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van den Heuvel FMA, Bos M, Geuzebroek GSC, Aarntzen EHJG, Maat I, Dieker HJ, Verkroost M, Rodwell L, Ten Oever J, van Crevel R, Habets J, Kouijzer IJE, Nijveldt R. The impact of implementing an endocarditis team in comparison to the classic heart team in a tertiary referral centre. BMC Cardiovasc Disord 2022; 22:114. [PMID: 35300594 PMCID: PMC8931961 DOI: 10.1186/s12872-022-02558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infective endocarditis (IE) is a complex disease for which the European Society of Cardiology guideline recommends a dedicated multidisciplinary endocarditis team (ET) approach since 2015. It is currently unknown whether this ET approach is beneficial compared to a classic heart team approach including bedside consultation by an infectious disease specialist in Western Europe. Methods This retrospective single centre, observational cohort study was conducted at the Radboudumc, a tertiary referral centre in the Netherlands. Consecutive patients treated for IE were included from September 2017 to September 2018 before implementation of a dedicated ET and from May 2019 to May 2020 afterwards. Results In total, 90 IE patients (45 patients before and 45 patients after the implementation of the ET) were included. No significant differences were found in diagnostic workup, surgical treatment (surgery performed 69% vs. 71%, p = 0.82), time to surgery because of an urgent indication (median 4 vs. 6 days, p = 0.82), in-hospital complications (53% vs. 67%, p = 0.20), and 6-month mortality (11% vs. 13%, p = 0.75) between IE patients treated before and after the implementation of the ET. Conclusion Formalization of the recommended multidisciplinary endocarditis team might not significantly improve the complication rate nor the short term outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02558-0.
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Affiliation(s)
- F M A van den Heuvel
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands.
| | - M Bos
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I Maat
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H J Dieker
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Rodwell
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Habets
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
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de Jaegere PPT, de Weger A, den Heijer P, Verkroost M, Baan J, de Kroon T, America Y, Brandon Bravo Bruinsma GJ. Treatment decision for transcatheter aortic valve implantation: the role of the heart team : Position statement paper of the Dutch Working Group of Transcatheter Heart Interventions. Neth Heart J 2020; 28:229-239. [PMID: 31981094 PMCID: PMC7190764 DOI: 10.1007/s12471-020-01367-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 11/24/2022] Open
Abstract
The current paper presents a position statement of the Dutch Working Group of Transcatheter Heart Valve Interventions that describes which patients with aortic stenosis should be considered for transcatheter aortic valve implantation and how this treatment proposal/decision should be made. Given the complexity of the disease and the assessment of its severity, in particular in combination with the continuous emergence of new clinical insights and evidence from physiological and randomised clinical studies plus the introduction of novel innovative treatment modalities, the gatekeeper of the treatment proposal/decision and, thus, of qualification for cost reimbursement is the heart team, which consists of dedicated professionals working in specialised centres.
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Affiliation(s)
- P P T de Jaegere
- Department of Cardiology, Erasmus University, Rotterdam, The Netherlands.
| | - A de Weger
- Department of Cardiothoracic Surgery, University Hospital Leiden, Leiden, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, University Hospital Nijmegen, Nijmegen, The Netherlands
| | - J Baan
- Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - T de Kroon
- Department of Cardiothoracic Surgery, Antonius Ziekenhuis Nieuwegein, Nieuwegein, The Netherlands
| | - Y America
- Department of Cardiology, Rijnstate Ziekenhuis Arnhem, Arnhem, The Netherlands
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Van Wely MH, Van Der Wulp K, Verkroost M, Gehlmann HG, Kievit PC, Van Garsse L, Morshuis W, Van Royen N. P4508Procedural success and clinical outcome of the resheathable Portico transcatheter aortic valve using primarily left subclavian access. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M H Van Wely
- Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, Netherlands
| | - K Van Der Wulp
- Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, Netherlands
| | - M Verkroost
- Radboud University Medical Centre, Department of Cardiothoracic Surgery, Nijmegen, Netherlands
| | - H G Gehlmann
- Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, Netherlands
| | - P C Kievit
- Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, Netherlands
| | - L Van Garsse
- Radboud University Medical Centre, Department of Cardiothoracic Surgery, Nijmegen, Netherlands
| | - W Morshuis
- Radboud University Medical Centre, Department of Cardiothoracic Surgery, Nijmegen, Netherlands
| | - N Van Royen
- Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, Netherlands
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Joustra R, Kievit P, Verkroost M, Gehlmann H, de Boer MJ. Ascending aorta perforation with cardiac tamponade 19 days after transcatheter aortic valve implantation. Neth Heart J 2016; 24:621-2. [PMID: 27573043 PMCID: PMC5039127 DOI: 10.1007/s12471-016-0867-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- R Joustra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - P Kievit
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Verkroost
- Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Gehlmann
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M-J de Boer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Anthonissen N, Menting T, Verkroost M, Morshuis W. Angiosarcoma of the Descending Aorta, Diagnostic Difficulties. EJVES Short Rep 2016; 32:4-6. [PMID: 28856306 PMCID: PMC5576002 DOI: 10.1016/j.ejvssr.2016.04.002] [Citation(s) in RCA: 10] [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: 01/28/2016] [Revised: 04/13/2016] [Accepted: 04/17/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Primary angiosarcomas of the aorta are rare and because of their non-specific presentation, the initial diagnosis is often very difficult. Report A 66 year old woman, initially suffering from night sweats and general malaise, is presented. A computerized tomography (CT) scan was performed which showed a filling defect of the descending aorta. This defect later caused embolic occlusion of the celiac vessels. The patient underwent surgical resection of the filling defect of the descending aorta and an embolectomy of the celiac vessels. The defect was histopathologically diagnosed as an angiosarcoma. The clinical presentation, diagnostic pitfalls, histopathological diagnosis, and the therapeutic management are discussed. Discussion In this case report, the importance of carefully diagnosing an angiosarcoma is highlighted as the consequences could be rapid metastasization or embolization. An angiosarcoma of the descending aorta was diagnosed, which is a rare malignancy. This malignancy is very hard to diagnose therefore long-term survival is uncertain. This malignancy is very aggressive for both local and distant recurrence. This case report reflects the difficulty in diagnosing this malignancy. It also shows the rapid progression of this disease.
