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Ruperti-Repilado FJ, Haag N, Fischer T, Santos Lopes B, Meier L, Wustmann K, Bonassin F, Attenhofer Jost C, Schwitz F, Schwerzmann M, Tobler D, von Felten S, Greutmann M. Impact of pulmonary valve replacement on ventricular function and cardiac events in patients with tetralogy of Fallot. A retrospective cohort study. Rev Esp Cardiol (Engl Ed) 2024; 77:408-417. [PMID: 38048843 DOI: 10.1016/j.rec.2023.11.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Our aim was to assess the impact of prosthetic pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) on changes in biventricular volumes and function and on adverse cardiac events. METHODS Adults with rTOF were identified from the SACHER-registry. Data from serial cardiac magnetic resonance imaging, echocardiography, exercise capacity and n-terminal pro b-type natriuretic peptide (NT-proBNP) were collected. The primary endpoint was right ventricular ejection fraction (RVEF) as measured by cardiac magnetic resonance. Secondary endpoints were biventricular volumes, left ventricular ejection fraction, exercise capacity and NT-proBNP levels, and time to adverse cardiac outcomes (atrial and ventricular arrhythmia, endocarditis). Associations between previous PVR and longitudinal changes in functional outcomes and time to adverse cardiac outcomes were analyzed using linear mixed-effects models and Cox proportional hazards models, respectively. RESULTS A total of 308 patients (153 with and 155 without PVR) with 887 study visits were analyzed. Previous PVR was not significantly associated with changes in RVEF (CE, -1.33; 95%CI, -5.87 to 3.21; P=.566). Previous PVR was associated with lower right ventricular end-diastolic volume but had no significant effect on left ventricular ejection fraction, exercise capacity, or NT-proBNP-levels. Previous PVR was associated with an increased hazard of atrial arrhythmias (HR, 2.09; 95%CI, 1.17-3.72; P=.012) and infective endocarditis (HR, 12.72; 95%CI, 4.69-34.49; P<.0001) but not with an increased hazard of sustained ventricular arrhythmias (HR, 0.64; 95%CI, 0.18-2.27; P=.490). CONCLUSIONS Previous PVR was not significantly associated with changes in RVEF but was associated with an increased risk of atrial arrhythmias and infective endocarditis.
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Affiliation(s)
| | - Nora Haag
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Fischer
- Master Program in Biostatistics, University of Zurich, Switzerland
| | - Bruno Santos Lopes
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiology, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Meier
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kerstin Wustmann
- Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Francesca Bonassin
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Attenhofer Jost
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabienne Schwitz
- Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. https://twitter.com/@DDaniel_Tobler
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Papa A, Nussbaumer C, Goulouti E, Schwitz F, Wustmann K, Tobler D, Greutmann M, Schwerzmann M. Prognostic value of right ventricular dyssynchrony in adults with repaired tetralogy of Fallot. Open Heart 2024; 11:e002583. [PMID: 38242560 PMCID: PMC10806502 DOI: 10.1136/openhrt-2023-002583] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Residual sequelae after surgical repair of tetralogy of Fallot (rTOF) affect clinical outcome. We investigated the prognostic impact of right ventricular (RV) dyssynchrony in adults with rTOF years after the surgical repair. METHODS Patients from the Swiss Adult Congenital HEart disease Registry were included. NT-proBNP levels, echocardiography, exercise testing and MRI data were collected. An offline strain analysis to quantify RV-ventricular and interventricular dyssynchrony was performed. The standard deviation of the time-to-peak shortening (TTP) of six RV segments defined the RV Dyssynchrony Index (RVDI). Maximal difference of TTP between RV and left ventricular segments defined the interventricular shortening delay (IVSD). Predictors of a composite adverse event (arrhythmias, hospitalisation for heart failure and death) were identified by multivariate Cox regression analysis. Their median values were used to create a risk score. RESULTS Out of 285 included patients (mean age 34±14 years), 33 patients (12%) experienced an adverse event during a mean follow-up of 48±21 months. No correlation was found between RVDI, IVSD and clinical events. NT-proBNP, right atrial area and peak heart rate were independent predictors of outcomes. After 4 years-follow-up, no adverse events occurred in patients at low risk (score=0 points), while an adverse event occurred in 62% of patients at high risk (score=3 points, p<0.001). CONCLUSION In our cohort of adults with rTOF, surrogates of RV dyssynchrony did not correlate with outcomes. A multimodality approach was effective in predicting the risk for adverse events.
