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Curio J, Nienaber S, Kuhn EW, Eghbalzadeh K, Ahmad W, Mehdiani A, Schröder J, Körber MI, Wienemann H, Baldus S, Adam M. Transcaval Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation Using a Dedicated Self-Expanding Device. JACC Case Rep 2024; 29:102320. [PMID: 38601848 PMCID: PMC11002802 DOI: 10.1016/j.jaccas.2024.102320] [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: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 04/12/2024]
Abstract
Novel dedicated devices allow transcatheter treatment of pure aortic regurgitation (AR). The JenaValve Trilogy Heart Valve System was introduced as the first dedicated and on-label AR transcatheter aortic valve replacement system, implementing a locator-based and calcium-independent anchoring mechanism. Here, we present the first-in-human transcatheter aortic valve replacement for pure AR via a transcaval access in a patient with prohibitive alternative arterial accesses.
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Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Stephan Nienaber
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Elmar W. Kuhn
- Department of Heart Surgery, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Heart Surgery, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Arash Mehdiani
- