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Hanuna M, Herz G, Stanzl AL, Li Y, Mueller CS, Kamla CE, Scherer C, Wassilowsky D, Juchem G, Orban M, Peterss S, Hagl C, Joskowiak D. Mid-Term Outcome after Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: Recovery and Quality of Life. J Clin Med 2024; 13:2254. [PMID: 38673527 PMCID: PMC11050874 DOI: 10.3390/jcm13082254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Extracorporeal life support (ECLS) therapy for refractory postcardiotomy cardiogenic shock (rPCS) is associated with high early mortality rates. This study aimed to identify negative predictors of mid-term survival and to assess health-related quality of life (HRQoL) and recovery of the survivors. Methods: Between 2017 and 2020, 142 consecutive patients received ECLS therapy following cardiac surgery. The median age was 66.0 [57.0-73.0] years, 67.6% were male and the median EuroSCORE II was 10.5% [4.2-21.3]. In 48 patients, HRQoL was examined using the 36-Item Short Form Survey (SF-36) and the modified Rankin-Scale (mRS) at a median follow-up time of 2.2 [1.9-3.2] years. Results: Estimated survival rates at 3, 12, 24 and 36 months were 47%, 46%, 43% and 43% (SE: 4%). Multivariable Cox Proportional Hazard regression analysis revealed preoperative EuroSCORE II (p = 0.013), impaired renal function (p = 0.010), cardiopulmonary bypass duration (p = 0.015) and pre-ECLS lactate levels (p = 0.004) as independent predictors of mid-term mortality. At the time of follow-up, 83.3% of the survivors were free of moderate to severe disability (mRS < 3). SF-36 analysis showed a physical component summary of 45.5 ± 10.2 and a mental component summary of 50.6 ± 12.5. Conclusions: Considering the disease to be treated, ECLS for rPCS is associated with acceptable mid-term survival, health-related quality of life and functional status. Preoperative EuroSCORE II, impaired renal function, cardiopulmonary bypass duration and lactate levels prior to ECLS implantation were identified as negative predictors and should be included in the decision-making process.
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Affiliation(s)
- Maja Hanuna
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - German Herz
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Andre L. Stanzl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ 08028, USA
| | - Christoph S. Mueller
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Christine E. Kamla
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Clemens Scherer
- Department of Cardiology, LMU University Hospital, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dietmar Wassilowsky
- Department of Anaesthesiology, LMU University Hospital, 81377 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Martin Orban
- Department of Cardiology, LMU University Hospital, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany; (G.H.)
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Herrmann FEM, Taha A, Nielsen SJ, Martinsson A, Hansson EC, Juchem G, Jeppsson A. Recurrence of Atrial Fibrillation in Patients With New-Onset Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting. JAMA Netw Open 2024; 7:e241537. [PMID: 38451520 PMCID: PMC10921254 DOI: 10.1001/jamanetworkopen.2024.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/17/2023] [Accepted: 01/18/2024] [Indexed: 03/08/2024] Open
Abstract
Importance New-onset postoperative atrial fibrillation (POAF) occurs in approximately 30% of patients undergoing coronary artery bypass grafting (CABG). It is unknown whether early recurrence is associated with worse outcomes. Objective To test the hypothesis that early AF recurrence in patients with POAF after CABG is associated with worse outcomes. Design, Setting, and Participants This Swedish nationwide cohort study used prospectively collected data from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry and 3 other mandatory national registries. The study included patients who underwent isolated first-time CABG between January 1, 2007, and December 31, 2020, and developed POAF. Data analysis was performed between March 6 and September 16, 2023. Exposure Early AF recurrence defined as an episode of AF leading to hospital care within 3 months after discharge. Main Outcomes and Measures The primary outcome was all-cause mortality. Secondary outcomes included ischemic stroke, any thromboembolism, heart failure hospitalization, and major bleeding within 2 years after discharge. The groups were compared with multivariable Cox regression models, with early AF recurrence as a time-dependent covariate. The hypothesis tested was formulated after data collection. Results Of the 35 329 patients identified, 10 609 (30.0%) developed POAF after CABG and were included in this study. Their median age was 71 (IQR, 66-76) years. The median follow-up was 7.1 (IQR, 2.9-9.0) years, and most patients (81.6%) were men. Early AF recurrence occurred in 6.7% of patients. Event rates (95% CIs) per 100 patient-years with vs without early AF recurrence were 2.21 (1.49-3.24) vs 2.03 (1.83-2.25) for all-cause mortality, 3.94 (2.92-5.28) vs 2.79 (2.56-3.05) for heart failure hospitalization, and 3.97 (2.95-5.30) vs 2.74 (2.51-2.99) for major bleeding. No association between early AF recurrence and all-cause mortality was observed (adjusted hazard ratio [AHR], 1.17 [95% CI, 0.80-1.74]; P = .41). In exploratory analyses, there was an association with heart failure hospitalization (AHR, 1.80 [95% CI, 1.32-2.45]; P = .001) and major bleeding (AHR, 1.92 [1.42-2.61]; P < .001). Conclusions and Relevance In this cohort study of early AF recurrence after POAF in patients who underwent CABG, no association was found between early AF recurrence and all-cause mortality. Exploratory analyses showed associations between AF recurrence and heart failure hospitalization, oral anticoagulation, and major bleeding.
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Affiliation(s)
- Florian E. M. Herrmann
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) Partner Site Munich Heart Alliance, Munich, Germany
| | - Amar Taha
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J. Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma C. Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gerd Juchem
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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von der Linden J, Herrmann F, Belyaev S, Juchem G, Peterss S, Hagl C, Dashkevich A. Surgical Bicuspid Aortic Valve Replacement with Rapid Deployment Aortic Valve Prosthesis in Sievers Type 0 versus Sievers Type 1 Morphology. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
| | - F. Herrmann
- Ludwig Maximilian University of Munich, München, Deutschland
| | - S. Belyaev
- Cardiac Surgery, University Hospital, LMU Munich, Munich, France
| | - G. Juchem
- Ludwig Maximilian University of Munich, München, Deutschland
| | - S. Peterss
- Kleine Düwelstraße 10, München, Deutschland
| | - C. Hagl
- Marchioninistraße 15, Mänchen, Deutschland
| | - A. Dashkevich
- Department of Cardiac Surgery, Clinic of Grosshadern, LMU, Munich, Deutschland
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Radner C, Hagl C, Juchem G, Dashkevich A. Coronary Sparing Aneurysmectomy. Thorac Cardiovasc Surg Rep 2023; 12:e41-e43. [PMID: 37342790 PMCID: PMC10287503 DOI: 10.1055/s-0043-1769929] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/06/2023] [Indexed: 06/23/2023] Open
Abstract
Repairing left ventricular aneurysms that form after myocardial infarction may be challenging, especially if located close to the important native coronary arteries. Here, we describe a rare case of anterolateral aneurysm of the basal LV wall and a safe, efficient approach for a patch plasty sparing the native left anterior descending.
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Affiliation(s)
- Caroline Radner
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munchen, Bavaria, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munchen, Bavaria, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munchen, Bavaria, Germany
| | - Alexey Dashkevich
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munchen, Bavaria, Germany
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Saha S, Lang A, von der Linden J, Wassilowsky D, Peterss S, Pichlmaier M, Hagl C, Juchem G, Joskowiak D. Clinical Results and Quality of Life after Nonelective Cardiac Surgery in Octogenarians. Thorac Cardiovasc Surg 2022; 70:384-391. [DOI: 10.1055/s-0041-1730029] [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] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Abstract
Background We analyzed the short-term and mid-term outcomes as well as the health-related quality of life (HRQOL) of octogenarians undergoing elective and urgent cardiac surgery.
Patients and Methods We retrospectively identified 688 consecutive octogenarians who underwent cardiac surgery at our center between January 2012 and December 2019. A propensity score matching was performed which resulted in the formation of 80 matched pairs. The patients were interviewed and the Short Form-36 survey was used to assess the HRQOL of survivors. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model.
Results The median age of the matched cohort was 82 years (p = 0.937), among whom, 38.8% of patients were female (p = 0.196). The median EuroSCORE II of the matched cohort was 19.4% (10.1–39.1%). The duration of postoperative mechanical ventilation was found to be independently associated with in-hospital mortality (odds ratio: 1.01 [95% confidence interval: 1.0–1.02], p = 0.038). The survival rates at 1, 2, and 5 years was 75.0, 72.0, and 46.0%, respectively. There was no difference in the total survival between the groups (p = 0.080). The physical health summary score was 41 (30–51) for the elective patients and 42 (35–49) for the nonelective octogenarians (p = 0.581). The median mental health summary scores were 56 (48–60) and 58 (52–60), respectively (p = 0.351).
Conclusion Cardiac surgery can be performed in octogenarians with good results and survivors enjoy a good quality of life; however, the indication for surgery or especially for escalation of therapy should always be made prudently, reserved, and in consideration of patient expectations.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | - Andrea Lang
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | | | - Dietmar Wassilowsky
- Department of Anesthesiology, Ludwig Maximilian University of Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
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Saha S, Mladenova R, Radner C, Horke KM, Buech J, Schnackenburg P, Ali A, Peterss S, Juchem G, Luehr M, Hagl C, Joskowiak D. Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis. J Clin Med 2022; 11:jcm11133599. [PMID: 35806881 PMCID: PMC9267565 DOI: 10.3390/jcm11133599] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: The objective of this study was to compare the long-term outcomes and health-related quality of life (HRQOL) of patients following surgery for infective native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Methods: We retrospectively identified 633 consecutive patients who had undergone surgery for infective endocarditis at our center between January 2005 and October 2018. The patients were interviewed, and the SF-36 survey was used to assess the HRQOL of survivors. Propensity score matching (2:1) was performed with data from a German reference population. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results: The median age of the cohort was 67 (55–74) years, and 75.6% were male. Operative mortality was 13.7% in the NVE group and 21.6% in the PVE group (p = 0.010). The overall survival at 1 year was 88.0% and was comparable between the groups. The physical health summary scores were 49 (40–55) for the NVE patients and 45 (37–52) for the PVE patients (p = 0.043). The median mental health summary scores were 52 (35–57) and 49 (41–56), respectively (p = 0.961). On comparison of the HRQOL to the reference population, the physical health summary scores were comparable. However, significant differences were observed with regard to the mental health summary scores (p = 0.005). Conclusions: Our study shows that there are significant differences in the various domains of HRQOL, not only between NVE and PVE patients, but also in comparison to healthy individuals. In addition to preoperative health status, it is important to consider the patient’s expectations regarding surgery. Further prospective studies are required.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
- Correspondence: author:
| | - Ralitsa Mladenova
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
| | - Caroline Radner
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Konstanze Maria Horke
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Joscha Buech
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Philipp Schnackenburg
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Ahmad Ali
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximillian University of Munich, 81377 Munich, Germany; (R.M.); (C.R.); (K.M.H.); (J.B.); (P.S.); (A.A.); (S.P.); (G.J.); (M.L.); (C.H.); (D.J.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany
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Belyaev S, Herrmann FEM, Dashkevich A, Wenke K, Vlachea P, von der Linden J, Banafsche R, Hagl C, Juchem G. Evaluation of a rapid deployment prosthesis strategy for the treatment of aortic valve endocarditis. Eur J Cardiothorac Surg 2022; 61:1109-1115. [DOI: 10.1093/ejcts/ezac018] [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] [Received: 07/01/2021] [Revised: 10/22/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to evaluate the surgical outcome of patients suffering from native aortic valve (NVE) or prosthetic aortic valve endocarditis (PVE) treated with the EDWARDS INTUITY Elite rapid-deployment valve prosthesis.
METHODS
Between February 2019 and June 2020, 25 patients suffering from NVE (n = 9; 36%) and PVE (n = 16; 64%) of the aortic valve received an INTUITY valve at our institution. Preoperative, operative and follow-up data were collected.
