1
|
Piran M, Nolting JK, Körperich H, Zabel R, Scholtz S, Friedrichs KP, Hakim-Meibodi K, Danebrock RI, Burchert W, Paluszkiewicz L. Clinically atypical abdominal manifestation of the lipoma localized in the right atrium: "Invagination hypothesis" revisited. Echocardiography 2022; 39:1462-1465. [PMID: 36266720 DOI: 10.1111/echo.15472] [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: 03/23/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiac lipomas are the second most common cardiac tumors. They are usually asymptomatic and diagnosed as incidental findings. We describe a 71-year-old patient with a tumor in the right atrium. In echocardiography and MRI scan, the diagnosis of a cardiac lipoma was suspected. Moreover, MRI demonstrated continuity of pericardial fat and the tumor in the right atrium by infolding of the atrial wall and epicardial adipose tissue in the space between the atrial walls, which might be a hint for the Waterstone groove hypothesis. An operative resection was performed which confirmed the suspected diagnosis.
Collapse
Affiliation(s)
- Misagh Piran
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Julia Kathinka Nolting
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Reinhard Zabel
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Smita Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kai Peter Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Raihanatou Ina Danebrock
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden, Deutschland
| | - Wolfgang Burchert
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
2
|
Gyoten T, Rojas SV, Fox H, Deutsch MA, Ruiz-Cano M, Hakim-Meibodi K, Gummert JF, Morshuis M, Schramm R. The HeartWare Ventricular Assist Device (HVAD): A Single Institutional 10-Year Experience. Thorac Cardiovasc Surg 2022; 70:482-492. [PMID: 35235989 DOI: 10.1055/s-0042-1742779] [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: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to analyze our 10-year experience with the HVAD in a real-world scenario in a high-volume German heart center. METHODS We retrospectively analyzed outcomes of adults (≥18 years) with terminal heart failure (HF), who underwent HVAD implantation for durable LVAD therapy in our center between October 2009 and March 2020. Primary and secondary end points were all-cause death after implantation and LVAD-associated complications, respectively. We focused the distinct analyses on risk profiles at the time of implantation and implant strategies, i.e., bridge-to-transplant (BTT) or destination therapy (DT). RESULTS A total of 510 patients were included, with 229 and 281 individuals in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 (45%) and 2 to 4, respectively. Median follow-up was 26 months (IQR: 5-54 months). Overall survival at 1, 3, and 5 years after HVAD implantation was 66% (95% CI; 61.7-70%), 49.4% (95% CI; 44.9-53.8%), and 37.4% (95% CI; 32.8-42%), not censored for LVAD exchange, LVAD explantation, or heart transplantation. INTERMACS level 1 and peri-operative temporary right heart assistance were independent risk factors for survival. Survival was best in BTT patients undergoing heart transplantation at any time during follow-up. The INTERMACS level at time of HVAD implantation did not affect survival after heart transplantation. Freedom from the combined end point of any device-associated severe complication and death was 44.5% (95% CI; 40-48.8%) at 1-year after implantation. CONCLUSION The HVAD is a reliable pump for durable mechanical circulatory support even in high-risk patients. Still, heart transplantation outperforms durable MCS therapy for a superior long-term survival.
Collapse
Affiliation(s)
- Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Interventional Cardiology, Heart and Diabetes Centre North Rhine Westphalia, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Marc-Andre Deutsch
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Maria Ruiz-Cano
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, University Hospital, Bad Oeynhausen, Germany
| |
Collapse
|
3
|
Omran H, Deutsch MA, Groezinger E, Zittermann A, Renner A, Neumann JT, Westermann D, Myles P, Ramosaj B, Pauly M, Scholtz W, Hakim-Meibodi K, Rudolph TK, Gummert J, Rudolph V. High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making. Eur Heart J 2022; 43:2388-2403. [PMID: 35165695 PMCID: PMC9246661 DOI: 10.1093/eurheartj/ehab918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 01/09/2023] Open
Abstract
AIMS Current troponin cut-offs suggested for the post-operative workup of patients following coronary artery bypass graft (CABG) surgery are based on studies using non-high-sensitive troponin assays or are arbitrarily chosen. We aimed to identify an optimal cut-off and timing for a proprietary high-sensitivity cardiac troponin I (hs-cTnI) assay to facilitate post-operative clinical decision-making. METHODS AND RESULTS We performed a retrospective analysis of all patients undergoing elective isolated CABG at our centre between January 2013 and May 2019. Of 4684 consecutive patients, 161 patients (3.48%) underwent invasive coronary angiography after surgery, of whom 86 patients (53.4%) underwent repeat revascularization. We found an optimal cut-off value for peak hs-cTnI of >13 000 ng/L [>500× the upper reference limit (URL)] to be significantly associated with repeat revascularization within 48 h after surgery, which was internally validated through random repeated sampling with 1000 iterations. The same cut-off also predicted 30-day major adverse cardiovascular events and all-cause mortality after a median follow-up of 3.1 years, which was validated in an external cohort. A decision tree analysis of serial hs-cTnI measurements showed no added benefit of hs-cTnI measurements in patients with electrocardiographic or echocardiographic abnormalities or haemodynamic instability. Likewise, early post-operative hs-cTnI elevations had a low yield for clinical decision-making and only later elevations (at 12-16 h post-operatively) using a threshold of 8000 ng/L (307× URL) were significantly associated with repeat revascularization with an area under the curve of 0.92 (95% confidence interval 0.88-0.95). CONCLUSION Our data suggest that for hs-cTnI, higher cut-offs than currently recommended should be used in the post-operative management of patients following CABG.
Collapse
Affiliation(s)
| | - Marcus A Deutsch
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Elena Groezinger
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Johannes T Neumann
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Paul Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - Burim Ramosaj
- Faculty of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Markus Pauly
- Faculty of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Werner Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | | | | |
Collapse
|
4
|
Schramm R, Zittermann A, Fuchs U, Fleischhauer J, Costard-Jäckle A, Ruiz-Cano M, Krenz LA, Fox H, Götte J, Günther SPW, Wlost S, Rojas SV, Hakim-Meibodi K, Morshuis M, Gummert JF. Donor-recipient risk assessment tools in heart transplant recipients: the Bad Oeynhausen experience. ESC Heart Fail 2021; 8:4843-4851. [PMID: 34704397 PMCID: PMC8712925 DOI: 10.1002/ehf2.13673] [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: 05/26/2021] [Revised: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS Some risk assessment tools have been developed to categorize mortality risk in heart transplant recipients, but it is unclear whether these tools can be used interchangeable in different transplant regions. METHODS AND RESULTS We performed a retrospective single-centre study in 1049 adult German heart transplant recipients under jurisdiction of Eurotransplant. Univariable and multivariable Cox regression analysis was used to generate a risk scoring system. C-statistics were used to compare our score with a US score and a French score regarding their ability to discriminate between 1 year survivors and non-survivors within our study cohort. Of 38 parameters assessed, seven recipient-specific parameters [age, height, dilated cardiomyopathy (DCM), ischaemic cardiomyopathy (ICM), total bilirubin, extracorporeal membrane oxygenation (ECMO), and biventricular assist device/total artificial heart (BVAD/TAH) implant], one donor-specific parameter (cold ischaemic time), and one recipient-independent and donor-independent other parameter (late transplant era) were statistically significant in predicting 1 year mortality. The initial score was generated by using the regression coefficients from the multivariable analysis as follows: 1.70 * ln age - 4.0 * ln height - 0.9 * diagnosis (= 1 if diagnosis = DCM) - 0.67 * diagnosis (= 1 if diagnosis = ICM) + 0.33 * ln total bilirubin + 1.74 * ln cold ischaemic time + 0.98 * mechanical circulatory support (MCS) implant (= 1 if MCS implant = ECMO) + 0.47 * MCS implant (= 1 of MCS implant = BVAD/TAH) - 0.66 * transplant era (= 1 if transplant era = 2017-2018). The initial score was converted into the Bad Oeynhausen (BO) score as a positive integer variable by means of the following formula: BO score = (initial score + 8) * 3. In patients scoring 2 to <7 points (n = 112), 7 to <11 points (n = 580), 11 to <15 points (n = 339), and 15 to 20 points (n = 18), 1 year survival was 93.1%, 84.2%, 66.9%, and 27.8%, respectively. The c-index of our score was 0.73 [95% confidence interval (CI): 0.69-0.77]. Values were in our cohort for the US and French scores 0.66 (95% CI: 0.62-0.70) and 0.63 (95% CI: 0.59-0.67), respectively. CONCLUSIONS Data indicate that our score, but also risk assessment tools from other transplant regions, may be used as a reliable support for risk-adjusted organ allocation and potentially help to improve outcomes in heart transplantation. Further developments will have to include as yet unaccounted risk factors for even more reliable predictions.