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Affiliation(s)
- Andrea Papa
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
- University Heart Center, University Hospital Basel, Basel, Switzerland
| | - Clement Nussbaumer
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Eleni Goulouti
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabienne Schwitz
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Kerstin Wustmann
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Daniel Tobler
- University Heart Center, University Hospital Basel, Basel, Switzerland
| | - Matthias Greutmann
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Markus Schwerzmann
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Thomet C, Moons P, Schwerzmann M, Schwitz F. Development of quality indicators of transfer and transition in adolescents and young adults with congenital heart disease. BMC Health Serv Res 2023; 23:1154. [PMID: 37880667 PMCID: PMC10601126 DOI: 10.1186/s12913-023-10183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Quality indicators are crucial in evaluating and comparing the quality of healthcare services. In the case of congenital heart disease, transition programmes for adolescents have been recommended to ensure uninterrupted healthcare and lifelong care. It is necessary to establish quality indicators in order to facilitate the evaluation of programme quality and to allow comparison between different centres. The objective of this study is therefore to develop a set of quality indicators for the transition of adolescents with congenital heart disease. METHODS The RAND/UCLA appropriateness method was employed in a four-step process to develop a set of quality indicators. First, a literature search was conducted on the dimensions of transitional care, based on which a preliminary set of quality indicators was developed. Second, experts were contacted, and an expert panel was established. Third, the panel members were asked to rate the appropriateness of the quality indicators in a two-round process. Finally, in the fourth step, we evaluated the data by measuring the median and Disagreement Index. RESULTS The expert panel consisted of 16 members, congenital cardiologists, nurses, transition experts, patients and research experts. The preliminary set of quality indicators comprised 16 items, categorized in process and structure criteria. Based on the panel's feedback, the set was refined to 12 quality indicators, which were rated as relevant and feasible. CONCLUSIONS This study represents the first attempt to develop quality indicators for transitional care services for adolescents with congenital heart disease. The set of 12 quality indicators was developed based on existing evidence and expert opinion. Further testing is needed to assess the feasibility of these quality indicators in daily practice. If successfully implemented, these quality indicators could allow comparison and facilitate benchmarking of transitional care services for adolescents with congenital heart disease.
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Affiliation(s)
- Corina Thomet
- Center of Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland.
- Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium.