RESULTS
In our cohort, the mean EuroSCORE II was 13.4%. Eleven patients (44%) received concomitant aortic root patch plasty. Four patients (16%) received coronary artery bypass graft surgery, 3 patients (12%) received mitral valve repair and 2 patients (8%) underwent replacement of the ascending aorta. The cardiopulmonary bypass and aortic cross-clamp times were 124 ± 56 and 75 ± 39 min, respectively. The mean intensive care unit stay was 5 days. The mean size of the implanted prostheses was 25 ± 2 mm and the mean prosthesis transvalvular gradient 3 months after surgery was 9 ± 4 mmHg. During follow-up, no case of recurrent endocarditis occurred, 1 patient died of multisystem organ failure which had already been present preoperatively.
CONCLUSIONS
Surgery for NVE and PVE of the aortic valve may be safely performed using the EDWARDS INTUITY Elite valve system. This procedure could be well implemented in cases with extensive infection, fragile root tissue and root abscesses requiring root reconstruction. In our institution, the rapid-deployment aortic valve replacement strategy has become an important tool in the armamentarium of the surgical endocarditis treatment.
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Affiliation(s)
- Sergey Belyaev
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | | | - Alexey Dashkevich
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Klaus Wenke
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Polyxeni Vlachea
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | | | - Ramin Banafsche
- Department of Vascular Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, University Hospital, LMU Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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9
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Bauer A, Korten I, Juchem G, Kiesewetter I, Kilger E, Heyn J. EuroScore and IL-6 predict the course in ICU after cardiac surgery. Eur J Med Res 2021; 26:29. [PMID: 33771227 PMCID: PMC7995398 DOI: 10.1186/s40001-021-00501-1] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite modern advances in intensive care medicine and surgical techniques, mortality rates in cardiac surgical patients are still about 3%. Considerable efforts were made to predict morbidity and mortality after cardiac surgery. In this study, we analysed the predictive properties of EuroScore and IL-6 for mortality in ICU, prolonged postoperative mechanical ventilation, and prolonged stay in ICU. METHODS We enrolled 2972 patients undergoing cardiac surgery. The patients either underwent aortic valve surgery (AV), mitral valve surgery (MV), coronary artery bypass grafting (CABG), and combined operations of aortic valve and coronary artery bypass grafting (AV + CABG) or of mitral and tricuspid valve (MV + TV). Different laboratory and clinical parameters were analysed. RESULTS EuroScore as well as IL-6 were associated with increased mortality after cardiac surgery. Furthermore, a higher EuroScore and elevated levels of IL-6 were predictors for prolonged mechanical ventilation and a longer stay in ICU. Especially, highly significant elevated IL-6 levels and an increased EuroScore showed a strong association. Statistics suggested superiority when both parameters were combined in a single model. CONCLUSION Our results suggest that EuroScore and IL-6 are helpful in predicting the course in ICU after cardiac surgery, and therefore, the use of intensive care resources. Especially, the combination of highly elevated levels of IL-6 and EuroScore may prove to be excellent predictors for an unfortunate postoperative course in ICU.
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Affiliation(s)
- Andreas Bauer
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany.,Department of Anesthesiology, Klinikum Rosenheim, Pettenkoferstraße 10, 83022, Rosenheim, Germany
| | - Insa Korten
- Division of Respiraotry Medicine, Department of Pediatrics, Inselspital and University of Bern, 3010 Bern, Switzerland
| | - Gerd Juchem
- Department of Cardiac Surgery, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany
| | - Isabel Kiesewetter
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany
| | - Erich Kilger
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany
| | - Jens Heyn
- Department of Anaesthesiology, University of Munich (LMU), Wolkerweg 16, 81375, Munich, Germany. .,Department of Anaesthesiology, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
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Kamla CE, Buech J, Doldi PM, Hagl C, Juchem G, Dashkevich A. Atrio-aortic erosion caused by Amplatzer Atrial Septal Occluder - a case report. J Cardiothorac Surg 2021; 16:36. [PMID: 33743762 PMCID: PMC7981898 DOI: 10.1186/s13019-021-01411-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background In specialized centers, percutaneous closure using specific occluders is the first-choice treatment in atrial septal defects (ASD). Late complications after this intervention, such as erosion of the aorta or the atria, are rare and have not been sufficiently approached and dealt with in literature. In our clinic we have been faced with the problematic situation of diagnosing and treating such cases. That is why, we have decided to share our experience with other colleagues. Case presentation We present two cases of severe late complications after percutaneous closure of atrial septal defects (ASD). In both cases, the atrial septal occluder (Amplatzer™ Atrial Septal Occluder Device, Abbott, Chicago USA) caused the erosion between the left atrium and the aortic root. The atrio-aortic erosion led to acute cardiac tamponade with upper venous congestion and shock. As the bleeding source remained undetectable for any imaging tools, a diagnostical sternotomy remained the only solution. The cause of the acute bleeding was discovered to be the erosion between the left atrium and the aortic root. The treatment consisted in the removal of the occluder, direct suturing of the perforated areas and the surgical closure of the remaining ASD. The patients fully recovered within the nine to fourteen days’ hospital stay. Six months after surgery both patients were well and able to recover their daily routine. Conclusions The atrio-aortic erosion after percutaneous closure of atrial septal defects is a surgical emergency. The more so, since it can be complicated by the absence of specific symptoms. A key-element in the diagnosis of this rare pathology remains the medical history of the patient, which the surgeon has to consider thoroughly and launch the diagnostic sternotomy without delay.
