by left atrial (LA) size.
Purpose
To investigate the role of LA volume index (LAVi) in real-world SMR patients undergoing TMVr.
Methods
SMR patients in a European multicenter registry were evaluated. Outcomes were evaluated according to LAVi at baseline. Main analysis was performed for all-cause mortality; residual mitral regurgitation, improvement of NYHA class and heart failure hospitalization were analyzed for patients available.
Results
823 included patients were divided according to LAVi into quintiles (≤42, 43–52, 53–62, 63–78, ≥79). A higher hazard for mortality occurred in the four upper quintiles compared to the lower quintile (HR [95% CI] 1.61 [1.08–2.4], 1.65 [1.11–2.46], 1.52 [1.02–2.26] and 1.35 [0.89–2.05]). The incidence of all-cause mortality per 100 patient-years was 14.6, 23, 23.9, 21.7 and 19.5, respectively. Consequently, a cut-off of 42ml/m2 was adopted, which was associated with a significantly higher hazard for mortality after a mean of 589 days (HR 1.54 [95%-CI 1.1–2.1], p=0.01). Technical success rate (postprocedural MR ≤2+) was higher in large LAVi group (95% vs. 91%, p=0.045). The endpoints of heart failure hospitalization, improvement of NYHA class were not different among groups. Multivariable Cox regression analysis including age, EF<30%, diabetes mellitus and NTproBNP showed LAVi >42ml/m2 to be an independent predictor of mortality.
Conclusion
LA dilatation defined by LAVi>42 ml/m2 was associated with higher mortality hazard in SMR patients undergoing TMVr after multivariable adjustment. Our findings warrant further study on whether timely TMVr intervention in patients with SMR and small LAVi can modify outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Lurz
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - A Petrescu
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - M Orban
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - N Karam
- Georges Pompidou APHP Site of Paris Ouest University Hospital, Department of Cardiology and Paris Cardiovascular Research Center, Paris, France
| | - E Lubos
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - H Thiele
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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8
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Bax L, Ludwig S, Kalbacher D, Blankenberg S, Reichenspurner H, Lubos E, Conradi L. Early Results of a Real-World Cohort of Patients Receiving Transcatheter Mitral Valve Implantation Using Dedicated Devices. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725688] [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: 10/21/2022]
Affiliation(s)
- L. Bax
- Hamburg, Germany, Deutschland
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9
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Iliadis C, Baldus S, Kalbacher D, Boekstegers P, Schillinger W, Ouarrak T, Zahn R, Butter C, Zuern C, Von Bardeleben R, Senges J, Bekeredjian R, Eggebrecht H, Pfister R. Impact of left atrial diameter on outcome in patients undergoing edge-to-edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions registry (TRAMI). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2632] [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
Left atrium (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation.
Methods
Data from the multicenter German transcatheter mitral valve intervention registry “TRAMI” were used to analyse the association of baseline LA diameter by tertiles and efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with the MitraClip.
Results
In 520 of 843 patients prospectively enrolled in TRAMI baseline LA diameter were reported (median [interquartile range] LA diameter in tertiles: 44 [40–46] mm, 51 [48–53] mm and 60 [55–66] mm). Larger LA diameters were significantly associated with secondary etiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all p<0.05). Technical success was not different across tertiles (96%, 95.4%, 98.4% respectively, p=0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke) (1.8%, 1.2% and 4.4%, p=0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7% respectively, p<0.01), as did hospitalization in survivors (60%, 67.6% and 78.9% respectively, p<0.05). The association between LA diameter and all-cause mortality remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter.