Collapse
Affiliation(s)
- Rene Schramm
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Armin Zittermann
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Uwe Fuchs
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Jan Fleischhauer
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Angelika Costard-Jäckle
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Maria Ruiz-Cano
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Luminata-Adriana Krenz
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Henrik Fox
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Julia Götte
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Sabina P W Günther
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Stefan Wlost
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Michiel Morshuis
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| | - Jan F Gummert
- Clinic for Thoracic- and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, D-32545, Germany
| |
Collapse
|
5
|
Deutsch MA, Zittermann A, Renner A, Schramm R, Götte J, Börgermann J, Fox H, Rojas SV, Gyoten T, Morshuis M, Koster A, Hulde N, Hinse D, Hakim-Meibodi K, Gummert JF. Risk-adjusted analysis of long-term outcomes after on- versus off-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:857-865. [PMID: 34333605 DOI: 10.1093/icvts/ivab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/23/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Recent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort. METHODS A total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis. RESULTS In the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87-1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32-0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47-0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87-1.08; P = 0.59 and HR 1.01, 95% CI 0.90-1.13; P = 0.91, respectively). CONCLUSIONS Data do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively.
Collapse
Affiliation(s)
- Marcus-André Deutsch
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - René Schramm
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Julia Götte
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Department of Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
| | - Henrik Fox
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Takayuki Gyoten
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Koster
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Nikolai Hulde
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Dennis Hinse
- Institute of Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
6
|
Gerçek M, Oldenburg O, Gerçek M, Fox H, Rudolph V, Puehler T, Omran H, Wolf LK, Hakim-Meibodi K, Zeiher AM, Gummert J, Dimitriadis Z. Prevalence of Sleep Disordered Breathing in Patients with Primary Mitral Regurgitation Undergoing Mitral Valve Surgery. J Clin Med 2021; 10:jcm10092039. [PMID: 34068674 PMCID: PMC8126064 DOI: 10.3390/jcm10092039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Sleep disordered breathing (SDB) is a frequent comorbidity in cardiac disease patients. Nevertheless, the prevalence and relationship between SDB and severe primary mitral regurgitation (PMR) has not been well investigated to date. METHODS A cohort of 121 patients with significant PMR undergoing mitral valve surgery were prospectively enrolled and received a cardiorespiratory single night polygraphy screening using ApneaLink before surgery. Eighty-two of them underwent a follow-up examination including a follow-up single-night sleep study 3 months after surgery. RESULTS The mean age of patients was 65.3 ± 12.0 years. Sixty patients (49.6%) were female. The mean EuroSCORE II was 2.5 ± 2.4%. Initially, 91 (75.2%) patients presented with SDB, among whom 50.4% (46 patients, 38.0% of total cohort) were classified as moderate to severe. These patients tended to require significantly longer postoperative intensive care and mechanical ventilation. Among the 82 patients who completed follow-up exams, mitral valve surgery led to a significant reduction in relevant SDB (20.7%). The apnea-hypopnea index (from 11/h [4;18] to 4/h [3;14] (p = 0.04)), the oxygenation-desaturation index (from 8/h [3;18] to 5/h [3;12] (p = 0.008)) as well as the saturation time below 90% (from 32 min [13;86] to 18 min [5;36] (p = 0.005)), were all shown to be improved significantly. CONCLUSION The prevalence of SDB is very high in patients with severe primary mitral regurgitation and may contribute to postoperative complications and prolonged intensive care. A significantly reduced but still high prevalence of SDB was observed 3 months after mitral valve surgery, highlighting the bidirectional relationship between SDB and heart failure.
Collapse
Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (M.G.); (H.F.); (V.R.); (H.O.); (L.K.W.)
| | - Olaf Oldenburg
- Clinic for Cardiology, Ludgerus-Kliniken Münster, 48153 Münster, Germany;
| | - Mustafa Gerçek
- Clinic for Cardiovascular Surgery, Heart Center Duisburg, 47137 Duisburg, Germany;
| | - Henrik Fox
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (M.G.); (H.F.); (V.R.); (H.O.); (L.K.W.)
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (M.G.); (H.F.); (V.R.); (H.O.); (L.K.W.)
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, Campus Kiel, University Medical Center Schleswig Holstein, 24105 Kiel, Germany;
| | - Hazem Omran
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (M.G.); (H.F.); (V.R.); (H.O.); (L.K.W.)
| | - Lisa Katharina Wolf
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (M.G.); (H.F.); (V.R.); (H.O.); (L.K.W.)
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (K.H.-M.); (J.G.)
| | - Andreas M. Zeiher
- Department of Cardiology, University Hospital Frankfurt, 60598 Frankfurt, Germany;
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany; (K.H.-M.); (J.G.)
| | - Zisis Dimitriadis
- Department of Cardiology, University Hospital Frankfurt, 60598 Frankfurt, Germany;
- Correspondence:
| |
Collapse
|
7
|
Gyoten T, Morshuis M, Fox H, Deutsch MA, Hakim-Meibodi K, Schramm R, Gummert JF, Rojas SV. Secondary aortic valve replacement in continuous flow left ventricular assist device therapy. Artif Organs 2021; 45:736-741. [PMID: 33432621 DOI: 10.1111/aor.13906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/04/2023]
Abstract
The purpose of the study was to investigate the outcome of secondary surgical aortic valve replacement (sSAVR) in patients with severe aortic regurgitation (AR) in the context of ventricular assist device (VAD) therapy. From 2009 to 2020, 792 patients underwent cf-LVAD implantation [HVAD (Medtronic, USA), n = 585, and HM 3 (Abbott, USA), n = 207]. All cf-LVAD patients with severe AR requiring secondary AVR were enrolled in this study. A total of six patients (median, 40 years, IQR; 34-61 years, 50% male) underwent secondary surgical aortic valve replacement (sSAVR) after cf-LVAD implantation. Median time of previous LVAD support was 26 months (IQR: 21-29 months). Two patients required additional tricuspid valve repair (TVR) and one patient underwent SAVR after failed TAVR. Four patients needed temporary right ventricular assist device (RVAD) with a median of 30 days (IQR; 29-33 days). Three patients were bridged to urgent heart transplantation due to persevering right heart failure, whereas two destination therapy (DT) candidates survived without any associated complications. An additional DT patient died of pneumonia 1 month after sSAVR. Secondary surgical aortic valve replacement in ongoing LVAD patients is an advanced procedure for a complex cohort. In our series, sSAVR was safely performed and effective, but involved a high-risk for subsequent right heart failure, requiring urgent heart transplantation. In LVAD patients with severe AR requiring treatment where TAVR is not feasible, sSAVR can be evaluated as salvage option for bridge to transplant patients or selected destination therapy candidates.
Collapse
Affiliation(s)
- Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Marcus-André Deutsch
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| |
Collapse
|
8
|
Fischlein T, Meuris B, Folliguet T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Cerutti E, Asch FM, Haverich A. Midterm outcomes with a sutureless aortic bioprosthesis in a prospective multicenter cohort study. J Thorac Cardiovasc Surg 2021; 164:1772-1780.e11. [PMID: 33597099 DOI: 10.1016/j.jtcvs.2020.12.109] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to report midterm clinical outcomes with a self-expandable sutureless aortic valve. METHODS Between 2010 and 2013, 658 patients at 25 European institutions received the Perceval sutureless valve (LivaNova Plc, London, United Kingdom). Mean follow-up was 3.8 years; late cumulative follow-up was 2325.2 patient-years. RESULTS The mean age of the population was 78.3 ± 5.6 years and 40.0% (n = 263) were 80 years of age or older; mean Society of Thoracic Surgeons-Predicted Risk of Mortality score was 7.2 ± 7.4. Concomitant procedures were performed in 31.5% (n = 207) of patients. Overall duration of cardiopulmonary bypass time was 64.8 ± 25.2 minutes and aortic cross-clamping time was 40.7 ± 18.1 minutes. Thirty-day all-cause mortality was 3.7% (23 patients), with an observed:expected ratio of 0.51. Overall survival was 91.6% at 1 year, 88.5% at 2 years, and 72.7% at 5 years. Peak and mean gradients remained stable during follow-up, and were 17.8 ± 11.3 mm Hg and 9.0 ± 6.3 mm Hg, respectively, at 5 years. Preoperatively, 33.4% of those who received the Perceval valve (n = 210) were in New York Heart Association functional class I or II versus 93.1% (n = 242) at 5 years. CONCLUSIONS This series, representing, to our knowledge, the longest follow-up with sutureless technology in a prospective, multicenter study, shows that aortic replacement using sutureless valves is associated with low mortality and morbidity and good hemodynamic performance.