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Affiliation(s)
- Christine E Kamla
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Philipp M Doldi
- Department of Internal Medicine I - Cardiology, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexey Dashkevich
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
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11
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Herrmann FEM, Schleith AS, Graf H, Sadoni S, Hagl C, Bagaev E, Juchem G. Tricuspid valve annuloplasty and mitral valve replacement are associated with bradyarrhythmia after mitral valve surgery. J Cardiovasc Electrophysiol 2021; 32:1103-1110. [PMID: 33566390 DOI: 10.1111/jce.14932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Mitral valve surgery has developed into a strong subspecialty of cardiac surgery with operative techniques and outcomes constantly improving. The development of bradyarrhythmias after mitral valve surgery is not completely understood. METHODS We investigated a cohort of 797 patients requiring mitral valve surgery with and without concomitant procedures. Incidences and predictors of pacemaker requirement as well as survival were analyzed. RESULTS In the complete follow-up period (median follow-up time: 6.09 years [95% confidence interval [CI]: 5.94-6.22 years, maximum 8.77 years) 80 patients (10% of the complete cohort) required pacemaker implantation for bradyarrhythmia. The cumulative rate of pacemaker implantation was 6.4% at 50 days (48 patients) with most (54.2%) requiring pacing for atrioventricular block. Mitral valve replacement (odds ratio [OR]: 1.905; 95% CI: 1.206-3.536; p = .041) and tricuspid ring annuloplasty (OR: 2.348; 95% CI: 1.165-4.730, p = .017) were identified as operative risk factors of pacemaker requirement after mitral valve surgery. Insulin-dependent diabetes mellitus was also identified as a predictor of pacemaker requirement (OR: 4.665; 95% CI: 1.975-11.02; p = .001). There was no difference in survival in the paced and unpaced groups. CONCLUSIONS After mitral valve surgery, a relevant subgroup of patients requires pacemaker implantation-most for atrioventricular block. We identified mitral valve replacement and tricuspid ring annuloplasty as significant operative risk factors and insulin-dependent diabetes mellitus as a demographic risk factor. While anatomic relationships help explain the operative risk factors the role of diabetes mellitus is not completely understood.
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Affiliation(s)
| | | | - Helen Graf
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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12
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Abstract
Tricuspid valve (TV) surgery is associated with a high risk of postoperative pacemaker requirement. We set out to identify the incidence of atrioventricular block (AVB) after TV surgery and determine whether atrioventricular conduction recovers within time.We investigated pre/intra- and postoperative predictors of AVB in patients who underwent tricuspid valve surgery (not only isolated TV surgery) at our institution between 2004 and 2017. Patients who had pacemakers prior to surgery were excluded.One year after surgery, 5.8% of the surviving cohort had received a pacemaker due to AVB. In the complete follow-up time, 33 out of 505 patients required pacemaker implantation because of AVB. Of the 37 patients who presented to the intensive care unit postoperatively with AVB III, 14 (38%) underwent pacemaker implantation for AVB, and 20 (54%) did not require a pacemaker. AVB III at ICU admission was identified as a predictor of pacemaker implantation (OR: 9.7, CI: 3.8-24.5, P < 0.001). TV endocarditis was also identified as a predictor (OR: 12.4, CI: 3.3-46.3, P < 0.001). Eleven out of 32 patients (34%) with tricuspid endocarditis required a pacemaker for AVB. The mean ventricular pacing burden within the first 5 years after pacemaker implantation was 79%.The issue of AVB after TV surgery is significant. Both the initial rhythm after surgery and etiology of the tricuspid disease can help predict pacemaker requirement. Within the first 5 years after surgery, the ventricular pacing burden remains high without relevant rhythm recovery.
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Affiliation(s)
| | - Helen Graf
- Department of Cardiac Surgery, Ludwig Maximilian University
| | - Petra Wellmann
- Department of Cardiac Surgery, Ludwig Maximilian University
| | | | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University
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13
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Herrmann FEM, Juchem G, Hagl C, Fichtner S, Sadoni S. Defibrillator therapy in patients with tricuspid valve clips: Which device to choose? Pacing Clin Electrophysiol 2020; 43:1572-1574. [PMID: 32845040 DOI: 10.1111/pace.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | | | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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14
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Polat E, Müller C, Sinani L, Neumann-Schniedewind P, Peterss S, Juchem G, Pichlmaier M, Hagl C. Long-Term Durability and Valve Integrity of Aortic Valve Bioprostheses: Single-Center Experience with Patients under 50 Years of Age. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705482] [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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15
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Joskowiak D, Meyer A, Lühr M, Kamla C, Peterss S, Juchem G, Hagl C. Long-Term Survival and Quality of Life of Patients with Prolonged Intensive Care Unit Stay: Fate of the Survivors. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705500] [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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16
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Büch J, Müller C, Saha S, Fabry T, Lühr M, Joskowiak D, Juchem G, Hagl C, Pichlmaier M, Peterss S. Beyond Industry Sponsored Trials—Severe, Symptomatic Aortic Stenosis and Low–Surgical Risk. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705299] [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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17
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Luehr M, Bauernschmitt N, Peterss S, Li Y, Heyn O, Dashkevich A, Oberbach A, Bagaev E, Pichlmaier MA, Juchem G, Hagl C. Incidence and Surgical Outcomes of Patients With Native and Prosthetic Aortic Valve Endocarditis. Ann Thorac Surg 2019; 110:93-101. [PMID: 31794735 DOI: 10.1016/j.athoracsur.2019.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 03/06/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the incidence and surgical outcomes of patients with native infective endocarditis (IE) and prosthetic aortic valve endocarditis (PVE) over the past decade at a single institution. METHODS Between January 2005 and December 2015, 289 patients (mean age, 63.3 ± 14.2 years) suffering from native IE (n = 186) and PVE (n = 103) of the aortic valve underwent surgical procedures. Perioperative data were acquired retrospectively for statistical analysis. RESULTS During the study period the mean incidence of endocarditis increased from 22.0 ± 4.2 (2005-2009) to 29.8 ± 10.1 (2010-2015) cases per year. In-hospital mortality was significantly increased in PVE (22.3%) versus IE (9.1%) patients (P < .001). In elective cases in-hospital mortality between the 2 groups was comparable (2.2% vs 4.6%; P = .288). Multivariate analysis identified urgent surgery (odds ratio [OR], 6.461; 95% CI, 1.941-21.509; P = .002), mitral regurgitation II (OR, 4.230; 95% CI, 1.249-14.331; P = .021), previous homograft operation (OR, 66.096; 95% CI, 2.369-1844.272; P = .0.14), and left ventricular ejection fraction < 40% (OR, 8.267; 95% CI, 1.931-35.388; P = .004) as independent risk factors for in-hospital mortality, whereas pathogen identification by preoperative blood cultures (OR, .228; 95% CI, 0.063-0.817; P = .023) was found to be independently protective. CONCLUSIONS Surgery for native IE and PVE of the aortic valve may be performed with satisfactorily results at experienced cardiac surgical centers. In comparison PVE patients suffer from a more than twice as high in-hospital mortality, more postoperative complications, and inferior long-term survival. However preoperative identification of causative pathogens in IE and PVE allows for improved in-hospital survival.
