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Jacob KA, Hussein N, van Wijk A, Heinisch PP, Salih C, Galetti L, Hörer J. Becoming a congenital heart surgeon: the long and challenging road. Interact Cardiovasc Thorac Surg 2022; 35:6763496. [PMID: 36260088 PMCID: PMC9580514 DOI: 10.1093/icvts/ivac250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/28/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Training in congenital cardiac surgery is potentially lengthier and more demanding than training in any other surgical field. The duration of training is proportional to the complexity of the specialization. The expertise of a wide range of procedures is required. There is no doubt that some individuals may acquire the requisite abilities with greater ease than others, but fundamentally, these are capabilities that can be taught and learnt. Moreover, congenital cardiac surgeons are required to have a detailed understanding of pathophysiology and morphology, in addition to the stamina and empathy required to manage these complex patients. A fellowship is just the start of such training and is followed by a long road eventually leading to a lifelong journey to become a qualified congenital cardiac surgeon. Effective mentorship is a prerequisite throughout training to guide surgeons on this journey.
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Affiliation(s)
- K A Jacob
- Corresponding author. University Medical Centre, Utrecht, Netherlands. Tel: +31 88 75 736 72; e-mail: (K. Jacob)
| | - N Hussein
- Castle Hill Hospital, Cottingham, England, UK
| | - A van Wijk
- University Medical Centre, Utrecht, Netherlands
| | - P P Heinisch
- German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany,University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - C Salih
- Evelina Children's Hospital, Guy's & St Thomas' Hospitals, London, UK
| | - L Galetti
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - J Hörer
- German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany,University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Felix SEA, Ramjankhan FZ, Buijsrogge MP, Jacob KA, Asselbergs FW, Oerlemans MIF, Kirkels JH, van Laake LW, Oppelaar AMC, Suyker WJL, de Jonge N. Outcome of mechanical circulatory support at the University Medical Centre Utrecht. Neth Heart J 2020; 28:210-218. [PMID: 32096095 PMCID: PMC7113343 DOI: 10.1007/s12471-020-01375-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The prevalence of heart failure (HF) is increasing substantially and, despite improvements in medical therapy, HF still carries a poor prognosis. Mechanical circulatory support (MCS) by a continuous-flow left ventricular assist device (cf-LVAD) improves survival and quality of life in selected patients. This holds especially for the short-term outcome, but experience regarding long-term outcome is growing as the waiting time for heart transplantation is increasing due to the shortage of donor hearts. Here we present our results from the University Medical Centre Utrecht. Methods Data of all patients with a cf-LVAD implant between March 2006 and January 2018 were collected. The primary outcome was survival. Secondary outcomes included adverse events defined according to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definitions, described per patient year. Results A total of 268 patients (69% male, mean age 50 ± 13 years) received a cf-LVAD. After a median follow-up of 542 (interquartile range 205–1044) days, heart transplantation had been performed in 82 (31%) patients, the cf-LVAD had been explanted in 8 (3%) and 71 (26%) had died. Survival at 1, 3 and 5 years was 83%, 72% and 57%, respectively, with heart transplantation, cf-LVAD explantation or death as the end-point. Death was most often caused by neurological complications (31%) or infection (20%). Major bleeding occurred 0.51 times and stroke 0.15 times per patient year. Conclusion Not only short-term results but also 5‑year survival after cf-LVAD support demonstrate that MCS is a promising therapy as an extended bridge to heart transplantation. However, the incidence of several major complications still has to be addressed. Electronic supplementary material The online version of this article (10.1007/s12471-020-01375-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S E A Felix
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - M P Buijsrogge
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - K A Jacob
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - M I F Oerlemans
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J H Kirkels
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - L W van Laake
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A M C Oppelaar
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - W J L Suyker
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - N de Jonge
- Department of Cardiology, Division Heart and Lungs, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands
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Jacob KA, Noorman M, Cox MGPJ, Groeneweg JA, Hauer RNW, van der Heyden MAG. Geographical distribution of plakophilin-2 mutation prevalence in patients with arrhythmogenic cardiomyopathy. Neth Heart J 2012; 20:234-9. [PMID: 22527912 DOI: 10.1007/s12471-012-0274-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is characterised by myocardial fibrofatty tissue infiltration and presents with palpitations, ventricular arrhythmias, syncope and sudden cardiac death. AC is associated with mutations in genes encoding the desmosomal proteins plakophilin-2 (PKP2), desmoplakin (DSP), desmoglein-2 (DSG2), desmocollin-2 (DSC2) and junctional plakoglobin (JUP). In the present study we compared 28 studies (2004-2011) on the prevalence of mutations in desmosomal protein encoding genes in relation to geographic distribution of the study population. In most populations, mutations in PKP2 showed the highest prevalence. Mutation prevalence in DSP, DSG2 and DSC2 varied among the different geographic regions. Mutations in JUP were rarely found, except in Denmark and the Greece/Cyprus region.
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Affiliation(s)
- K A Jacob
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584, CM, Utrecht, the Netherlands
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Nuttall GA, Eckerman KM, Jacob KA, Pawlaski EM, Wigersma SK, Marienau MES, Oliver WC, Narr BJ, Ackerman MJ. Does low-dose droperidol administration increase the risk of drug-induced QT prolongation and torsade de pointes in the general surgical population? Anesthesiology 2007; 107:531-6. [PMID: 17893447 DOI: 10.1097/01.anes.0000281893.39781.64] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The US Food and Drug Administration issued a black box warning regarding the use of droperidol and the potential for torsade de pointes (TdP). METHODS The primary objective of this retrospective study was to determine whether low-dose droperidol administration increased the incidence of TdP in the general surgical population during a 3-yr time period before and after the Food and Drug Administration black box warning. A random sample of 150 surgical patients during each time interval was selected to estimate the droperidol use for each time period. RESULTS During the time period before the black box warning (July 1, 1998 to June 30, 2001), 2,321/139,932 patients (1.66%) had QT prolongation, TdP, or death within 48 h after surgery. We could identify no patients who clearly developed TdP before the black box warning. There was one patient for whom the cause of death could not positively be ruled out as due to TdP. In the time period after the black box warning (July 1, 2002 to June 30, 2005), 2,207 patients (1.46%) had documented QT prolongation, TdP, or death within 48 h after surgery, including only two cases (<0.1%) of TdP. The incidence of droperidol exposure was approximately 12% (exact 95% confidence interval, 7.3-18.3%) before the black box warning and 0% after placement of the black box warning on droperidol. Therefore, we estimate that approximately 16,791 patients (95% confidence interval, 10,173-25,607) were exposed to droperidol, none of whom experienced documented TdP. CONCLUSIONS This indicates that the Food and Drug Administration black box warning for low dose droperidol is excessive and unnecessary.
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