Conclusion
LA enlargement is a strong and independent predictor of adverse long-term outcome in mitral regurgitation suggesting that timely transcatheter mitral valve repair may have the potential to modify outcome.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott Vascular.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Boekstegers
- Helios Hospital Siegburg-Bonn, Helios Clinic Siegburg, Department of Cardiology and Angiology, Siegburg, Germany
| | - W Schillinger
- Georg-August University, Georg-August-University Göttingen, Heart Center, Department of Cardiology, Goettingen, Germany
| | - T Ouarrak
- IHF Gmbh - Institut Fuer Herzinfarktforschung, “Stiftung Institut für Herzinfarktforschung”, Ludwigshafen, Foundation Institute for Myocardial Infa, Ludwigshafen, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Clinic, Department of Medicine B, Ludwigshafen, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology Department, Heart Center Brandenburg Bernau, Bernau bei Berlin, Germany
| | - C.S Zuern
- University Hospital of Tuebingen, University Clinic Tübingen, Department of Cardiology, Tuebingen, Germany
| | - R.S Von Bardeleben
- University Medical Center Mainz, University Medicine Mainz, Center for Cardiology, Heart Valve Center, Mainz, Germany
| | - J Senges
- IHF Gmbh - Institut Fuer Herzinfarktforschung, “Stiftung Institut für Herzinfarktforschung”, Ludwigshafen, Foundation Institute for Myocardial Infa, Ludwigshafen, Germany
| | - R Bekeredjian
- Robert Bosch Hospital, Robert-Bosch-Hospital Stuttgart, Cardiology Department, Stuttgart, Germany
| | - H Eggebrecht
- CardioVascular Center Bethanien (CCB), Cardiology Centrum Bethanien – CCB, Frankfurt am Main, Frankfurt, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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10
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Koell B, Ludwig S, Bhadra O, Schofer N, Schirmer J, Conradi L, Reichenspurner H, Blankenberg S, Lubos E, Kalbacher D. Impact of tricuspid regurgitation and its postprocedural reduction on long term outcome in patients undergoing percutaneous mitral valve edge to edge repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2637] [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
Prevalence of functional tricuspid valve regurgitation (TR) in the adult population is high and mostly considered as a consequence of left-sided heart failure. In patients with moderate-to-severe and severe mitral regurgitation (MR), relevant concomitant TR is found in about 30–50%. For many years the concept of a reduction of secondary TR after mitral valve surgery has been widely accepted. However, more recently, compelling data have shown that surgically untreated functional TR can persist or even worsen despite the correction of the associated left-sided lesion.
In line with previous research, studies have indicated that preexisting concomitant TR is an independent predictor for adverse outcome in patients undergoing percutaneous mitral valve Edge-to-Edge Repair (pMVR).
Purpose
This study intends to determine the extent to which the severity of tricuspid regurgitation, measured six months after pMVR, impacts the outcome.
Methods
Between September 2008 and July 2018, 805 consecutive patients with moderate-to-severe or severe MR underwent pVMR therapy with the MitraClip device at our center. We exclude patients with missing date of follow-up (n=54) and patients with missing values for baseline tricuspid regurgitation (n=93). We analyze, therefore, data of 658 patients with a median follow-up time of 4.93 (4.2, 4.99) years. Severity of TR was evaluated at baseline and six months after pMVR.
Results
Among 658 high-risk patients (mean age 75.4±8.7 years, 59.7% male, median STS Score 3.9 [2.4, 6.1]), 248 patients were suffering from no/mild (37.6%), 213 from moderate (32.6%) and 197 patients from severe (29.9%) TR. Functional MR was present in 429 (65.5%) patients. Procedural success was achieved in the majority of patients (no/mild TR 90.3%, moderate TR 91.1%, severe TR 90.4%). Overall, mortality rates up to two-year follow-up were highest for patients with severe TR (no/mild TR 30.2%, moderate TR 37.6%, severe TR 42.6%, p=0.023). The risk for overall mortality (Kaplan-Meier analysis, p=0.0027, Figure 1) was related to increasing TR severity. However, Kaplan-Meier analysis showed no relevant differences for the combined endpoint of death and rehospitalization (p=0.058). Interestingly, in a pairwise comparison, the risk for patients with pre-existing severe TR and postprocedural reduction to mild or moderate TR (n=17) was reduced for the combined endpoint (p=0.021) compared to patients with persistent severe TR (n=28).
Conclusion
Moderate and severe TR in high-risk patients undergoing pMVR is associated with an increased risk for overall mortality. While preliminary, the presented data suggest a favorable outcome in patients with a postprocedural reduction in the severity of TR. The results of this study indicate the importance of developing new therapeutic strategies in high-risk patients with combined MR and TR, probably leading to concomitant tricuspid valve interventions.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Koell
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - S Ludwig
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - O Bhadra
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - J Schirmer
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - L Conradi
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - H Reichenspurner
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - E Lubos
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
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11
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Koell B, Ludwig S, Bhadra O, Gossling A, Schofer N, Schirmer J, Conradi L, Reichenspurner H, Blankenberg S, Lubos E, Kalbacher D. Acute hemodynamic changes and long term prognostic impact of pulmonary hypertension in patients undergoing percutaneous mitral valve edge to edge repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2638] [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
Pulmonary hypertension (PH) due to left heart disease is the most common form of PH. Published literature suggests increased perisurgical mortality in patients undergoing surgical repair in the setting of preexisting PH. The data on the impact of preexisting PH on clinical outcomes after percutaneous Mitral Valve Edge-to-Edge Repair (pMVR) is limited to observational studies and rely mostly on echocardiographic data.
Purpose
The aim of the current study is to evaluate the influence of preexisting PH in patients undergoing pMVR analyzing periprocedural invasive right heart catheterization data.
Methods
Between September 2008 and July 2018, a total of 911 patients with moderate-to-severe or severe mitral regurgitation (MR) underwent pMVR at our center. This analysis includes 331 patients with a complete data set for pre- and postprocedural right heart catheterization and echocardiographic assessment as well as available follow-up information after the implantation. Patients are divided according to the etiology of PH. The combined primary endpoint consists of all-cause mortality and rehospitalization for heart failure. Furthermore, a sub-analysis is performed for all patients with preexisting post-capillary PH. Patients with post-capillary PH are divided into two groups based on a postprocedural decrease of pulmonary artery wedge pressure (mPAWP) below the threshold of 15mmHg. Univariate and multivariate Cox regression analyses are performed to assess the influence on long-term outcome.
Results
Of all 331 patients (57.7% [n= 191] male) undergoing pMVR, 195 (62.1%) had functional MR. Median ejection fraction was 40.5% (29.3, 54.0). Patients were followed-up for a maximum of 4.41 years and the median follow-up time was 1.98 years. Preexisting PH (mean pulmonary artery pressure ≥25 mmHg) was found in 236 (71.1%) patients: 49 patients had pre-capillary PH (≤15 mmHg), 187 had post-capillary PH (pcPH; n=183; mPAWP >15 mmHg). In Kaplan-Meier analysis, no statistically significant difference could be found in overall mortality in patients without or with PH, irrespective of etiology (p=0.43). However, in patients suffering from post-capillary PH, patients with a postprocedural reduction of mPAWP below the threshold of 15mmHg showed a significantly lower risk for overall long-term mortality compared to patients without a relevant mPAWP reduction (p=0.018). Multivariate analysis revealed acute postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH to have a significant influence on mortality (HR 2.81 [1.35, 5.86]; p=0.006; Figure 1).