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Affiliation(s)
- Maximilian Luehr
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany.
| | - Nina Bauernschmitt
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, New Jersey
| | - Oliver Heyn
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Alexey Dashkevich
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Oberbach
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Gerd Juchem
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
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Herrmann FEM, Ehrenfeld F, Wellmann P, Hagl C, Sadoni S, Juchem G. Thrombocytopenia and end stage renal disease are key predictors of survival in patients with cardiac implantable electronic device infections. J Cardiovasc Electrophysiol 2019; 31:70-79. [PMID: 31702855 DOI: 10.1111/jce.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) infections are associated with a high mortality. Our aim was to identify key predictors of survival in patients with CIED infections as to be able to detect high-risk patients and possibly affect modifiable factors. METHODS AND RESULTS In this observational study, we collected data from 277 patients with CIED infections treated in our department between 2001 and 2017; predictors of survival were evaluated. The median time since the last CIED procedure was 0.83 years (interquartile range [IQR]: 0.25-3.01), median time since initial CIED implant was 4.79 years (IQR: 0.90-11.0 years). Survival at 30 days was 94.9% (95% confidence interval [CI]: 92.3-97.5) and survival at 1 year was 80.9% (CI: 76.4-85.7). Age (odds ratio [OR]: 1.05, CI: 1.01-1.09; P = .009), end stage renal disease (ESRD) with dialysis (OR: 5.14, CI: 1.87-14.11; P = .001), positive blood cultures (OR: 2.19, CI: 1.08-4.45; P = .030), and thrombocytopenia (OR: 2.3, CI, 1.03-5.15; P = .042) were identified as predictors of death within 1 year of treatment of CIED infection. CONCLUSION Patients with CIED infection with prior ESRD with dialysis or preoperative thrombocytopenia are at an increased risk of 1-year mortality. We suggest that these patients be evaluated critically and resources be allocated to these patients more liberally. A greater understanding of the role of platelets in immunity may improve treatment of advanced infection in the future.
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Affiliation(s)
| | - Felix Ehrenfeld
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Petra Wellmann
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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Joskowiak D, Meusel D, Kamla C, Hagl C, Juchem G. Impact of Preoperative Functional Status on Quality of Life after Cardiac Surgery. Thorac Cardiovasc Surg 2019; 70:205-212. [PMID: 31499539 DOI: 10.1055/s-0039-1696953] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND With increasing importance, health-related quality of life (HRQoL) has become a crucial outcome measure of cardiac surgery. The aim of this study was to assess the dynamics of HRQoL change within 12 months after surgery and to identify predictors of deterioration in physical and mental health. METHODS The cohort of this prospective study included 164 consecutive patients who underwent elective surgery. HRQoL was assessed on the basis of the Short-Form 36 questionnaire at three different times: upon admission and at 3 and 12 months after surgery. The minimal clinically important difference (MCID) was used to determine whether the surgery resulted in deterioration of HRQoL. RESULTS In general, physical and mental health status improved within the first year after cardiac surgery. However, after 12 months, 7.9 and 21.2% of patients had clinically significant poorer physical (PCS) and mental component summary (MCS) scores, based on the MCID approach. The results of multivariate analysis identified preoperative health status, age < 70 years, coronary artery bypass grafting, and a previous neurological event as predictors of deterioration in postoperative HRQoL. The greatest risks for deterioration were higher preoperative PCS and MCS scores. CONCLUSION Although we were able to demonstrate a general improvement in the HRQoL following cardiac surgery, in one-fifth of patients, there was no recovery of mental health status even after 1 year. As this effect is mainly determined by preoperative functional status, HRQoL should be an integral part of medical consultation, especially in younger patients with a positive perception of quality of life.
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Affiliation(s)
- Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilians University Munich, Munchen, Bayern, Germany
| | - Daniela Meusel
- Department of Cardiac Surgery, Ludwig Maximilians University Munich, Munchen, Bayern, Germany
| | - Christine Kamla
- Department of Cardiac Surgery, Ludwig Maximilians University Munich, Munchen, Bayern, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilians University Munich, Munchen, Bayern, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilians University Munich, Munchen, Bayern, Germany
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Herrmann FEM, Juchem G, Hagl C, Schramm R, Sadoni S. Incidental detection of single coil right ventricular lead perforation during aortic valve surgery. J Cardiovasc Electrophysiol 2019; 30:1371-1372. [PMID: 31115942 DOI: 10.1111/jce.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022]
Abstract
It is unknown how many pacemaker and implantable cardioverter defibrillator (ICD) leads perforate during lead placement. Symptoms of a perforated lead include shortness of breath and chest pain. Signs of perforation can include a high pacing threshold, reduced lead sensing, and a high lead impedance. We present the case of a patient where perforation of the single coil right ventricular lead was not evident in imaging but incidentally detected during operative aortic valve replacement. The lead perforation rate during device implantation is around 1%-ICD leads have a higher perforation rate.