Collapse
Affiliation(s)
- Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
| | - Bart Meuris
- Cardiac Surgery, UZ Gasthuisberg, Leuven, Belgium
| | - Thierry Folliguet
- Cardiac Surgery and Transplantation, Hôpital Henri Mondor assistance Publique Hôpitaux de Paris, Paris, France
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Herzzentrum Universitaet Leipzig, Klinik fur Herzchirurgie, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Elisa Cerutti
- Clinical Affairs Department, LivaNova plc, London, United Kingdom
| | - Federico M Asch
- MedStar Health Research Institute, Washington Hospital Center, Washington, DC
| | - Axel Haverich
- Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
9
|
Hata M, Hakim-Meibodi K, Bleiziffer S, Schramm R, Gummert J. A New Surgical Option for Functional Mitral Valve Regurgitation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Gyoten T, Rojas SV, Fox H, Schramm R, Hakim-Meibodi K, Ruiz-Cano M, Gummert JF, Morshuis M, Sandica E. Mechanical circulatory support as a bridge to candidacy in adults with transposition of the great arteries and a systemic right ventricle. Eur J Cardiothorac Surg 2020; 59:ezaa373. [PMID: 33226086 DOI: 10.1093/ejcts/ezaa373] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Clinical experience with continuous flow ventricular assist devices (VADs) in patients with transposition of the great arteries (TGA) including dextro-TGA and congenitally corrected TGA is rare, and indications as well as potential benefits or specific hurdles remain unclear. Therefore, our goal was to report on our experience regarding VAD therapy in adult patients with TGA as a bridge to candidacy. METHODS We performed a single-centre retrospective study of all adult patients with TGA with systemic right ventricular failure who had continuous flow VAD implants between 2010 and 2018. Study end points were all causes of death, major cardiac and cerebrovascular adverse events or pump thrombosis. Follow-up continued until the time of the heart transplant. RESULTS A total of 6 patients (4 men) had a continuous flow VAD implanted in the context of a failing systemic right ventricle (dextro-TGA after the Mustard procedure: n = 3; congenitally corrected TGA: n = 3). Demographics: mean age 32 ± 5.7 years; median Interagency Registry for Mechanically Assisted Circulatory Support: level II (range 1-4), mean pulmonary artery 48 ± 13 mmHg, mean pulmonary vascular resistance 5.6 ± 3.5 Wood units. Postoperative data: intensive care unit stay: 16 ± 9.7 days; in-hospital survival: 100%; no early VAD-related complications occurred. Mean follow-up: 33 ± 18 months; persistent left-side paresis: n = 1; minor (non-disabling) stroke: n = 2. Post-VAD pulmonary artery: 19 ± 3.4 mmHg; P < 0.005; post-VAD pulmonary resistance: 2.2 ± 0.55 Wood units; P = 0.066. Four patients had heart transplants after a mean waiting time of 30 months after the VAD was implanted; 2 patients are still on the waiting list (waiting time: 52 and 24 months). CONCLUSIONS Continuous flow VAD therapy is a feasible therapeutic option in adult patients with TGA and a failing systemic right ventricle as a bridge to candidacy and a bridge to a heart transplant.
Collapse
Affiliation(s)
- Takayuki Gyoten
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - René Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Maria Ruiz-Cano
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Eugen Sandica
- Center for Congenital Heart Defects, Heart and Diabetes Centre, North Rhine Westphalia, Bad Oeynhausen, Germany
| |
Collapse
|
11
|
Omran H, Deutsch M, Groezinger E, Renner A, Neumann J, Westermann D, Scholtz W, Rudolph T, Gummert J, Rudolph V, Hakim-Meibodi K. Usefulness of troponin in selecting patients for invasive coronary angiography after cardiac surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Great uncertainty exists about the indication for invasive coronary angiography (ICA) in patients with suspected acute coronary syndrome following cardiac surgery.
Aim
The aim of this study was to define clinical criteria that best identify patients who benefit from ICA after cardiac surgery.
Methods
We performed a retrospective analysis of all patients who underwent cardiac surgery between January 2009 and May 2019 at our center. Exclusion criteria included pediatric patients as well as pacemaker, TAVR and LVAD implantation and heart transplantation procedures. The primary outcome was usefulness of ICA as defined by consequent PCI or re-operation due to ICA findings. ECG changes (ST-elevations) and high-sensitivity Troponin I (hsTrop I) were analyzed.
Results
48,136 patients were screened and after applying exclusion criteria 29,359 patients were finally included in the analysis (mean age 67.8±11.0 years, 31.1% females, Euroscore II 5.14±8.9%). A total of 1,171 patients (4%) underwent post-op ICA. The primary outcome occurred in 440 patients (1.5%) of which 290 underwent consequent PCI and 214 underwent consequent re-operation. Baseline characteristics are shown in table 1. Unadjusted analyses did not identify significant differences in the level of cardiac biomarkers between useful-ICA and unuseful-ICA groups.
In multivariate regression analysis, only ST-elevation on ECG predicted the primary outcome (OR 1.33, 95% CI 1.003–1.76).
Dichotomizing hsTrop I concentrations by applying the guideline-specified cut-off (>70x URL) resulted in correct classification of useful-ICA patients in 95.7%. However, the false-positive rate was also extremely high (83.6%) with a positive predictive value (PPV) of 1.6% and a negative predictive value (NPV) of 99.6% (accuracy 17.5%).
Using area under the curve (ROC) analysis following optimal cut-off values for hsTrop I were identified: in CABG patients a cut-off value of >650x URL (corresponding absolute value 17000 ng/L) was defined with a corresponding sensitivity of 83.3%, specificity of 83.6%, PPV of 8.9% and NPV of 99.6% (accuracy 83.6%). In non-CABG patients (i.e. valve or aortic procedures), the cut-off was about twice as high as that for CABG patients (1,350x URL or 35,000 ng/L) with a corresponding sensitivity of 84.1%, specificity of 89.2%, PPV of 5.9% and NPV of 99.9% (accuracy 89.1%).
Conclusion
Our study demonstrates that currently recommended cut-off concentrations of high-sensitivity troponin are not useful for guiding clinical decision-making in patients with suspected acute coronary syndrome following cardiac surgery, while substantially higher cut-off values might be useful. Those cut-off values critically depend on the type of cardiac surgery performed (CABG vs. non-CABG).