Conclusion
In contrast to previously published findings, the present results were not able to show a significant impact of PH, disregarding its etiology, on outcome. Nevertheless, a postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH is associated with a favorable outcome.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Koell
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - S Ludwig
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - O Bhadra
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - A Gossling
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - N Schofer
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - J Schirmer
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - L Conradi
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - H Reichenspurner
- University Heart & Vascular Center Hamburg, Department for Cardiovascular Surgery, Hamburg, Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - E Lubos
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
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12
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Ludwig S, Kalbacher D, Schofer N, Schäfer A, Koell B, Seiffert M, Schirmer J, Schäfer U, Westermann D, Reichenspurner H, Blankenberg S, Lubos E, Conradi L. Early results of a real-world series with two transapical transcatheter mitral valve replacement devices. Clin Res Cardiol 2020; 110:411-420. [PMID: 33074368 PMCID: PMC7907022 DOI: 10.1007/s00392-020-01757-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
Aims Transcatheter mitral valve replacement (TMVR) with dedicated devices promises to fill the treatment gap between open-heart surgery and edge-to-edge repair for patients with severe mitral regurgitation (MR). We herein present a single-centre experience of a TMVR series with two transapical devices. Methods and results A total of 11 patients were treated with the Tendyne™ (N = 7) or the Tiara™ TMVR systems (N = 4) from 2016 to 2020 either as compassionate-use procedures or as commercial implants. Clinical and echocardiographic data were collected at baseline, discharge and follow-up and are presented in accordance with the Mitral Valve Academic Research Consortium (MVARC) definitions. The study cohort [age 77 years (73, 84); 27.3% male] presented with primary (N = 4), secondary (N = 5) or mixed (N = 2) MR etiology. Patients were symptomatic (all NYHA III/IV) and at high surgical risk [logEuroSCORE II 8.1% (4.0, 17.4)]. Rates of impaired RV function (72.7%), severe pulmonary hypertension (27.3%), moderate or severe tricuspid regurgitation (63.6%) and prior aortic valve replacement (63.6%) were high. Severe mitral annulus calcification was present in two patients. Technical success was achieved in all patients. In 90.9% (N = 10) MR was completely eliminated (i.e. no or trace MR). Procedural and 30-day mortality were 0.0%. At follow-up NYHA class was I/II in the majority of patients. Overall mortality after 3 and 6 months was 10.0% and 22.2%. Conclusions TMVR was performed successfully in these selected patients with complete elimination of MR in the majority of patients. Short-term mortality was low and most patients experienced persisting functional improvement. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01757-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany. .,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.
| | - D Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - N Schofer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - A Schäfer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - B Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - M Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - J Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - U Schäfer
- Marienkrankenhaus Hamburg, Department of Cardiology, Angiology and Intensive Care, Hamburg, Germany
| | - D Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - H Reichenspurner
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - S Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany
| | - E Lubos
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - L Conradi
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research (DZHK), Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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13
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Conradi L, Ludwig S, Kalbacher D, Schäfer A, Schneeberger Y, Schofer N, Schäfer U, Blankenberg S, Reichenspurner H, Lubos E. Results of an Early Series of Transcatheter Mitral Valve Implantation with Dedicated Devices: Experience with Three Different Transapical and Transseptal Devices. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705341] [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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Affiliation(s)
- D Kalbacher
- Department of General and Interventional Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - S Ludwig
- Department of General and Interventional Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - N Schofer
- Department of General and Interventional Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - J Schirmer
- Cardiovascular Surgery, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - H Reichenspurner
- Cardiovascular Surgery, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - L Conradi
- Cardiovascular Surgery, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - S Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - E Lubos
- Department of General and Interventional Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
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15
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Ludwig S, Voigtlaender L, Ruebsamen N, Kalbacher D, Koell B, Linder M, Waldschmidt L, Schirmer J, Seiffert M, Conradi L, Schaefer U, Reichenspurner H, Blankenberg S, Westermann D, Schofer N. P3858High H2FPEF score is an independent predictor of adverse outcome in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Recently, the H2FPEF score has been developed in an evidence-based approach relying on simple clinical and echocardiographic variables. It enables the identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF) which is associated with a dismal prognosis. Left ventricular diastolic dysfunction, a key mechanism in HFpEF, is also a common finding in patients with severe aortic stenosis.