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Affiliation(s)
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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21
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Herrmann FEM, Lamm P, Wellmann P, Milz S, Hagl C, Juchem G. Autologous endothelialized vein allografts in coronary artery bypass surgery - Long term results. Biomaterials 2019; 212:87-97. [PMID: 31108275 DOI: 10.1016/j.biomaterials.2019.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 04/20/2019] [Accepted: 05/10/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of autologous graft material restricts the ability to treat patients requiring coronary artery bypass surgery (CABG). An off the shelf tissue engineered small diameter vascular graft is the holy grail of cardiovascular surgery. METHODS Allograft saphenous veins were harvested from organ donors, cryopreserved, deendothelialized and then seeded with autologous endothelial cells prior to implantation during coronary artery bypass surgery. All patients treated were followed-up until death and angiographic results were collected. Grafts were explanted during autopsy and immunohistochemistry was performed. RESULTS Twelve patients received 15 engineered grafts. Mean patient survival was 9.1 ± 1.8 years. Six month graft patency was 80 (95% CI: 59-100) and 9 month graft patency was 50 (95% CI: 27-93) - graft patency detected up to 32 months after surgery. Immunohistochemistry in grafts explanted showed a presence of CD31 and CD68 positive cells in the luminal region of the vessel walls and layers of Collagen Type I in the abluminal vessel walls. CONCLUSIONS Our small diameter tissue engineered vascular graft shows openness up to 32 months after implantation. Immunohistochemistry suggests that monocyte activation may lead to vessel remodeling with thickening of the vessel wall. Research should concentrate on a manipulation of remodeling processes.
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Affiliation(s)
| | - Peter Lamm
- Department of Cardiac Surgery, Chirurgisches Klinikum Muenchen Sued, Munich, Germany
| | - Petra Wellmann
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Stefan Milz
- Department of Anatomy, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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Vondran M, Rylski B, Berezowski M, Polycarpou A, Born F, Guenther S, Luehr M, Juchem G, Beyersdorf F, Hagl C, Dashkevich A. Preemptive Extracorporeal Life Support for Surgical Treatment of Severe Constrictive Pericarditis. Ann Thorac Surg 2019; 108:1376-1381. [PMID: 31077660 DOI: 10.1016/j.athoracsur.2019.03.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 10/02/2018] [Revised: 02/24/2019] [Accepted: 03/26/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical treatment of constrictive pericarditis (CP) is particularly challenging because of the increased risk of right heart failure. The necessity of postoperative extracorporeal life support (ECLS) can result in mortality rates of 100%. Preemptive implantation of ECLS may improve postoperative outcomes; however, no data are currently available on its use. We conducted a retrospective study to evaluate the feasibility of our strategy. METHODS Between September 2012 and June 2016, ECLS was established percutaneously through the groin vessels in 12 individually selected patients with high-risk CP immediately before pericardiectomy in the operating theater as part of the surgical strategy. Prolonged weaning was performed in the intensive care unit. Demographic characteristics, perioperative data, and survival were analyzed. RESULTS The median patient age was 61.5 years (first quartile, third quartile: 51.3, 68.5 years), with a preoperative central venous pressure of 24 mm Hg (first quartile, third quartile: 21, 28 mm Hg). Furthermore, the pulmonary artery pressure was greater than 60 mm Hg in 50% of patients and a dip plateau sign existed in 75% before surgery. The median duration of ECLS therapy was 132 hours (first quartile, third quartile: 96, 168 hours) with a length of stay on the intensive care unit of 10 days (first quartile, third quartile: 7.0, 16.8 days). There was no intraoperative death. The cumulative 30-day, 1-year, and 5-year survival rates were 83% ± 11%, 75% ± 13%, and 75% ± 13%, respectively. CONCLUSIONS From our real-world data, preemptive use of perioperative ECLS, assigned by individual team decision in selected patients with severe CP, is a feasible and safe strategy.
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Affiliation(s)
- Maximilian Vondran
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Mikolaj Berezowski
- Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Polycarpou
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabina Guenther
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexey Dashkevich
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
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Herrmann FEM, Graf H, Wellmann P, Sadoni S, Hagl C, Juchem G. Etiology of tricuspid valve disease is a predictor of bradyarrhythmia after tricuspid valve surgery. J Cardiovasc Electrophysiol 2019; 30:1108-1116. [DOI: 10.1111/jce.13937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/25/2019] [Accepted: 03/28/2019] [Indexed: 01/07/2023]
Affiliation(s)
| | - Helen Graf
- Department of Cardiac SurgeryLudwig Maximilian UniversityMunich Germany
| | - Petra Wellmann
- Department of Cardiac SurgeryLudwig Maximilian UniversityMunich Germany
| | - Sebastian Sadoni
- Department of Cardiac SurgeryLudwig Maximilian UniversityMunich Germany
| | - Christian Hagl
- Department of Cardiac SurgeryLudwig Maximilian UniversityMunich Germany
| | - Gerd Juchem
- Department of Cardiac SurgeryLudwig Maximilian UniversityMunich Germany
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24
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Joskowiak D, Meusel D, Hagl C, Juchem G. Impact of Preoperative Functional Status on the Health-Related Quality of Life after Cardiac Surgery—A Prospective Study. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678852] [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)
- D. Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - D. Meusel
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - G. Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
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25
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Graf H, Herrmann F, Wellmann P, Sadoni S, Hagl C, Juchem G. Permanent Pacemaker Requirement after Tricuspid Valve Surgery. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678950] [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)
- H. Graf
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - F. Herrmann
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - P. Wellmann
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - S. Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - G. Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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Kamla C, Buchholz S, Born F, Khaladj N, Peterss S, Brunner S, Hoechter D, Juchem G, Pichlmaier M, Hagl C, Guenther S. 6-Year Single-Center Experience of Extracorporeal Life Support in Cardiogenic Shock: What Have We Learned, Where Are We Going? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679005] [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)
- C. Kamla
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Buchholz
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - F. Born
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - N. Khaladj
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Peterss
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Brunner
- Medical Department I (Cardiology), Ludwig-Maximilian-University, Munich, Germany
| | - D. Hoechter
- Department of Anesthesiology, Ludwig-Maximilian-University, Munich, Germany
| | - G. Juchem
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - M. Pichlmaier