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
- Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Markus Schwerzmann
- Center of Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Fabienne Schwitz
- Center of Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
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Greutmann M, Tobler D, Engel R, Heg D, Mueller C, Frenk A, Gabriel H, Rutz T, Buechel RR, Willhelm M, Trachsel L, Freese M, Ruperti-Repilado FJ, Valsangiacomo Buechel E, Beitzke D, Haaf P, Wustmann K, Schwitz F, Possner M, Schwitter J, Bouchardy J, Schwerzmann M. Effect of phosphodiesterase-5 inhibition on SystEmic Right VEntricular size and function. A multicentre, double-blind, randomized, placebo-controlled trial: SERVE. Eur J Heart Fail 2023; 25:1105-1114. [PMID: 37264734 DOI: 10.1002/ejhf.2924] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/11/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
AIMS In adults with congenital heart disease and systemic right ventricles, progressive right ventricular systolic dysfunction is common and is associated with adverse outcomes. Our aim was to assess the impact of the phosphodiesterase-5-inhibitor tadalafil on right ventricular systolic function. METHODS AND RESULTS This was a double-blind, randomized, placebo-controlled, multicentre superiority trial (NCT03049540) involving 100 adults with systemic right ventricles (33 women, mean age: 40.7 ± 10.7 years), comparing tadalafil 20 mg once daily versus placebo (1:1 ratio). The primary endpoint was the change in right ventricular end-systolic volume after 3 years of therapy. Secondary endpoints were changes in right ventricular ejection fraction, exercise capacity and N-terminal pro-B-type natriuretic peptide concentration. Primary endpoint assessment by intention to treat analysis at 3 years of follow-up was possible in 83 patients (42 patients in the tadalafil group and 41 patients in the placebo group). No significant changes over time in right ventricular end-systolic volumes were observed in the tadalafil and the placebo group, and no significant differences between treatment groups (3.4 ml, 95% confidence interval -4.3 to 11.0, p = 0.39). No significant changes over time were observed for the pre-specified secondary endpoints for the entire study population, without differences between the tadalafil and the placebo group. CONCLUSIONS In this trial in adults with systemic right ventricles, right ventricular systolic function, exercise capacity and neuro-hormonal activation remained stable over a 3-year follow-up period. No significant treatment effect of tadalafil was observed. Further research is needed to find effective treatment for improvement of ventricular function in adults with systemic right ventricles.
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Affiliation(s)
- Matthias Greutmann
- University Heart Center, Department of cardiology, University of Zurich, Zürich, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Reto Engel
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - André Frenk
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Tobias Rutz
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Willhelm
- University Clinic of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Trachsel
- University Clinic of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Michael Freese
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Kerstin Wustmann
- Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland
| | - Fabienne Schwitz
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mathias Possner
- University Heart Center, Department of cardiology, University of Zurich, Zürich, Switzerland
| | - Juerg Schwitter
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiac MR Center of the University Hospital Lausanne and CMR Corelab (swissCVIcorelab, CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University (UniL), Lausanne, Switzerland
| | - Judith Bouchardy
- Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Division of Cardiology, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Markus Schwerzmann
- Department of Cardiology, Center for Congenital Heart Disease, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Schwitz F, Torti J, Lingard L. What about Happiness? A Critical Narrative Review with Implications for Medical Education. Perspect Med Educ 2023; 12:208-217. [PMID: 37304335 PMCID: PMC10253238 DOI: 10.5334/pme.856] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/18/2023] [Indexed: 06/13/2023]
Abstract
Introduction Despite abundant scholarship and improvement initiatives, the problem of physician wellbeing persists. One reason might be conceptual: the idea of 'happiness' is rare in this work. To explore how it might influence the conversation about physician wellbeing in medical education, we conducted a critical narrative review asking: 'How does happiness feature in the medical education literature on physician wellbeing at work?' and 'How is happiness conceptualized outside medicine?' Methods Following current methodological standards for critical narrative review as well as the Scale for the Assessment of Narrative Review Articles, we conducted a structured search in health research, humanities and social sciences, a grey literature search, and consultation with experts. After screening and selection, content analysis was performed. Results Of 401 identified records, 23 were included. Concepts of happiness from the fields of psychology (flow, synthetic happiness, mindfulness, flourishing), organizational behaviour (job satisfaction, happy-productive worker thesis, engagement), economics (happiness industry, status treadmill), and sociology (contentment, tyranny of positivity, coercive happiness) were identified. The medical education records exclusively drew on psychological concepts of happiness. Discussion and Conclusion This critical narrative review introduces a variety of conceptualizations of happiness from diverse disciplinary origins. Only four medical education papers were identified, all drawing from positive psychology which orients us to treat happiness as individual, objective, and necessarily good. This may constrain both our understanding of the problem of physician wellbeing and our imagined solutions. Organizational, economical and sociological conceptualizations of happiness can usefully expand the conversation about physician wellbeing at work.