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Affiliation(s)
- N Anthonissen
- Department of Cardiothoracic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - T Menting
- Department of Vascular Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - W Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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Schönberger JP, Bredée JJ, van Oeveren W, van Zundert AA, Verkroost M, Terwoorst J, Bavinck JH, Berreklouw E, Wildevuur CR. Preoperative therapy of low-dose aspirin in internal mammary artery bypass operations with and without low-dose aprotinin. J Thorac Cardiovasc Surg 1993; 106:262-7. [PMID: 7688059] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of preoperative low-dose aspirin (1 mg/kg of body weight) and intraoperative low-dose aprotinin (2 million kallikrein inactivator units) treatment on perioperative blood loss and blood requirements in patients who undergo internal mammary artery bypass operations is unknown. Therefore, we retrospectively studied 75 matching patients who underwent internal mammary artery operations, and they were allocated to one of three groups: low-dose aspirin and aprotinin treatment (group 1, n = 25), low-dose aspirin treatment without aprotinin (group 2, n = 25), and neither aspirin nor aprotinin treatment (group 3, n = 25). Although the perioperative blood loss was similar, the blood requirements tended to be higher (p = 0.09) in the patients who were treated with aspirin (group 2) than in the control patients (group 3). When aprotinin was added to the priming solution in patients who were treated with aspirin (group 1), blood loss was significantly lower (p < 0.05) than that of group 2 patients but not of control patients. Blood requirements were significantly lower (p < 0.01) than those of patients in groups 2 and 3. Blood products were needed in 29%, 62%, and 75% of patients in groups 1, 2, and 3, respectively.
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Affiliation(s)
- J P Schönberger
- Department of Cardiopulmonary Surgery, Catharina Hospital, Eindhoven, The Netherlands
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Berreklouw E, Hoogsteen J, van Wandelen R, Verkroost M, Schonberger J, Bavinck H, Michels R, Bonnier H, el Deeb M, el Gamal M. Bilateral mammary artery surgery or percutaneous transluminal coronary angioplasty for multivessel coronary artery disease? An analysis of effects and costs. Eur Heart J 1989; 10 Suppl H:61-70. [PMID: 2516807 DOI: 10.1093/eurheartj/10.suppl_h.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Seventy-two patients with stable or unstable angina treated since 1983 by multivessel-PTCA(MVP) were retrospectively compared with 44 similar patients that were suitable for MVP, but who had undergone bilateral mammary artery (BIMA) surgery (and additional vein grafts in 60.5% of the patients) since 1986. Both groups were comparable (P = not significant [NS]) for gender, age, most risk factors, objective ischaemia and left ventricular function; however, in the BIMA group there were more previous infarctions (P = 0.02), hypertension (P = 0.03), three-vessel disease (P = 0.0001), and less severe angina (P = 0.007). In the BIMA group, a mean of 3.1 (range 2-5) vessels were treated and in the MVP group 2.0 (range 2-3) vessels (P = 0.0001). Both groups were almost completely revascularized (NS). In 39.5% of the BIMA group, no veins were used and in 20.9% the BIMAs were used as sequential grafts. In-hospital mortality was comparable: 2.3% for BIMA and 1.4% for MVP, so were periprocedural infarctions (13.6% vs 8.3%), rethoracotomies (9.1% vs 0%), emergency procedures (0% vs 5.7%), low cardiac output (2.3% vs 5.6%) and other complications (18.2% vs 9.2%). The mean stay (days) on the ICU/CCU for BIMA was 2.3 and for MVP 1.6 (P = 0.005) and the mean hospital stay for BIMA 12.3 and for MVP 6.6 (P = 0.0001). The maximum and mean follow-up (months) of 43 BIMA and 71 MVP hospital survivors was 35 vs 72 and 9.5 vs 22.3 (P = 0.0001) with a late mortality of 0% and 4.2% (NS). MVP patients, including 12 with re-procedures, had more recurrent angina (17.7% vs 4.7%, P less than 0.05) and more often used anti-anginal medications (62.0% vs 18.6%, P less than 0.0001). Late complications (excluding re-procedures) were comparable for MVP and BIMA (20% vs 9.3%, 4.4% vs 0%, 9.2% vs 14%). MVP patients had more re-hospitalizations (34 vs 5, P less than 0.0001), re-catheterizations (33% vs 2.3%, P less than 0.0001) and cardiac re-procedures (16 vs 0, P = 0.0006) than BIMA patients. Recurrent-angina-free survival at 1 year was 96% after BIMA and 64% after MVP (P less than 0.01). Event-free survival at 1 year was 86% after BIMA and 58% after MVP (P less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- E Berreklouw
- Catharina Hospital, Department of Cardiopulmonary surgery, Eindhoven, The Netherlands
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