Objective
To assess the prognostic impact of the H2FPEF score in patients with preserved ejection fraction and severe aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR).
Methods
Among 1148 patients with preserved ejection fraction who received TAVR at our institution between 2013 and 2018, data for calculation of the H2FPEF score was available in 535 patients. Score variables include BMI >30 kg/m2, arterial hypertension, atrial fibrillation, pulmonary hypertension >35 mmHg, age >60 years, and elevated LV filling pressure. Patients were dichotomized according to “low” (1–5 points; n=377) and “high” H2FPEF scores (6–9; n=158). Kaplan-Meier survival curves and Cox regression analyses were used to assess the prognostic impact of H2FPEF scores. Median follow-up time was 0.3 years.
Results
TAVR patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral regurgitation (19.4% vs. 33.6%, p<0.001) as well as tricuspid regurgitation (15.2% vs. 35.1%, p<0.001), and presented with lower stroke volume index (42.2 ml/m2 vs. 36.0 ml/m2, p<0.001) compared to those with low H2FPEF scores. All-cause mortality one year after TAVR was significantly higher in patients in the high H2FPEF score group (10.5% vs. 21.0%, p=0.0019, Figure 1). Multivariate analysis revealed a high H2FPEF score to be independently predictive for 1-year all-cause mortality (HR 2.66, 95% CI: 1.41–5.02, p=0.025). Among the single H2FPEF score variables, atrial fibrillation (HR 3.45, 95% CI: 1.86–6.40, p<0.001) and systolic pulmonary hypertension >55 mmHg (HR=2.68, 95% CI: 0.97–7.40, p=0.057) were strong independent predictors of adverse outcome.
Figure 1. All-cause mortality of patients undergoing TAVR after one year stratified by low (1–5 points) and high (6–9) H2FPEF score
Conclusion
An elevated H2FPEF score of >6 is independently predictive for mortality in patients with preserved ejection fraction undergoing TAVR for severe aortic stenosis. Our findings provide evidence that the H2FPEF score, which was meant for diagnostic use originally, is able to serve as a prognostic tool in patients with preserved ejection fraction undergoing TAVR, highlighting the adverse impact of diastolic dysfunction in patients with preserved ejection fraction and aortic stenosis.
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Affiliation(s)
- S Ludwig
- University Heart Center Hamburg, Hamburg, Germany
| | | | - N Ruebsamen
- University Heart Center Hamburg, Hamburg, Germany
| | - D Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - B Koell
- University Heart Center Hamburg, Hamburg, Germany
| | - M Linder
- University Heart Center Hamburg, Hamburg, Germany
| | | | - J Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | - M Seiffert
- University Heart Center Hamburg, Hamburg, Germany
| | - L Conradi
- University Heart Center Hamburg, Hamburg, Germany
| | - U Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - D Westermann
- University Heart Center Hamburg, Hamburg, Germany
| | - N Schofer
- University Heart Center Hamburg, Hamburg, Germany
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16
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Kalbacher D, Tigges EP, Boekstegers P, Puls M, Plicht B, Eggebrecht H, Nickenig G, Von Bardeleben RS, Zuern CS, Franke J, Sievert H, Ouarrak T, Senges J, Lubos E. P4730Underweight is associated with unfavourable short- and long-term outcomes after MitraClip therapy: a body mass index derived subgroup analysis of the German Transcatheter Mitral Valve Interventions (. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1106] [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
Underweight and obesity represent classical risk factors for patients undergoing cardiac surgery or interventional treatment. The multicentre German Transcatheter Mitral Valve Interventions (TRAMI) registry comprises a large and prospectively enrolled real-world cohort of patients treated by MitraClip implantation.
Aims
The current analysis examines the impact of underweight, overweight and obesity on intra-hospital, short and long-term outcomes in patients treated by MitraClip therapy.