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Affiliation(s)
- Fabienne Schwitz
- Cardiologist and medical educator, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Suit 102A, London, Canada
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, CH 3010 Bern, Switzerland
| | - Jacqueline Torti
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Suit 102A, London, Canada
| | - Lorelei Lingard
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Medical Sciences Building, Suit 102A, London, Canada
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Schnegg B, Muster C, Wieser M, Pavlicek-Bahlo M, Wiedermann S, Dobner S, Bruno J, Capek L, Potratz P, Jenni H, Sidler D, Chanias I, Daskalakis M, Consiglio J, Schwitz F, Thomet C, Schwerzmann M, Immer F, Longnus S, Martinelli M, Hunziker L, Siepe M, Reineke D. From Vpra of 100% to Transplantation, Journey of the First Ocs-dbd Case in Switzerland. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.491] [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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Nussbaumer C, Schwitz F, Elchinova E, Goulouti E, Wustmann K, Papa A, Schwerzmann M. Impact of left atrial size and strain on new atrial arrhythmias during a 5-year follow-up in adults with congenital heart disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1826] [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
Introduction
Atrial arrhythmias are a common and important cause of morbidity and mortality in adults with congenital heart disease (ACHD). In acquired heart disease, left atrial (LA) strain has been shown to predict supraventricular tachyarrhythmias (SVT). This study sought to investigate if LA strain is also a reliable predictor of SVT in the ACHD population.
Method
We retrospectively obtained baseline clinical and echocardiographic data, including LA function parameters and strain, in 206 ACHD patients. Only patients with sinus rhythm at baseline and 5-years follow-up were included (median age 29, IQR 22–41 years). 157 participants had a left heart defect (aortic stenosis or aortic coarctation, with or without correction) and 49 a right heart defect (Fallot physiology). Diagnosis of sustained SVT was determined from clinical reports during the follow-up period (standard 12-lead ECG, ECG Holter).
Results
During a median follow-up of 6.2 years, a new or recurrent sustained SVT occurred in 16 patients (7.8%). Patients baseline characteristics are depicted in Table 1. Patients who developed SVT were older, had larger LA dimensions and left ventricular mass, more likely diastolic dysfunction on echo, and a lower peak LA longitudinal strain (PALS). PALS was a good predictor of SVT risk in patients with left and right heart defects with an area under the receiver-operating-curve of 0.857. By Cox regression analysis, patient in the lowest quartile for PALS had a 16.7-fold higher hazard ratio of SVT (95% confidence interval, 4.7 to 59.0, p<0.001) in comparison with the top three quartiles. Overall freedom from arrhythmia after 1, 3 and 5 years of follow-up was 98.1%, 96.1% and 94.2%, respectively. The freedom from SVT as a function of PALS quartiles is shown in Figure 1.
Conclusion
PALS provides predictive information about the occurrence of SVT in the ACHD population, regardless of the type of the lesion. Including the measurement of LA strain in the follow-up of these patients may permit to better identify patients at risk of future atrial arrhythmias.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Universitätsklinik für Kardiologie, Inselspital Bern
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Affiliation(s)
- C Nussbaumer
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
| | - F Schwitz
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
| | - E Elchinova
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
| | - E Goulouti
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
| | - K Wustmann
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
| | - A Papa
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
| | - M Schwerzmann
- Bern University Hospital, Inselspital, Center for Congenital Heart Disease , Bern , Switzerland
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Schwitz F, Bartenstein A, Huwendiek S. [Workplace-based Assessments: A Needs Analysis of Residents and Supervisors]. Praxis (Bern 1994) 2022; 111:605-611. [PMID: 35975414 DOI: 10.1024/1661-8157/a003877] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Workplace-based Assessments: A Needs Analysis of Residents and Supervisors Abstract. During residency training, four workplace-based assessments (WBA) are planned per year in the form of Mini-CEX and/or DOPS. They were introduced as a tool for giving feedback and defining learning objectives in the clinical setting. The aim of the present study is to identify facilitating and inhibiting factors. The results will provide information to improve the use of this learning tool to effectively promote learning in the workplace. First, all users must be trained in its use. In particular, it is important to provide immediate and specific feedback that identifies opportunities for improvement and sets achievable learning goals. Documentation should be user-friendly and provide an overview of the learning process. WBAs should not be perceived as a duty, but as a tool for valuable learning moments.