Troponin_Curves post-op
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- H Omran
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - M.A Deutsch
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - E Groezinger
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - A Renner
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Neumann
- University Heart & Vascular Center Hamburg, Clinic for Cardiology, Hamburg, Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Clinic for Cardiology, Hamburg, Germany
| | - W Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - T Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Gummert
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - V Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - K Hakim-Meibodi
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
12
|
Gerçek M, Faber L, Rudolph V, Fox H, Puehler T, Omran H, Wolf LK, Paluszkiewicz L, Zeiher AM, Hakim-Meibodi K, Gummert J, Dimitriadis Z. Myocardial adaptation as assessed by speckle tracking echocardiography after isolated mitral valve surgery for primary mitral regurgitation. Int J Cardiovasc Imaging 2020; 37:913-920. [PMID: 33051820 PMCID: PMC7969695 DOI: 10.1007/s10554-020-02065-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
The risk of left ventricular (LV) and right ventricular (RV) maladaptation after surgery for isolated primary mitral regurgitation (PMR) is poorly defined. We aimed to evaluate LV and RV contractile function using speckle-tracking analysis alongside with quantification of exercise tolerance in patients with PMR after mitral valve surgery. All consecutive patients with symptomatic PMR undergoing mitral valve surgery between July 2015 and May 2017 were prospectively enrolled. Sequential echocardiographic studies along with clinical assessment were performed before and three months after surgery. Mean age in 138 patients was 65.8 ± 12.7 years, 48.2% (66) of whom were female. Mean LV ejection fraction decreased from 57 ± 12% to 50 ± 11% (p < 0.001), LV global longitudinal strain deteriorated from -19.2 ± 4.1% to -15.7 ± 3.8% (p < 0.001), and mechanical strain dispersion increased from 88 ± 12 to 117 ± 115 ms (p = 0.004). There was a reduction in tricuspid annulus plane systolic excursion from 22 ± 5 mm to 18 ± 4 mm (p < 0.001), as well as a slight deterioration of RV free wall mean longitudinal strain from -16.9 ± 5.6% to -15.7 ± 4.1% (p = 0.05). The rate of moderate to severe tricuspid regurgitation significantly decreased (p < 0.005). Regarding exercise tolerance, the New York Heart Association class improved (p < 0.001) and the walking distance increased (p < 0.001). During mid-term follow up after surgery for PMR, a deterioration of LV and RV contractile function measures could be observed. However, the clinical status, LV dimensions, and concomitant tricuspid regurgitation improved which in particular imply more effective RV contractile pattern.
Collapse
Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
| | - Lothar Faber
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Hazem Omran
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Lisa Katharina Wolf
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Andreas M Zeiher
- Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Zisis Dimitriadis
- Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
13
|
Götte J, Zittermann A, Hakim-Meibodi K, Hata M, Schramm R, Bleiziffer S, Parsa MA, Gummert J, Renner A. Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair. Thorac Cardiovasc Surg 2020; 70:93-99. [PMID: 32998167 DOI: 10.1055/s-0040-1716324] [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: 10/23/2022]
Abstract
BACKGROUND Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. METHODS We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. RESULTS During a median follow-up period of 37 months (range: 0.1-108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37-3.36), advanced age (HR: 1.07, CI: 1.01-1.14 per year), diabetes (HR: 1.97, CI: 1.13-3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01-1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13-1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). CONCLUSION Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.
Collapse
Affiliation(s)
- Julia Götte
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Armin Zittermann
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Kavous Hakim-Meibodi
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Masatoshi Hata
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Rene Schramm
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Sabine Bleiziffer
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Mohammed Amin Parsa
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Jan Gummert
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| | - Andre Renner
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, 32545, Germany
| |
Collapse
|
14
|
Schramm R, Morshuis M, Schoenbrodt M, Boergermann J, Hakim-Meibodi K, Hata M, Gummert JF. Current perspectives on mechanical circulatory support. Eur J Cardiothorac Surg 2020; 55:i31-i37. [PMID: 30608535 PMCID: PMC6526098 DOI: 10.1093/ejcts/ezy444] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 01/29/2023] Open
Abstract
![]()
Mechanical circulatory support gained a significant value in the armamentarium of heart failure therapy because of the increased awareness of the prevalence of heart failure and the tremendous advances in the field of mechanical circulatory support during the last decades. Current device technologies already complement a heart transplant as the gold standard of treatment for patients with end-stage heart failure refractory to conservative medical therapy. This article reviews important aspects of mechanical circulatory support therapy and focuses on currently debated issues.
Collapse
Affiliation(s)
- Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Michael Schoenbrodt
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jochen Boergermann
- Clinic for Cardiac- and Vascular Surgery, Heart Centre Duisburg, Duisburg, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Masatoshi Hata
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| |
Collapse
|
15
|
Morshuis M, Rojas SV, Hakim-Meibodi K, Razumov A, Gummert JF, Schramm R. Heart transplantation after SynCardia ® total artificial heart implantation. Ann Cardiothorac Surg 2020; 9:98-103. [PMID: 32309157 DOI: 10.21037/acs.2020.03.12] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The SynCardia total artificial heart (TAH)® is the only approved TAH device. This report summarizes our single-center experience with the SynCardia TAH® with particular focus on the outcome after subsequent heart transplantation. Methods We retrospectively analysed the outcome of all transplanted SynCardia TAH® patients at our center between 2001 and 2019 in comparison to transplanted left ventricular assist device (LVAD) and biventricular assist device (BVAD) patients and to transplanted patients without prior durable mechanical circulatory support (non-MCS). Results Only a fraction (n=69; 37.3%) of all SynCardia TAH® patients (n=193) were transplanted. The majority (81.2%) of those were in high-urgency status at the time of transplantation. Survival in transplanted SynCardia TAH® patients was significantly poorer when compared to LVAD-, BVAD- and non-MCS patients (P=0.008). Conclusions Heart transplantation in SynCardia TAH® patients requires distinct risk stratification to improve outcomes.
Collapse
Affiliation(s)
- Michiel Morshuis
- Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Artyom Razumov
- Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - René Schramm
- Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| |
Collapse
|
16
|
Hata M, Fujita B, Hakim-Meibodi K, Gummert JF. Papillary Muscle Heads Focalization for Functional Mitral Valve Regurgitation. Ann Thorac Surg 2020; 110:e59-e61. [PMID: 32199828 DOI: 10.1016/j.athoracsur.2020.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/02/2019] [Revised: 01/24/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022]
Abstract
Mitral valve annuloplasty has been the gold standard for treatment of functional mitral valve regurgitation. However, annuloplasty for functional mitral regurgitation may cause augmented posterior leaflet tethering, which results in functional anterior prolapse. Herein we added papillary muscle heads focalization for such patients. All separated papillary muscle heads are sutured together, and the roots of chordae at each papillary muscle are unifocalized on both sides. Stitches are positioned at the same distances from corresponding leaflet edges to adjust the height of leaflet edges in each segment. This is a simple and effective technique to correct for functional anterior prolapse after annuloplasty.
Collapse
Affiliation(s)
- Masatoshi Hata
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany.
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
17
|
Schramm R, Zittermann A, Morshuis M, Schoenbrodt M, von Roessing E, von Dossow V, Koster A, Fox H, Hakim-Meibodi K, Gummert JF. Comparing short-term outcome after implantation of the HeartWare® HVAD® and the Abbott® HeartMate 3®. ESC Heart Fail 2020; 7:908-914. [PMID: 32190985 PMCID: PMC7261579 DOI: 10.1002/ehf2.12649] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 01/29/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Centrifugal continuous flow pumps are currently the state of the art in left ventricular assist device therapy. This study was conducted to compare the results after implantation of the HVAD® and the HeartMate 3®. METHODS AND RESULTS We retrospectively analysed preoperative and post-operative patient data of all 106 patients, who received a HeartMate 3 (HM3) at our centre between 2014 and 2018. A total of 392 patients receiving a sintered HVAD® served as controls. Patient matching was performed for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at the time of implant, perioperative right heart failure, and implantation strategy, that is, bridge to transplant or destination therapy, as well as preoperative renal function, that is, as indicated by serum creatinine levels. A total of 79 matched pairs could be identified. During a median follow-up of 15.3 months (range: 0-30 months), 23 (29.1%) and 19 (24.1%) patients died in the HVAD and HM3 groups, respectively, with a hazard ratio for mortality of 0.84 [95% confidence interval (CI): 0.46-1.54; P = 0.568]. Freedom from cerebrovascular events did not differ significantly between study groups, with a hazard ratio of 0.57 (95% CI: 0.23-1.45; P = 0.241). The risk of driveline infection was significantly lower in the HM3 (n = 33) than in the HVAD (n = 55) group (hazard ratio = 0.54; 95% CI: 0.35-0.84; P = 0.006). Eight HVAD, but no HM3, patients developed a pump thrombosis during follow-up (P = 0.148). CONCLUSIONS Performance of both currently used centrifugal left ventricular assist device systems is comparable in terms of short-term patient survival and freedom from cerebrovascular events. In our single-centre experience, HM3 patients less frequently develop driveline infections and no pump thrombosis, which requires further evaluation.