Methods and results
From 08/2010 until 07/2013, 799 patients (age 75.3±8.6 years, male gender 60.7%, median logistic EuroSCORE 20% [12; 31], functional mitral regurgitation (MR): 69.3%) were prospectively enrolled into the multicentre, industry-independent German Transcatheter Mitral Valve Interventions registry. Patients were stratified according to body mass index (BMI) into four groups: BMI<20 kg/m2 (underweight, n=49), BMI 20.0 to <25.0 kg/m2 (normal weight, n=293), BMI 25.0 to <30.0 kg/m2 (overweight, n=296) and BMI≥30 kg/m2 (obese, n=132). Procedure and radiation time were comparable among all groups. Significant increased rates of procedural failure (12.2% vs. 2.1 [normal weight], p<0.001), transfusion/bleeding (20.8% vs. normal weight: 5.6%, obesity: 7.0%, p<0.01), sepsis or multiorgan failure and low cardiac output failure were found for underweight patients only. Kaplan-Meier survival curves demonstrated inferior survival for underweight patients, but comparable outcomes for all other patients (global log rank test, p<0.01). Multivariable Cox-regression analysis (adjusted for age, gender, creatinine≥1.5mg/dl, diabetes, left ventricular ejection fraction<30% and chronic obstructive pulmonary disease) confirmed underweight (as compared to normal weight) as an independent risk factor of death (hazard ratio [HR]: 1.58, 95%-confidence interval (CI): 1.01–2.46, p=0.044) and overweight as protective against death (HR: 0.71; 95%-CI: 0.55–0.93; p=0.011).
Conclusion
Underweight patients are exposed to increased rates of procedural failure, bleeding and low cardiac output as well as increased short- and long-term mortality rates when undergoing MitraClip implantation and should therefore be carefully discussed within the heart team.
Acknowledgement/Funding
The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott.
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Affiliation(s)
- D Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - E P Tigges
- University Heart Center Hamburg, Hamburg, Germany
| | | | - M Puls
- Georg-August University, Gottingen, Germany
| | - B Plicht
- Herzzentrum Westfalen, Cardiology Clinic, Dortmund, Germany
| | - H Eggebrecht
- CardioVascular Center Bethanien (CCB), Frankfurt am Main, Germany
| | | | | | - C S Zuern
- Eberhard-Karls University of Tubingen, Tubingen, Germany
| | - J Franke
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - T Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - E Lubos
- University Heart Center Hamburg, Hamburg, Germany
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17
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Conradi L, Deuschl F, Ludwig S, Schäfer A, Kalbacher D, Voigtländer L, Schneeberger Y, Schofer N, Blankenberg S, Reichenspurner H, Schäfer U. Transcatheter Mitral Valve Implantation Using Dedicated Devices: Early Experience Using Different Transapical and Transseptal Devices. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678844] [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)
- L. Conradi
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - F. Deuschl
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Ludwig
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - D. Kalbacher
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | - N. Schofer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | - U. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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18
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Sequeira M, Bhadra O, Kalbacher D, Schofer N, Deuschl F, Schäfer A, Schneeberger Y, Blankenberg S, Reichenspurner H, Schäfer U, Conradi L. Percutaneous Management of Vascular Injury after Transfemoral Aortic Valve Implantation. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678873] [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)
- M. Sequeira
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - O. Bhadra
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - D. Kalbacher
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Schofer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - F. Deuschl
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | | | | | | | - U. Schäfer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - L. Conradi
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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19
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Reichart D, Kalbacher D, Ruebsamen N, Tigges E, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schaefer U, Lubos E. 3070The impact of residual mitral valve regurgitation on outcome after MitraClip therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3070] [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: 11/14/2022] Open
Affiliation(s)
- D Reichart
- University Heart Center Hamburg, Hamburg, Germany
| | - D Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - N Ruebsamen
- University Heart Center Hamburg, Hamburg, Germany
| | - E Tigges
- University Heart Center Hamburg, Hamburg, Germany
| | - J Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - L Conradi
- University Heart Center Hamburg, Hamburg, Germany
| | - U Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | - E Lubos