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Affiliation(s)
- Fabienne Schwitz
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern, Bern, Schweiz
- Beide Autor_innen haben gleichermassen zum Manuskript beigetragen
| | - Andreas Bartenstein
- Universitätsklinik für Kinderchirurgie, Inselspital, Universitätsspital Bern, Bern, Schweiz
- Beide Autor_innen haben gleichermassen zum Manuskript beigetragen
| | - Sören Huwendiek
- 3 Abteilung für Assessment und Evaluation, Institut für Medizinische Lehre, Universität Bern, Bern, Schweiz
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Greutmann M, Ruperti J, Schwitz F, Haag N, Santos Lopes B, Meier L, Babic D, Valsangiacomo Buechel E, Kellenberger C, Bonassin F, Attenhofer Jost C, Schwerzmann M, Wustmann K, Tobler D. High Variability of Right Ventricular Volumes and Function in Adults with Severe Pulmonary Regurgitation Late After Tetralogy of Fallot Repair. Am J Cardiol 2022; 166:88-96. [PMID: 34949470 DOI: 10.1016/j.amjcard.2021.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 01/20/2023]
Abstract
Our aim was to assess changes of right ventricular end-diastolic volumes (RVEDVi) and right ventricular ejection fraction (RVEF) in asymptomatic adults with repaired tetralogy of Fallot, with native right ventricular outflow tract and severe pulmonary regurgitation by serial cardiac magnetic resonance imaging (CMR). The study included 23 asymptomatic adults who underwent ≥3 CMR studies (total of 88 CMR studies). We compared changes in RVEDVi and RVEF between first and last study (median follow-up: 8.8 years, interquartile range: 6.3 to 13.1 years) and between all study pairs. Variability of measurements between study pairs (65 consecutive and 139 nonconsecutive CMR study pairs) were assessed using Bland-Altman analysis and intraclass correlation coefficients. On average, there were no significant changes of RVEDVi or RVEF over the study period (change in RVEDVi: +0.4 ± 17.8 ml/m2, change in RVEF: -1.0 ± 5.5%). Assessment of variability of measurements between study pairs demonstrated no systematic change in RVEDVi and RVEF between study pairs with limits of agreement within the range of previously published studies (RVEDVi -29.1 to +27.2 ml/m2; RVEF -11.5% to 10.2%). High intraclass correlation coefficients for RVEDVi (0.943, 95% CI 0.906 to 0.965, p <0.001) and RVEF (0.815, 95% CI 0.697 to 0.887, p <0.0001) indicate high reliability of reported measurements. In conclusion, in asymptomatic adults with repaired tetralogy of Fallot with native right ventricular outflow tracts and severe pulmonary regurgitation, CMR measurements of RV volumes and RVEF remain stable during follow-up with variability between CMR studies in individual patients, as expected for interobserver and interstudy variability. Measurements derived from a single CMR study or changes occurring between 2 CMR studies should be used with caution for clinical decision-making.