Collapse
Affiliation(s)
- Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| | - Michael Schoenbrodt
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| | - Ellen von Roessing
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| | - Vera von Dossow
- Institute of Anesthesiology, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Andreas Koster
- Institute of Anesthesiology, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Cardiology, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westphalia, Georgstr. 11, D-32503, Bad Oeynhausen, Germany
| |
Collapse
|
18
|
Gerçek M, Hakim-Meibodi K, Rudolph V, Gummert J, Deutsch MA. First Report on the Surgical Removal of the PASCAL Device After Failed Transcatheter Mitral Valve Repair. JACC Cardiovasc Interv 2020; 13:651-652. [PMID: 31838111 DOI: 10.1016/j.jcin.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 09/20/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marcus-André Deutsch
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
19
|
Razumov A, Marcus-André D, Zittermann A, Schramm R, Hakim-Meibodi K, Gummert J, Morshuis M. SynCardia Total Artificial Heart: A17-Year Single-Center Experience with 187 Patients. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705362] [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]
|
20
|
Hata M, Zittermann A, Hakim-Meibodi K, Börgermann J, Gummert J. Minimally invasive mitral valve repair or replacement for degenerative mitral regurgitation. Interact Cardiovasc Thorac Surg 2019; 28:575-580. [PMID: 30476075 DOI: 10.1093/icvts/ivy305] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/26/2018] [Accepted: 10/03/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study describes our experience with minimally invasive mitral valve (MV) repair and chordal-sparing replacement in patients with degenerative MV regurgitation. METHODS Between February 2009 and October 2015, a total of 960 patients underwent isolated minimally invasive MV repair, whereas 95 patients underwent chordal-sparing MV replacement. We performed a propensity score-matched analysis in 85 pairs to compare overall survival and major adverse cardiac and cerebrovascular event (MACCE) -free survival over an 8-year follow-up period. For sensitivity analyses, in the entire study cohort, we used the multivariable-adjusted Cox regression analysis to assess the overall mortality and MACCE. RESULTS In the propensity score-matched pairs, the 7-year probability of survival was 76.3% in the repair group and 78.8% in the replacement group (P = 0.60). Similarly, freedom from MACCE at year 7 of follow-up did not differ between the repair and replacement groups (78.6% and 72.3%, respectively; P = 0.48). The corresponding values for 7-year freedom from valve reintervention were 95.6% and 98.8%, respectively (P = 0.31). In the entire study cohort, the multivariable-adjusted hazard ratio (HR) of mortality for the replacement versus the repair group was 1.31 [95% confidence interval (CI) 0.68-2.50; P = 0.42], and the multivariable-adjusted HR of MACCE was 1.03 (95% CI 0.61-1.74; P = 0.91). CONCLUSIONS Our findings suggest that mid-term clinical outcomes do not significantly differ between patients undergoing MV repair or chordal-sparing MV replacement.
Collapse
Affiliation(s)
- Masatoshi Hata
- Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr - University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr - University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr - University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr - University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr - University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
21
|
Ljajikj E, Zittermann A, Koster A, Börgermann J, Schönbrodt M, Hakim-Meibodi K, Gummert J, Morshuis M. Extracorporeal resuscitation as a further modifier of clinical outcome in patients with left ventricular assist device implantation and Interagency Registry for Mechanically Assisted Circulatory Support level 1. Interact Cardiovasc Thorac Surg 2019; 27:139-141. [PMID: 29444276 DOI: 10.1093/icvts/ivx433] [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] [Received: 11/07/2017] [Accepted: 12/21/2017] [Indexed: 02/04/2023] Open
Abstract
In cardiogenic shock patients with Interagency Registry for Mechanical Circulatory Support (INTERMACS) level 1, the need for temporary circulatory support is a predictor and modifier of patient outcome. Because this group includes patients with and without cardiopulmonary resuscitation (CPR) and is thus very heterogeneous, we investigated whether a further subclassification is useful. We compared 30-day and 1-year mortality of patients who underwent left ventricular assist device implantation after extracorporeal CPR with the aid of an extracorporeal life support system (CPR+ group; n = 40) with cardiogenic shock patients in which the extracorporeal life support system was implanted under non-CPR conditions (CPR- group, n = 68). In the CPR+ and CPR- groups, 30-day mortality was 27.5% (n = 11) and 8.8% (n = 6), respectively (P = 0.014). The values for 1-year mortality were 57.5% (n = 23) and 36.8% (n = 25), respectively (P = 0.023). The age- and gender-adjusted hazard ratios of 30-day and 1-year mortality for the CPR+ group versus the CPR- group were 3.88 (95% confidence interval 1.29-11.7; P = 0.016) and 1.79 (95% confidence interval 1.01-3.17; P = 0.045), respectively. In conclusion, our data show that left ventricular assist device implantation with extracorporeal life support following CPR is associated with high 30-day and 1-year mortality. Further multicentre studies are needed to confirm these results and potentially add CPR as a new modifier to the INTERMACS profile.
Collapse
Affiliation(s)
- Edis Ljajikj
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Koster
- Institute of Anesthesiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Schönbrodt
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
22
|
Puehler T, Zittermann A, Dia M, Emmel E, Gercek M, Börgermann J, Hakim-Meibodi K, Gummert J. Off-pump Revascularization with Bilateral versus Single Mammary Arteries-A Propensity Score-Matched Analysis. Thorac Cardiovasc Surg 2019; 68:687-694. [PMID: 30738416 DOI: 10.1055/s-0039-1677835] [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: 10/27/2022]
Abstract
BACKGROUND Coronary artery bypass grafting is the first-line therapy for severe multivessel coronary artery disease. We aimed to investigate the clinical outcome in patients undergoing isolated off-pump surgery with the single or bilateral internal mammary artery (SIMA or BIMA) approach. METHODS We performed a propensity score-matched analysis in 1,852 consecutive patients, aged 50 to 70 years, who underwent myocardial revascularization at our institution between July 2009 and August 2016. Primary end point was the probability of survival. RESULTS Mean follow-up was 36.3 (range: 0.1-89.6) months. The probability of survival in the SIMA and BIMA groups was 98.6 and 99.0% at year 1, 92.0 and 92.5% at year 5, and 85.6 and 81.6% at year 7, respectively, with a hazard ratio (HR) of mortality for the BIMA group versus the SIMA group of 0.98 (95% confidence interval[CI]: 0.64-1.52; p = 0.94). There was evidence for interaction between diabetes and study group on mortality risk (HR = 2.59, 95% CI: 1.07-6.23; p = 0.034). Freedom from mediastinitis/wound infection was higher in the SIMA group than in the BIMA group (99.5 and 96.9%, respectively; HR of an event = 6.39, 95% CI: 2.88-14.18; p < 0.001). The corresponding values in the subgroups of diabetic patients were 98.6 and 90.9%, respectively (HR = 6.45, 95% CI: 2.24-18.58; p = 0.001). Mediastinitis/wound infection was associated with increased mortality risk (HR = 2.96, 95% CI: 1.29-6.78; p = 0.010). CONCLUSION Overall, our data indicate similar probability of survival up to a maximum follow-up of 7 years by off-pump surgery with the SIMA or BIMA approach. However, in diabetic patients, the clinical outcome indicates caution regarding the use of the BIMA approach.