- University Heart Center Hamburg, Hamburg, Germany
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20
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Kalbacher D, Schaefer U, Von Bardeleben RS, Eggebrecht H, Sievert H, Nickenig G, Butter C, Ouarrak T, Zahn R, Baldus S, Ince H, Schillinger W, Boekstegers P, Senges J, Lubos E. 1210Long-term follow-up in the German TRAnscatheter mitral valve Interventions (TRAMI) registry: survival and predictors of mortality. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1210] [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: 11/14/2022] Open
Affiliation(s)
- D Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - U Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - H Eggebrecht
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | | | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - T Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - R Zahn
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - H Ince
- University Hospital Rostock, Rostock, Germany
| | - W Schillinger
- University Medical Center Gottingen (UMG), Gottingen, Germany
| | | | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - E Lubos
- University Heart Center Hamburg, Hamburg, Germany
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21
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Tigges E, Kalbacher D, Ruebsamen N, Reichart D, Deuschl F, Conradi L, Schirmer J, Reichenspurner H, Schaefer U, Blankenberg S, Lubos E. P1672Characteristics of long-term survival after successful transcatheter mitral valve repair in high-risk patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1672] [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)
- E Tigges
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - D Kalbacher
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - N Ruebsamen
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - D Reichart
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - F Deuschl
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - L Conradi
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - J Schirmer
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - H Reichenspurner
- University Heart Center Hamburg, Cardiovascular Surgery, Hamburg, Germany
| | - U Schaefer
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
| | - E Lubos
- University Heart Center Hamburg, Interventional Cardiology, Hamburg, Germany
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22
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Conradi L, Deuschl F, Schäfer A, Kalbacher D, Schirmer J, Schofer N, Blankenberg S, Reichenspurner H, Schäfer U. Transapical Transcatheter Mitral Valve Implantation Using Dedicated Devices: A Preliminary Series. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627921] [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)
- L. Conradi
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - F. Deuschl
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Schäfer
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - D. Kalbacher
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - J. Schirmer
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Schofer
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Blankenberg
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - U. Schäfer
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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Pausch J, Schäfer A, Schneeberger Y, Kalbacher D, Deuschl F, Reichenspurner H, Schäfer U, Conradi L. Contained Aortic Root Rupture: A Rare Complication after Transfemoral Implantation of Self-Expandable Aortic Valve Bioprosthesis. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628117] [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)
- J. Pausch
- University Heart Center Hamburg, UKE, Hamburg, Germany
| | - A. Schäfer
- University Heart Center Hamburg, UKE, Hamburg, Germany
| | | | - D. Kalbacher
- University Heart Center Hamburg, UKE, Hamburg, Germany
| | - F. Deuschl
- University Heart Center Hamburg, UKE, Hamburg, Germany
| | | | - U. Schäfer
- University Heart Center Hamburg, UKE, Hamburg, Germany
| | - L. Conradi
- University Heart Center Hamburg, UKE, Hamburg, Germany
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Reichart D, Kalbacher D, Rübsamen N, Tigges E, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schäfer U, Girdauskas E, Lubos E. Echocardiographic Analysis and Outcome in Patients with Functional Mitral Regurgitation Receiving MitraClip Therapy. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627924] [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)
- D. Reichart
- Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
| | - D. Kalbacher
- Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
| | - N. Rübsamen
- Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
| | - E. Tigges
- Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
| | - J. Schirmer
- Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
| | - S. Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
| | - L. Conradi
- Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
| | - U. Schäfer
- Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