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
| | - S. Guenther
- Department of Cardiac Surgery, Ludwig-Maximilian-University, Munich, Germany
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Herrmann FEM, Wellmann P, Sadoni S, Schramm R, Hagl C, Juchem G. Sinus node dysfunction after heart transplantation-An analysis of risk factors and atrial pacing burden. Clin Transplant 2018; 32:e13202. [DOI: 10.1111/ctr.13202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 12/23/2022]
Affiliation(s)
| | - Petra Wellmann
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - René Schramm
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - Christian Hagl
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - Gerd Juchem
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
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Herrmann FEM, Wellmann P, Hagl C, Juchem G. Pediatric heart transplantation-What are the risk factors for pacemaker implantation and how much pacing is required? Pacing Clin Electrophysiol 2018; 41:267-276. [DOI: 10.1111/pace.13276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/03/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Petra Wellmann
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - Christian Hagl
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
| | - Gerd Juchem
- Department of Cardiac Surgery; Ludwig Maximilian University; Munich Germany
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Abstract
ZusammenfassungNeue Einblicke in die Struktur und Funktion des menschlichen Blutgefäßsystems und die Interaktion der Gefäßintima mit dem Blut führen zu einem umfassenden Verständnis des Krankheitsbildes der Chronischen Venenerkrankung in den unteren Extremitäten, das sich auf dem Boden ungünstiger physikalischer Durchblutungsbedingungen im Zusammenwirken mit heute gut aufgeklärten zellphysiologischen Prozessen autokatalytisch immer stärker ausprägt. Eine zentrale Stellung nehmen dabei das hochspezialisierte Endothel der Venulen und die zugehörigen Perizyten in den engen nutritiven Mikrogefäß-netzen (Vasa venarum) der Venenwand ein. Bei Reflux und Stase kann es im Venenblut zur Freisetzung schon in kleinsten Konzentratio-nen hochwirksamer, in metabolischer Koope-ration zwischen Plättchen und Neutrophilen Granulozyten gebildeter Freisetzungsprodukte kommen, die in den spezialisierten Venulen der Gefäßwand zu einem raschen Zusammenbruch der Endothelschranke und zur lokalen Entste-hung entzündlicher Ödeme führen. Durch den ausschließlich auf den Perizyten vorliegenden Gewebefaktor werden rasch interstitielle Gerinnungsprozesse initiiert, die auch auf den In-travasalraum übergreifen können. In der Folge kommt es auch zu sich autokatalytisch verstärkenden und immer weiter ausbreitenden entzündlichen Prozessen. Übliche Therapieansätze müssen vor diesem Hintergrund neu überdacht werden.
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Herrmann FEM, Wellmann P, Hagl C, Juchem G. P983Risk factors for pacemaker implantation after heart transplantation - analysis of a complete cohort vs. the paediatric subgroup. Europace 2017. [DOI: 10.1093/ehjci/eux151.164] [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: 11/14/2022] Open
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Dashkevich A, Hagl C, Juchem G, Luehr M, Pichlmaier MA. Management of Retrograde False Lumen Perfusion After Hybrid Arch Repair in Acute Aortic Dissection. Ann Thorac Surg 2017; 103:e377-e379. [PMID: 28359505 DOI: 10.1016/j.athoracsur.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 08/08/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 11/26/2022]
Abstract
Patients with acute aortic dissections involving the arch and descending aorta can effectively be treated using the frozen elephant trunk technique. We describe here the novel technique of temporary banding of the descending aorta onto the stent of the hybrid graft in 3 patients who developed unmanageable bleeding from the distal suture line due to retrograde false lumen perfusion and disintegration of the adventitia. Retrograde false lumen perfusion was stopped and therefore bleeding controlled in all patients. Temporal aortic banding represents a novel, feasible, and effective bailout technique for otherwise unmanageable bleeding with fatal outcome in hybrid arch surgery.
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Affiliation(s)
- Alexey Dashkevich
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Maximilian Luehr
- Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
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32
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Herrmann F, Wellmann P, Hagl C, Juchem G. Characterization of Bradyarrhythmias Leading to Post–Heart Transplant Pacemaker Implantation: Sinus Node Dysfunction versus Atrioventricular Block. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598915] [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)
- F.E.M. Herrmann
- Department of Cardiac Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - P. Wellmann
- Department of Cardiac Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - G. Juchem
- Department of Cardiac Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
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33
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Mueller C, Sipahi N, Buchholz S, Vlachea P, Hagl C, Juchem G. Change of Paradigm? Ten-year Outcome of Aortic Pericardial Tissue Valves in Patients Younger than 50 Years of Age - is the „Bio“-Trend Justified? Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lamm P, Juchem G, Reichart B, Kilian E. Insertion of the intraaortic balloon pump via the ascending aorta or the aortic arch using the HEARTSTRING Proximal Seal System. Heart Surg Forum 2015; 18:E116-7. [PMID: 26115158 DOI: 10.1532/hsf.1326] [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] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE The HEARTSTRING Proximal Seal System is used to avoid aortic clamping to insert the intraaortic balloon pump (IABP) in the ascending aorta or the aortic arch. This technique is used when calcification or atheroma prevents side clamping of the ascending aorta or the aortic arch. DESCRIPTION A vein graft or a small-caliber vascular prosthesis for the later insertion of the IABP is sewn to the ascending aorta or the aortic arch using the HEARTSTRING Proximal Seal System. EVALUATION In our department, this technique is applied whenever insertion of the IABP is not feasible via the femoral arteries. CONCLUSION The technique allows the safe insertion of the IABP via the ascending aorta or the aortic arch.
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Affiliation(s)
- Peter Lamm
- Department of Cardiac Surgery, Chirurgische Klinik Dr. Rinecker, Munich.
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Sodian R, Juchem G, Pfeffer C, Hagl C. Three-Dimensional Printing in Cardiac Surgery: Single-Centre Experience. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Sodian R, Schmauss D, Hagl C, Juchem G. Repair of left atrioventricular disruption after mitral valve replacement using extracorporeal life support system for effective ventricular unloading. Eur J Cardiothorac Surg 2014; 47:1103-4. [PMID: 25079773 DOI: 10.1093/ejcts/ezu308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/07/2014] [Indexed: 11/14/2022] Open
Abstract
Atrioventricular (AV) disruption is a rare but fatal complication after prosthetic mitral valve replacement. Surgical management is controversial and ranges from epicardial tissue sealing to open repair using autologous or xenogenic patch techniques to autotransplantation of the heart. We report the successful repair of an AV disruption Type I using an extracorporeal life support (ECLS) system for effective ventricular unloading followed by epicardial patch closure. The surgical management of AV disruption benefits from the use of ECLS, as it allows effective decompression of the heart without requiring full heparinization.