Collapse
Affiliation(s)
- Thomas Puehler
- Klinik für Herz- und Gefäßchirurgie, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Armin Zittermann
- Department of Cardio-Thoracic Surgery, Heart Center NRW, Bad Oeynhausen, Germany
| | - Mohamad Dia
- Herzzentrum Duisburg, Duisburg, Nordrhein-Westfalen, Germany
| | - Eric Emmel
- Department of Cardio-Thoracic Surgery, Heart Center NRW, Bad Oeynhausen, Germany
| | - Mustafa Gercek
- Herzzentrum Duisburg, Duisburg, Nordrhein-Westfalen, Germany
| | | | - Kavous Hakim-Meibodi
- Department of Cardio-Thoracic Surgery, Heart Center NRW, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Cardio-Thoracic Surgery, Heart Center NRW, Bad Oeynhausen, Germany
| |
Collapse
|
23
|
Schramm R, Zittermann A, Morshuis M, Fuchs U, Fleischhauer J, Hakim-Meibodi K, Gummert J. Risk Stratification in Heart Transplantation According to Donor and Recipient Risk Factors. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1679017] [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)
- R. Schramm
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - A. Zittermann
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - M. Morshuis
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - U. Fuchs
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - J. Fleischhauer
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - K. Hakim-Meibodi
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - J. Gummert
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
24
|
Schramm R, Zittermann A, Morshuis M, Schoenbrodt M, Freifrau E, Hakim-Meibodi K, Gummert J. Short-Term Outcome after Centrifugal Continuous Flow Left Ventricular Assist Device Implantation Comparing the HeartWare, HVAD, and Abbot Heartmate III. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678826] [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)
- R. Schramm
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - A. Zittermann
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - M. Morshuis
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - M. Schoenbrodt
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - E. Freifrau
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - K. Hakim-Meibodi
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - J. Gummert
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
25
|
Ljajikj E, Zittermann A, Koster A, Börgermann J, Schönbrodt M, Hakim-Meibodi K, Gummert J, Morshuis M. Corrigendum to ‘Extracorporeal resuscitation as a further modifier of clinical outcome in patients with left ventricular assist device implantation and Interagency Registry for Mechanically Assisted Circulatory Support 1 level’ [Interact CardioVasc Thorac Surg 2018;27:139–41]†. Interact Cardiovasc Thorac Surg 2018; 27:794. [DOI: 10.1093/icvts/ivy308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Edis Ljajikj
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Koster
- Institute of Anesthesiology, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Schönbrodt
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
26
|
Furukawa N, Kuss O, Preindl K, Renner A, Aboud A, Hakim-Meibodi K, Benzinger M, Pühler T, Ensminger S, Fujita B, Becker T, Gummert JF, Börgermann J. Anaortic off-pump versus clampless off-pump using the PAS-Port device versus conventional coronary artery bypass grafting: mid-term results from a matched propensity score analysis of 5422 unselected patients†. Eur J Cardiothorac Surg 2017; 52:760-767. [DOI: 10.1093/ejcts/ezx235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 05/22/2017] [Indexed: 02/04/2023] Open
|
27
|
Aissaoui N, Morshuis M, Maoulida H, Salem JE, Lebreton G, Brunn M, Chatellier G, Hagège A, Schoenbrodt M, Puymirat E, Latremouille C, Varnous S, Ouldamar S, Guillemain R, Diebold B, Guedeney P, Barreira M, Mutuon P, Guerot E, Paluszkiewicz L, Hakim-Meibodi K, Schulz U, Danchin N, Gummert J, Durand-Zaleski I, Leprince P, Fagon JY. Management of end-stage heart failure patients with or without ventricular assist device: an observational comparison of clinical and economic outcomes†. Eur J Cardiothorac Surg 2017; 53:170-177. [DOI: 10.1093/ejcts/ezx258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 06/17/2017] [Indexed: 12/19/2022] Open
|
28
|
Puehler T, Dia M, Ibishi A, El-Hashem G, Renner A, Hakim-Meibodi K, Ensminger S, Boergermann J, Zittermann A, Gummert J. Carotid Artery Stenosis does not Increase the Perioperative Risk of Stroke in Patients Undergoing Aortic Non-Clamping and No-touch off-pump Surgery- A Retrospective Single-Center Analysis. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598806] [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)
- T. Puehler
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - M. Dia
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Ibishi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - G. El-Hashem
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Renner
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - K. Hakim-Meibodi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - S. Ensminger
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - J. Boergermann
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Zittermann
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - J. Gummert
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| |
Collapse
|
29
|
Puehler T, Dimitriadis Z, Paluszkewitcz L, Oldenburg O, Hakim-Meibodi K, Horstkotte D, Faber L, Gummert J. Clinical Outcome and Myocardial Function after Isolated Mitral Valve Surgery in Patients with Chronic Mitral Regurgitation. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598903] [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)
- T. Puehler
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - Z. Dimitriadis
- HDZ NRW, Ruhr Universität Bochum, Klinik für Kardiologie, Bad Oeynhausen, Germany
| | - L. Paluszkewitcz
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - O. Oldenburg
- HDZ NRW, Ruhr Universität Bochum, Klinik für Kardiologie, Bad Oeynhausen, Germany
| | - K. Hakim-Meibodi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - D. Horstkotte
- HDZ NRW, Ruhr Universität Bochum, Klinik für Kardiologie, Bad Oeynhausen, Germany
| | - L. Faber
- HDZ NRW, Ruhr Universität Bochum, Klinik für Kardiologie, Bad Oeynhausen, Germany
| | - J. Gummert
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| |
Collapse
|
30
|
Schäfer T, Doose C, Fujita B, Utzenrath M, Egron S, Schmitz C, Scholtz S, Kütting M, Hakim-Meibodi K, Börgermann J, Gummert J, Steinseifer U, Ensminger S. Preclinical determination of the best functional position for transcatheter heart valves implanted in rapid deployment bioprostheses. EUROINTERVENTION 2017; 12:1706-1714. [DOI: 10.4244/eij-d-16-00237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
31
|
Pühler T, Fujita B, Renner A, Hakim-Meibodi K, Bögermann J, Morshuis M, Gummert J, Ensminger S. Operative Myokardrevaskularisation bei schlechter linksventrikulärer Funktion – STICH forever? Aktuel Kardiol 2016. [DOI: 10.1055/s-0042-114219] [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)
- T. Pühler
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - B. Fujita
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - A. Renner
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - K. Hakim-Meibodi
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - J. Bögermann
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - M. Morshuis
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - J. Gummert
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - S. Ensminger
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| |
Collapse
|
32
|
Fischlein T, Meuris B, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Gaggianesi S, Madonna F, Laborde F, Asch F, Haverich A. The sutureless aortic valve at 1 year: A large multicenter cohort study. J Thorac Cardiovasc Surg 2016; 151:1617-1626.e4. [PMID: 26936009 DOI: 10.1016/j.jtcvs.2015.12.064] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 05/11/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sutureless aortic valve replacement (AVR) offers an alternative to standard AVR in aortic stenosis. This prospective, single-arm study aimed to demonstrate safety and effectiveness of a bovine pericardial sutureless aortic valve at 1 year. METHODS From February 2010 to September 2013, 658 patients (mean age 78.3 ± 5.6 years; 40.0% octogenarian; 64.4% female; mean Society of Thoracic Surgeons score 7.2 ± 7.4) underwent sutureless AVR in 25 European centers. Concomitant cardiac procedures were performed in 29.5% and minimally invasive cardiac surgery in 33.3%. RESULTS One-year site-reported event rates were 8.1% for all-cause mortality, 4.5% for cardiac mortality, 3.0% for stroke, 1.9% for valve-related reoperation, 1.4% for endocarditis, and 0.6% for major paravalvular leak. No valve thrombosis, migration, or structural valve deterioration occurred. New York Heart Association class improved at least 1 level in 77.5% and remained stable (70.4% New York Heart Association class I or II at 1 year). Mean effective orifice area was 1.5 ± 0.4 cm(2); pressure gradient was 9.2 ± 5.0 mm Hg. Left ventricular mass decreased from 138.5 g/m(2) before surgery to 115.3 g/m(2) at 1 year (P < .001). Echocardiographic core laboratory findings confirmed that paravalvular leak was rare and remained stable during follow-up. CONCLUSIONS The Perceval sutureless valve resulted in low 1-year event rates in intermediate-risk patients undergoing AVR. New York Heart Association class improved in more than three-quarters of patients and remained stable. These data support the safety and efficacy to 1 year of the Perceval sutureless valve in this intermediate-risk population.
Collapse
Affiliation(s)
- Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.
| | - Bart Meuris
- Department of Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Misfeld
- Klinik fur Herzchirurgie, Herzzentrum Universitaet Leipzig, Leipzig, Germany
| | | | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Sara Gaggianesi
- Clinical Affairs Department, Sorin Group Italia Srl, Saluggia, Italy
| | | | - François Laborde
- Cardiac Medico-Surgical Department, Institute Mutualiste Montsouris, Paris, France
| | - Federico Asch
- MedStar Cardiovascular Research Network, Washington Hospital Center, Washington, DC
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation & Vascular Surgery, Hannover Medical School, Germany
| | | |
Collapse
|
33
|
Helms S, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Renner A, Gummert J. Coronary Revascularization in Diabetic Patients: 3-year Survival Data for Off-pump and on-pump Technique. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571596] [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]
|
34
|
Preindl K, Zittermann A, Diaz D, Hakim-Meibodi K, Ensminger S, Diegeler A, Gummert J, Börgermann J. Complexity of Coronary Artery Disease and Revascularization Quality in Off-pump versus on-Pump Surgery - Single-Center Analysis from the GOPCABE Study. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571593] [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]
|
35
|
Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Madonna F, Meuris B, Haverich A, Shrestha M. Clinical and haemodynamic outcomes in 658 patients receiving the Perceval sutureless aortic valve: early results from a prospective European multicentre study (the Cavalier Trial)†. Eur J Cardiothorac Surg 2015; 49:978-86. [PMID: 26245628 DOI: 10.1093/ejcts/ezv257] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [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: 01/02/2015] [Accepted: 06/18/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The aim of the Cavalier trial was to evaluate the safety and performance of the Perceval sutureless aortic valve in patients undergoing aortic valve replacement (AVR). We report the 30-day clinical and haemodynamic outcomes from the largest study cohort with a sutureless valve. METHODS From February 2010 to September 2013, 658 consecutive patients (mean age 77.8 years; 64.4% females; mean logistic EuroSCORE 10.2%) underwent AVR in 25 European Centres. Isolated AVRs were performed in 451 (68.5%) patients with a less invasive approach in 219 (33.3%) cases. Of the total, 40.0% were octogenarians. Congenital bicuspid aortic valve was considered an exclusion criterion. RESULTS Implantation was successful in 628 patients (95.4%). In isolated AVR through sternotomy, the mean cross-clamp time and the cardiopulmonary bypass (CPB) time were 32.6 and 53.7 min, and with the less invasive approach 38.8 and 64.5 min, respectively. The 30-day overall and valve-related mortality rates were 3.7 and 0.5%, respectively. Valve explants, stroke and endocarditis occurred in 0.6, 2.1 and in 0.1% of cases, respectively. Preoperative mean and peak pressure gradients decreased from 44.8 and 73.24 mmHg to 10.24 and 19.27 mmHg at discharge, respectively. The mean effective orifice area improved from 0.72 to 1.46 cm(2). CONCLUSIONS The current 30-day results show that the Perceval valve is safe (favourable haemodynamic effect and low complication rate), and can be implanted with a fast and reproducible technique after a short learning period. Short cross-clamp and CPB times were achieved in both isolated and combined procedures. The Perceval valve represents a promising alternative to biological AVR, especially with a less invasive approach and in older patients.
Collapse
Affiliation(s)
- François Laborde
- Cardiac Medico-Surgical Department, Institute Mutualiste Montsouris, Paris, France
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany
| | | | - Martin Misfeld
- Herzzentrum Universitaet Leipzig, Klinik fur Herzchirurgie, Leipzig, Germany
| | | | - Marian Zembala
- Silesian University Center for Heart Disease, Zabrze, Poland
| | | | - Bart Meuris
- Department of Cardiac Surgery, U.Z. Gasthuisberg, Leuven, Belgium
| | - Axel Haverich
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
36
|
Fujita B, Kütting M, Scholtz S, Utzenrath M, Hakim-Meibodi K, Paluszkiewicz L, Schmitz C, Börgermann J, Gummert J, Steinseifer U, Ensminger S. Development of an algorithm to plan and simulate a new interventional procedure. Interact Cardiovasc Thorac Surg 2015; 21:87-95. [PMID: 25847966 DOI: 10.1093/icvts/ivv080] [Citation(s) in RCA: 18] [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: 01/08/2015] [Accepted: 03/13/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The number of implanted biological valves for treatment of valvular heart disease is growing and a percentage of these patients will eventually undergo a transcatheter valve-in-valve (ViV) procedure. Some of these patients will represent challenging cases. The aim of this study was to develop a feasible algorithm to plan and in vitro simulate a new interventional procedure to improve patient outcome. METHODS In addition to standard diagnostic routine, our algorithm includes 3D printing of the annulus, hydrodynamic measurements and high-speed analysis of leaflet kinematics after simulation of the procedure in different prosthesis positions as well as X-ray imaging of the most suitable valve position to create a 'blueprint' for the patient procedure. RESULTS This algorithm was developed for a patient with a degenerated Perceval aortic sutureless prosthesis requiring a ViV procedure. Different ViV procedures were assessed in the algorithm and based on these results the best option for the patient was chosen. The actual procedure went exactly as planned with help of this algorithm. CONCLUSIONS Here we have developed a new technically feasible algorithm simulating important aspects of a novel interventional procedure prior to the actual procedure. This algorithm can be applied to virtually all patients requiring a novel interventional procedure to help identify risks and find optimal parameters for prosthesis selection and placement in order to maximize safety for the patient.
Collapse
Affiliation(s)
- Buntaro Fujita
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Maximilian Kütting
- Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany
| | - Smita Scholtz
- Department for Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Marc Utzenrath
- Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany
| | - Kavous Hakim-Meibodi
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Christoph Schmitz
- Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany
| | - Jochen Börgermann
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Ulrich Steinseifer
- Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany
| | - Stephan Ensminger
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
37
|
Potapov E, Garbade J, Hakim-Meibodi K, Strueber M, Gummert J, Mohr F, Falk V, Krabatsch T, Morshuis M. The HeartMate II Pump in Clinical Practice - Results From 479 Patients Analyzed in a Retrospective European Multi-Center Study. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
38
|
Puehler T, Ensminger S, Schoenbrodt M, Börgermann J, Rehn E, Hakim-Meibodi K, Morshuis M, Gummert J. Mechanical circulatory support devices as destination therapy-current evidence. Ann Cardiothorac Surg 2014; 3:513-24. [PMID: 25452913 DOI: 10.3978/j.issn.2225-319x.2014.08.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/23/2014] [Indexed: 01/23/2023]
Abstract
Advanced heart failure is an increasing problem worldwide. Nowadays, mechanical circulatory support devices (MSCD) are an established therapeutic option for terminal heart failure after exhaustion of medical and conventional surgical treatment, and are becoming a realistic alternative to heart transplantation (HTX). There are a number of different treatment options for these patients, such as bridge to transplantation (BTT), bridge to candidacy (BTC), bridge to recovery (BTR) and the destination therapy (DT) option. The latter option has become more frequent throughout the last years, due to a donor organ shortage and an increasing number of older patients with terminal heart failure who are not eligible for HTX. These factors have led to a rapidly increasing number of LVAD implantations as well as centers which perform these procedures. This has also been due to improved LVAD survival rates and quality of life following the introduction of smaller, intrapericardial and more durable continuous flow left ventricular devices. The most common complications for these patients are device-related problems, such as coagulation disorders, gastrointestinal bleeding, device related infection, pump thrombosis or cerebrovascular accidents. However, some questions still remain unanswered or under debate, such as the exact time-point for LVAD implantation. In addition, aspects such as better biocompatibility for LVADs remain a major challenge. This review will concentrate on DT for terminal heart failure and provide an overview of the current evidence for LVAD implantation in this patient group, with particular emphasis on indication and time-point of implantation, choice of LVADs, and long term outcomes and quality of life.
Collapse
Affiliation(s)
- Thomas Puehler
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Michael Schoenbrodt
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Erik Rehn
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Hospital of the Rhine University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
39
|
Renner A, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Gummert JF. Early and mid-term clinical outcome in younger and elderly patients undergoing mitral valve repair with or without tricuspid valve repair. Interact Cardiovasc Thorac Surg 2014; 20:85-9. [PMID: 25320141 DOI: 10.1093/icvts/ivu337] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data regarding durability and midterm benefits of mitral valve (MV) repair in elderly patients are scarce. To evaluate the feasibility and safety of MV repair in elderly patients, we performed a retrospective data analysis. METHODS We compared clinical outcomes in younger patients (<75 years: n = 462) and older patients (≥75 years: n = 100) undergoing MV repair with or without tricuspid valve (TV) repair. The primary end-point was 30-day mortality. RESULTS The preoperative risk profile (EuroSCORE, NYHA class, percentage pulmonary hypertension, percentage diabetes) was higher in older patients compared with younger patients. Nevertheless, operative complications such as low cardiac output syndrome, stroke, infections, the need of haemofiltration and IABP use did not differ significantly between the two groups. The thirty-day mortality rate was 0% in older patients and 1% in younger patients (P = 0.30). In the subgroup of patients with double valve repair, the 30-day mortality rate in older patients (n = 28) and younger patients (n = 46) was 0 and 4%, respectively (P = 0.27). In older and younger patients, the 6-month mortality rate was 4 and 2%, respectively (P = 0.16), and the 1-year mortality rate was 10 and 3%, respectively (P = 0.001). The propensity score-adjusted odds ratio of 1-year mortality with the group of younger patients as a reference was 2.04 (95% confidence interval: 0.77-5.40; P = 0.15) for older patients. Freedom from 1-year reoperation did not differ significantly between age groups. CONCLUSIONS Data demonstrate excellent postoperative mortality rates in older patients undergoing MV repair with or without TV repair. Consequently, even in older patients with numerous comorbidities, MV repair should be considered a suitable surgical method.