| | - E. Girdauskas
- Department of Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
| | - E. Lubos
- Department of General and Interventional Cardiology, University Heart Center, University of Hamburg, Hamburg, Germany
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Reichart D, Kalbacher D, Tigges E, Thomas C, Schofer N, Deuschl F, Schirmer J, Blankenberg S, Reichenspurner H, Schaefer U, Conradi L, Lubos E. P152MitraClip therapy in ideal patients with a post-interventional mitral regurgitation equal or below grade 1. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p152] [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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Kalbacher D, Tigges E, Thomas C, Deuschl F, Schofer N, Schirmer J, Conradi L, Reichenspurner H, Blankenberg S, Schaefer U, Lubos E. P1364Impact of post-procedural mitral stenosis on long-term outcome in high-surgical risk patients treated successfully by MitraClip implantation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1364] [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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27
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Deuschl F, Schofer N, Ruebsamen N, Voigtlaender L, Kalbacher D, Seiffert M, Schaefer A, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schaefer U. P3287Peri-procedural predictors for cerebrovascular events in a TAVI all-comers population, a single center experience comprising 1313 patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3287] [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: 11/13/2022] Open
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Schrage B, Kalbacher D, Schwarzl M, Waldeyer C, Becher P, Blankenberg S, Lubos E, Schaefer U, Westermann D. 3860Distinct hemodynamic changes after interventional mitral valve edge to edge repair in different phenotypes of heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3860] [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: 11/13/2022] Open
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29
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Deuschl F, Voigtlaender L, Schofer N, Ruebsamen N, Kalbacher D, Seiffert M, Schneeberger Y, Schirmer J, Reichenspurner H, Blankenberg S, Conradi L, Schaefer U. P4269Prognostic impact of obesity after transcatheter aortic valve implantation in patients with severe aortic valve stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4269] [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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Reichart D, Kalbacher D, Schofer N, Deuschl F, Schirmer J, Blankenberg S, Reichenspurner H, Schäfer U, Lubos E, Conradi L. MitraClip Therapy for Patients with End-Stage Heart Failure: A Durable Option? J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.299] [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: 11/16/2022] Open
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31
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Reichart D, Kalbacher D, Schofer N, Deuschl F, Schirmer J, Blankenberg S, Reichenspurner H, Schäfer U, Lubos E, Conradi L. MitraClip Therapy in “Ideal” Patients with a Post-Interventional Mitral Regurgitation ≤1. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598668] [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)
- D. Reichart
- University Heart Center Hamburg, Hamburg, Germany
| | - D. Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - N. Schofer
- University Heart Center Hamburg, Hamburg, Germany
| | - F. Deuschl
- University Heart Center Hamburg, Hamburg, Germany
| | - J. Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - U. Schäfer
- University Heart Center Hamburg, Hamburg, Germany
| | - E. Lubos
- University Heart Center Hamburg, Hamburg, Germany
| | - L. Conradi
- University Heart Center Hamburg, Hamburg, Germany
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Reichart D, Kalbacher D, Schofer N, Deuschl F, Schirmer J, Blankenberg S, Reichenspurner H, Schäfer U, Lubos E, Conradi L. MitraClip Therapy for Patients with End-Stage Heart Failure: A Durable Option? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598720] [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)
- D. Reichart
- University Heart Center Hamburg, Hamburg, Germany
| | - D. Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - N. Schofer
- University Heart Center Hamburg, Hamburg, Germany
| | - F. Deuschl
- University Heart Center Hamburg, Hamburg, Germany
| | - J. Schirmer
- University Heart Center Hamburg, Hamburg, Germany
| | | | | | - U. Schäfer
- University Heart Center Hamburg, Hamburg, Germany
| | - E. Lubos
- University Heart Center Hamburg, Hamburg, Germany
| | - L. Conradi
- University Heart Center Hamburg, Hamburg, Germany
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Schirmer J, Lubos E, Kalbacher D, Schlüter M, Tigges E, Conradi L, Treede H, Goldmann B, Schäfer U, Blankenberg S, Reichenspurner H. Acute Changes in NT-proBNP after Successful MitraClip Implantation Predict Long-Term Clinical Outcome. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544545] [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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