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Affiliation(s)
- Matthias Greutmann
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Javier Ruperti
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Fabienne Schwitz
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Nora Haag
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Santos Lopes
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lukas Meier
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela Babic
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Christian Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Francesca Bonassin
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Attenhofer Jost
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Schwerzmann
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Kerstin Wustmann
- Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Nozica N, Asatryan B, Noti F, Baldinger SH, Lam A, Haeberlin A, Servatius HS, Seiler J, Schwitz F, Tanner H, Wustmann KB, Delacretaz E, Schwerzmann M, Reichlin T, Roten L. P1007Efficacy and safety of atrial ablation procedures in patients with complete d-TGA and atrial switch at a Swiss tertiary center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0599] [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
Introduction
Patients with complete transposition of the great arteries (d-TGA) and atrial switch face a high lifetime risk of arrhythmias. Interventions in these patients are challenging because of their particular anatomy. Reports on ablation procedures in this patient population are scarce and missing for Switzerland.
Method
We retrospectively analyzed all ablation procedures performed in the above-mentioned population at a Swiss tertiary care center.
Results
Among 73 d-TGA pts. (71% male; N=37 Senning; N=36 Mustard) followed at our center, 17 ablations were performed in 11 pts. (15%; one ablation in 8 pts., two in 2 pts. and five in 1 patient). Median age at first ablation was 34 years (range 15–49 years). A total of 17 different intra-atrial reentry tachycardias (IART) and 3 AVNRT were targeted. Of the IART, 10 were cavotricuspid isthmus (CTI)-dependent and 7 were not. In two procedures (12%) only the systemic venous (SV) baffle was accessed for ablation. In 15 procedures (88%), ablation was performed within the pulmonary venous (PV) baffle. Access to the PV baffle was retrograde via the aorta in 6 cases (35%), via a baffle leak in 3 (18%) and via baffle puncture in 6 (35%). All procedures with retrograde approach to the PV baffle or with SV baffle only ablation were performed up to January 2012 and all remaining procedures afterwards. The 3 pts. requiring repeat procedures had retrograde or SV baffle approaches initially, and one additional ablation via baffle puncture was successful. The CTI was targeted in 10 pts. (91%) and ablation was finally successful in all with bidirectional block demonstrated in 8 pts. The coronary sinus was found to drain into the SV baffle in 5 pts. (46%) and useful for assessment of CTI block. The seven CTI-independent IART were scar-related micro-reentries. Ablation of all 3 AVNRTs was successful after one procedure without recurrence. Slow pathway ablation was performed in the SV baffle in two and in the PV baffle in one case (Figure). After a median follow-up of 7 months (range 2–186 months) 9 pts. are without recurrence and in 2 pts. rare self-limited arrhythmias still occur. No procedural complications occurred.
Conclusion
Arrhythmias in patients with complete d-TGA and atrial switch are mainly CTI-dependent IART or scar-related micro-reentries, and a few patients also have AVNRT. Ablation of these arrhythmias is safe and successful if PV baffle access is achieved via a baffle leak or baffle puncture.
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Affiliation(s)
- N Nozica
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - B Asatryan
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Noti
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S H Baldinger
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Lam
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - A Haeberlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H S Servatius
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - J Seiler
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - F Schwitz
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - H Tanner
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - K B Wustmann
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - E Delacretaz
- Clinique Cecil de recherche cardio-vasculaire, Lausanne, Switzerland
| | - M Schwerzmann
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - L Roten
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
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Attenhofer Jost C, Zimmerli Vgtli M, Grnenfelder K, Lam A, Schwitz F, Wustmann K, Tanner H. Women in cardiology: past, present and future. Cardiovasc Med 2019. [DOI: 10.4414/cvm.2019.02022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital
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Johannes J, Greutmann M, Tobler D, Bouchardy J, Stambach D, Wustmann K, Schwitz F, Schwerzmann M. The impact of trisomy 21 on treatment modalities and outcome in adults with congenital heart disease in Switzerland. Pulm Circ 2018; 9:2045894018811147. [PMID: 30338722 PMCID: PMC6287318 DOI: 10.1177/2045894018811147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Trisomy 21 (T21) is associated in 40-45% of cases with heart defects, most commonly shunt lesions. These defects, if not repaired, can lead to irreversible shunt-induced pulmonary hypertension (i.e. Eisenmenger syndrome [ES]). In ES patients, intracardiac repair is no longer possible, but selective pulmonary vasodilators may increase exercise capacity and improve prognosis. This study aimed to estimate the prevalence of cardiac defects and ES in adult T21 patients and to assess the impact of T21 on treatment modalities and outcome in ES patients. A questionnaire was sent to 6906 Swiss physicians inviting them to indicate the number of adults with T21 under their care (survey report). We also analyzed all adults with ES (with and without T21) included in the Swiss Adult Congenital HEart disease Registry (SACHER) and studied the impact of T21 on the use of selective pulmonary vasodilators and survival. In the survey, 348 physicians cared for 695 adult T21 patients. Overall, 24% of T21 survey patients were known to have a cardiac defect, one in four with a defect had developed ES and 13% of those with ES were on specific pulmonary vasodilators. In SACHER, ES was present in 2% of adults with congenital heart disease and selective pulmonary vasodilators were used in 68% of ES patients with T21. In SACHER, survival during follow-up was worse with higher nt-proBNP levels (hazard ratio [HR] = 1.15 per 1000 units, 95% confidence interval [CI] = 1.02-1.29) and lower left ventricular ejection fraction (HR = 1.07 per percent decrease, 95% CI = 1.01-1.13). Age at inclusion and T21 did not affect survival. The prevalence of cardiac defects in adults with T21 in Switzerland is half the prevalence in children. T21 is over-represented among adults with ES. Raised awareness of the therapeutic options for T21 patients with ES is warranted.
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Affiliation(s)
- Judith Johannes
- 1 Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Greutmann
- 2 University Heart Center, Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Daniel Tobler
- 3 Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Judith Bouchardy
- 4 Department of Cardiology and Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.,5 Division of Cardiology, Hôpitaux Universitaires de Genève (HUG), Genève, Switzerland
| | | | - Kerstin Wustmann
- 1 Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabienne Schwitz
- 1 Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Schwerzmann
- 1 Center for Congenital Heart Disease, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Tobler D, Schwerzmann M, Bouchardy J, Engel R, Stambach D, Attenhofer Jost C, Wustmann K, Schwitz F, Rutz T, Gabriel H, Kuen HP, Auf der Maur C, Oxenius A, Seeliger T, Santos Lopes B, Bonassin F, Greutmann M, On Behalf Of Sacher. Swiss Adult Congenital HEart disease Registry (SACHER) - rationale, design and first results. Swiss Med Wkly 2017; 147:w14519. [PMID: 29120021 DOI: 10.4414/smw.2017.14519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2013, a prospective registry for adults with congenital heart disease (CHD) was established in Switzerland, providing detailed data on disease characteristics and outcomes: Swiss Adult Congenital HEart disease Registry (SACHER). Its aim is to improve the knowledge base of outcomes in adults with CHD. The registry design and baseline patient characteristics are reported. METHODS All patients with structural congenital heart defects or hereditary aortopathies, followed-up at dedicated adult CHD clinics, are asked to participate in SACHER. Data of participants are pseudonymised and collected in an electronic, web-based, database (secuTrial®). Collected data include detailed diagnosis, type of repair procedures, previous complications and adverse outcomes during follow-up. RESULTS From May 2014 to December 2016, 2836 patients (54% male, mean age 34 ± 14 years), with a wide variety of congenital heart lesions, have been enrolled into SACHER. Most prevalent were valve lesions (25%), followed by shunt lesions (22%), cyanotic and other complex congenital heart disease (16%), diseases affecting the right heart, i.e., tetralogy of Fallot or Ebstein anomaly (15%), and diseases of the left ventricular outflow tract (13%); 337 patients (12%) had concomitant congenital syndromes. The majority had undergone previous repair procedures (71%), 47% of those had one or more reinterventions. CONCLUSION SACHER collects multicentre data on adults with CHD. Its structure enables prospective data analysis to assess detailed, lesion-specific outcomes with the aim to finally improve long-term outcomes.
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Affiliation(s)
- Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Markus Schwerzmann
- University Clinic of Cardiology, Centre for Congenital Heart Disease, Inselspital, University Hospital Bern, Switzerland
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland, and Division of Cardiology, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Reto Engel
- Cardiology, Kantonsspital St. Gallen, Switzerlana
| | | | - Christine Attenhofer Jost
- Klinik im Park, Zurich, Switzerland; University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
| | - Kerstin Wustmann
- University Clinic of Cardiology, Centre for Congenital Heart Disease, Inselspital, University Hospital Bern, Switzerland
| | - Fabienne Schwitz
- University Clinic of Cardiology, Centre for Congenital Heart Disease, Inselspital, University Hospital Bern, Switzerland
| | - Tobias Rutz
- Department of Cardiology and Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Austria
| | - Hans Peter Kuen
- Centre for Congenital Heart Disease, Paediatric and Adult Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christoph Auf der Maur
- Centre for Congenital Heart Disease, Paediatric and Adult Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Angela Oxenius
- University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
| | - Theresa Seeliger
- University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
| | - Bruno Santos Lopes
- University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
| | - Francesca Bonassin
- University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
| | - Matthias Greutmann
- University Heart Centre, Department of Cardiology, University of Zurich, Switzerland
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Schwerzmann M, Schwitz F, Thomet C, Kadner A, Pfammatter JP, Wustmann K. Challenges of congenital heart disease in grown-up patients. Swiss Med Wkly 2017; 147:w14495. [PMID: 28975959 DOI: 10.4414/smw.2017.14495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nowadays, more than 90% of all children born with congenital heart disease (CHD) reach adult life. Although initially considered to be cured, the majority of them continue to need specialised follow-up because they require re-do interventions or are at increased risk of cardiovascular complications and premature death. Arrhythmias are the most common cause of unscheduled hospital visits for grown-up CHD (GUCH) patients, accounting for one third of emergency admissions in these patients. Some GUCH patients are also at increased risk for sudden cardiac death. The principles of arrhythmia management and the prevention of sudden cardiac death in GUCH patients are similar to those used in adults with acquired heart disease, but are not evidence based. Decompensated heart failure is the other leading cause of death. Conventional medical heart-failure therapy for left ventricular dysfunction is not effective in GUCH patients at highest risk of heart failure, i.e., those with right or single ventricular failure. Careful haemodynamic assessment and structural interventions are the first step to consider in GUCH patients presenting with heart failure symptoms. Adults with moderate or complex CHD and regular follow-up in specialised GUCH centres have a survival benefit compared with patients without such follow-up. Cardiac surgery in GUCH patients should be performed by surgeons trained in treatment of CHD, i.e., surgeons also operating on paediatric patients. A structured transition programme with a defined transfer of care from the paediatric to the adult care environment is important to avoid lapses of care in today's adolescents with CHD. For GUCH patients with an intervention performed decades ago and no specific cardiac follow-up in later life, referral to a specialised GUCH centre is recommended and may save lives.
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Affiliation(s)
- Markus Schwerzmann
- Grown-up Congenital Heart Disease, Centre for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Switzerland
| | - Fabienne Schwitz
- Grown-up Congenital Heart Disease, Centre for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Switzerland
| | - Corina Thomet
- Grown-up Congenital Heart Disease, Centre for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Switzerland
| | - Alexander Kadner
- Centre for Congenital Heart Disease, Department for Cardiovascular Surgery, University Hospital Inselspital, University of Bern, Switzerland
| | - Jean-Pierre Pfammatter
- Paediatric Cardiology, Centre for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Switzerland
| | - Kerstin Wustmann
- Grown-up Congenital Heart Disease, Centre for Congenital Heart Disease, University Hospital Inselspital, University of Bern, Switzerland
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