Collapse
Affiliation(s)
- André Renner
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Anas Aboud
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
40
|
Laborde F, Fischlein T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Meuris B, Haverich A. 018 * CLINICAL AND HAEMODYNAMIC OUTCOMES IN 658 PATIENTS RECEIVING THE PERCEVAL SUTURELESS AORTIC VALVE: EARLY RESULTS FROM A PROSPECTIVE EUROPEAN MULTICENTRE STUDY (CAVALIER TRIAL). Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.18] [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
|
41
|
Aboud A, Liebing K, Hakim-Meibodi K, Börgermann J. Reply to Simons and Weerwind. Eur J Cardiothorac Surg 2014; 47:391-2. [PMID: 24771756 DOI: 10.1093/ejcts/ezu181] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anas Aboud
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kai Liebing
- Medical Technology, Friedrich Schiller University, Jena, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
42
|
Hata M, Gummert JF, Börgermann J, Hakim-Meibodi K. Mitral chordae myxoma-chordae replacement with a premeasured gore-tex loop using a minimally invasive video-assisted approach. J Cardiothorac Surg 2013; 8:227. [PMID: 24330768 PMCID: PMC4029285 DOI: 10.1186/1749-8090-8-227] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 12/06/2013] [Indexed: 12/01/2022] Open
Abstract
Cardiac myxomas are one of the most common types of primary cardiac tumors and are associated with embolization, angina, and sudden death. Most cardiac myxomas arise from the fossa ovalis, while those that arise from the mitral valve are exceedingly rare and those that arise from the chordae are even rarer. We report the case of a 28-year-old Caucasian woman who suffered from a brain infarction. A duplex ultrasound showed no cerebrovascular stenosis or occlusion, but an echocardiogram revealed a left ventricle pedunculated mobile mass (5 mm in diameter) that was attached to the mitral valve chordae tendineae. We elected cardiac surgery to resect the cardiac tumor and to avoid further embolic events. The traditional surgical strategy—mitral valve replacement through full sternotomy—has many disadvantages, particularly for young women. Therefore we desided to use the Premeasured Gore-Tex chordal loop method followed by annuloplasty using a minimally invasive video-assisted approach. Exploration of the mitral valve showed a globular tumor involving the anterior mitral leaflet chordae tendineae, which was removed along with the involved chordae tendineae. Histopathological examination of the tissue revealed a benign polypoid myxoma. The patient had an uneventful recovery and has remained symptom-free. Echocardiography one week after surgery showed satisfactory valve function. We believe our surgical treatment was the most appropriate option for this case and it resulted in an excellent medical outcome and improved the quality of life, including only a small lateral scar without the need for teratogenic anticoagulants.
Collapse
Affiliation(s)
- Masatoshi Hata
- Department of Cardiothoracic Surgery, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.
| | | | | | | |
Collapse
|
43
|
Jategaonkar SR, Dimitriadis Z, Hakim-Meibodi K, Gummert J, Horstkotte D, Scholtz W. Delayed coronary ischemia after transfemoral aortic valve implantation. J Heart Valve Dis 2013; 22:762-766. [PMID: 24597395] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) offers a less invasive treatment alternative to surgical aortic valve replacement for high-risk patients. Although the procedure can be performed at low risk, life-threatening complications may arise in single cases during or even months after the procedure. Here, the details are presented of two patients who underwent TAVI by a transfemoral approach with Medtronic CoreValve prostheses and suffered myocardial ischemia months later. The patients' anatomy with small aortic root, narrow sinus of Valsalva and small distance between the annulus base and coronary arteries and/or the relative oversizing of the CoreValve prosthesis with a high positioning may have contributed to this late complication. Hence, caution is mandatory in this type of patient, with exact pre-procedural planning and close follow up required.
Collapse
Affiliation(s)
- Smita R Jategaonkar
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Zisis Dimitriadis
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Werner Scholtz
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| |
Collapse
|
44
|
Renner A, Zittermann A, Aboud A, Pühler T, Hakim-Meibodi K, Quester W, Tschoepe D, Börgermann J, Gummert JF. Coronary Revascularization in Diabetic Patients: Off-Pump Versus On-Pump Surgery. Ann Thorac Surg 2013; 96:528-34. [DOI: 10.1016/j.athoracsur.2013.04.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
|
45
|
Fuchs U, Zittermann A, Ensminger S, Schulze B, Hakim-Meibodi K, Gummert J, Schulz U. Clinical Outcome in Cardiac Transplant Recipients Receiving Tacrolimus Retard. Transplant Proc 2013; 45:2000-4. [DOI: 10.1016/j.transproceed.2013.01.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/15/2013] [Indexed: 12/18/2022]
|
46
|
Aboud A, Liebing K, Börgermann J, Ensminger S, Zittermann A, Renner A, Hakim-Meibodi K, Gummert J. Excessive negative venous line pressures and increased arterial air bubble counts during miniaturized cardiopulmonary bypass: an experimental study comparing miniaturized with conventional perfusion systems. Eur J Cardiothorac Surg 2013; 45:69-74. [PMID: 23666376 DOI: 10.1093/ejcts/ezt257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Miniaturized cardiopulmonary bypass (MCPB) is increasingly used in cardiac surgery, because it can lower clinically significant complications such as systemic inflammatory response, haemolysis and high transfusion requirements. A limitation of MCPB is the risk of excessive negative pressure in the venous line during volume depletion, probably leading to gaseous microembolism. METHODS In an experimental study with 24 pigs, we compared conventional open cardiopulmonary bypass (CCPB group, n = 11) with MCPB (n = 13). The same pump and identical tubing materials were used in both groups. Primary endpoints were pressure values in the venous line and the right atrium as well as the amount of air bubbles >500 µm. Secondary endpoints were biochemical parameters of systemic inflammatory response, ischaemia, haemodilution and haemolysis. RESULTS Nearly 20% of venous pressure values were below -150 mmHg and approximately 10% of the right atrial pressure values were below -100 mmHg in the MCPB group, during the experiment. No such low values were observed in the CCPB group. In addition, the number of large arterial air bubbles was higher in the MCPB group compared with the CCPB group (mean ± standard deviation [SD]: 13 444 ± 5709 vs 0.9 ± 0.6, respectively; P < 0.001). Bubble volume was also significantly larger during MCPB compared with CCPB (mean ± SD: 1522 ± 654 vs 4.1 ± 2.5 µl, respectively; P < 0.001). Blood levels of interleukin-6, free haemoglobin and creatine kinase were significantly higher in the CCPB group compared with the MCPB group. CONCLUSIONS Despite the benefits of MCPB regarding systemic inflammatory response and haemolysis, this technique is associated with excessive negative venous line pressures and a significant increase in the number and volume of arterial air bubbles compared with CCPB. Mini-perfusion systems and the management of MCPB require further refinements to avoid such adverse effects.
Collapse
Affiliation(s)
- Anas Aboud
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Schulz U, Morshuis M, Oezpeker C, Hakim-Meibodi K, Ensminger S, Börgermann J, Gummert J. Impact of Different Indications for HU Listing of VAD Patients on Survival after Heart Transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
48
|
Börgermann J, Furukawa N, Aboud A, Schönbrodt M, Renner A, Hakim-Meibodi K, Becker T, Zittermann A, Kuss O, Gummert JF. Ministernotomy versus conventional sternotomy for aortic valve replacement: Propensity score analysis of 808 patients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332320] [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]
|
49
|
Renner A, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Gummert JF. Clinical outcome in elderly patients undergoing mitral valve repair. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332623] [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]
|
50
|
Fuchs U, Zittermann A, Ensminger S, Hakim-Meibodi K, Schulz U, Gummert JF. Three-year follow-up results in heart transplant recipients receiving tacrolimus retard (Advagraf®). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332601] [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]
|