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Affiliation(s)
- Ralf Sodian
- Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Daniel Schmauss
- Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich, Germany Department of Plastic Surgery and Handsurgery, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich, Germany
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Sodian R, Juchem G, Weber S, Gerber N, Khaladj N, Hagl C. Printing of 3-dimensional models for surgical planning of complex aortic arch surgery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND The management of type A intramural hematoma (IMH) is controversial. Although most Western countries still recommend immediate surgical repair, some centers in Asia have shown good results recently with medical treatment alone. Here, we present a case of type A IMH which was discovered during the operation to be a thrombosed type A dissection. CASE REPORT An 83-year-old female patient presented with acute chest pain. After diagnostic exclusion of myocardial infarction, computed tomography was performed, which showed an IMH from the ascending to the descending aorta. No intimal flap could be detected. The ascending aorta was replaced surgically with a prosthesis. During the operation, we found a ruptured intimal plaque, which had caused dissection of the aorta with thrombosis of the false lumen. The true diagnosis-thrombosed type A dissection and not IMH-was revealed neither by computed tomography nor by transesophageal echocardiography. CONCLUSION Type A IMH should still be treated with immediate surgical repair because in many cases it turns out to be thrombosed type A dissection.
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Affiliation(s)
- Sebastian Michel
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Ralf Sodian
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
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Khaladj N, Juchem G, Hagl C, Sodian R. Modified Cabrol shunt by means of a saphenous vein graft after redo aortic root surgery due to a graft infection. Eur J Cardiothorac Surg 2013; 45:583. [PMID: 23803510 DOI: 10.1093/ejcts/ezt330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nawid Khaladj
- Department of Cardiac Surgery, University Hospital Munich, Munich, Germany
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Abstract
The wall of myocardial terminal vessels, consisting of a continuous endothelial tube with an adventitial coat of pericytes in their extracellular matrix, constitutes a remarkably tight barrier to solute transport between the blood and the parenchyma. This constructional principle of precapillary arterioles, capillaries and postcapillary venules extends both up- and downstream into the arterial and venous limbs, where the original microvessel tube widens and becomes the innermost layer-the intima-of all the larger coronary vessels. In the myocardium's smallest functional units and in the intima of the coronaries, the pericytes play key roles by virtue of both their central histological localization and their physiological functions. Recognition and integration of these properties has led to new pathogenetic models for diverse heart diseases and suggests that current therapeutic concepts need to be revised.
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Affiliation(s)
- Stephan Nees
- Department of Physiology, University of Munich (LMU), Schillerstr. 44, 80336, Munich, Germany.
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41
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Schramm R, Mair H, Becker C, Schwarz F, Bombien R, Juchem G, Sodian R, Kupatt C, Schmitz C. Partial inferior sternotomy and deep hypothermic circulatory arrest for rescue of a failed TAVI case: what does constitute 'inoperable'? Thorac Cardiovasc Surg 2013; 61:431-4. [PMID: 23344755 DOI: 10.1055/s-0032-1327762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 65-year-old male patient was considered inoperable by conventional means for a previous triple coronary artery bypass grafting with a patent in situ right internal mammary artery graft to the left anterior descending artery crossing the thorax at midline directly behind the sternum. Transcatheter aortic valve implantation failed due to loss of the prosthetic device in the left ventricular outflow tract. Mandatory conversion was accomplished by an inferior partial T-shape sternotomy and extracorporeal circulation draining from the right atrium and feeding into the right femoral artery. A conventional 27-mm aortic valve bioprosthesis was successfully implanted during deep hypothermic circulatory arrest. The patient recovered normally exhibiting no neurological or cardiocirculatory complications.
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Affiliation(s)
- René Schramm
- Clinic of Cardiac Surgery, Ludwig Maximilian University - Munich, Campus Grosshadern, Munich, Germany.
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Juchem G, Weiss DR, Hagl C, Nees S. Pericytes in the human myocardium: Not only an anatomical "internet" coordinating coronary vessels, but also key functional players? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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43
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Primaychenko M, Ueberfuhr P, Juchem G, Schmitz C, Erlmeier M, Sodian R, Hagl C. Secondary sternal closure in high risk patients with a Titanium Sternal Fixation System after cardiac surgery. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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44
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Kowert A, Brenner P, Pichlmaier M, Hagl C, Juchem G. ICD in destination therapy after Jarvik 2000 LVAD implantation. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Kowert A, Vicol C, Hagl C, Juchem G. Follow-up after surgical ablation therapy for atrial fibrillation (AF) using an implantable cardiac rhythm monitoring device (ICM). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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46
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Sodian R, Juchem G, Peterß S, Khaladj N, Schmitz C, Hagl C. Intramural hematoma or aortic dissection? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Kowert A, Kupatt C, Schmitz C, Juchem G. Valve-in-valve concept in acute aortic insufficiency following transcatheter aortic valve replacement. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Nees S, Weiss D, Partsch H, Juchem G. Abundant Pericytes in the Venous Intima and the Vasa Venarum: Evidence for Their Key Role in Venous Thrombosis. J Vasc Surg Venous Lymphat Disord 2013; 1:113. [DOI: 10.1016/j.jvsv.2012.10.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Nees S, Weiss DR, Juchem G. Pericytes: not only an anatomical “internet” coordinating coronary vessels, but also key functional players? FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.856.7] [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: 11/11/2022]
Affiliation(s)
| | - Dominik R Weiss
- Transfusion Medicine and HemostaseologyFA-University of Erlangen-NurembergErlangen-NurembergGermany
| | - Gerd Juchem
- Cardiac SurgeryUniversity of MunichMunichGermany
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50
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Juchem G, Bauer A, Postrach J, Reichart B, Nees S. Quercetin glucuronide preserves cardiac function in porcine hearts during perfusion with human whole blood by inhibiting platelet/neutrophil activation and preserving venular barrier function. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.857.4] [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: 11/11/2022]
Affiliation(s)
- Gerd Juchem
- Cardiac SurgeryUniversity of MunichMunichGermany
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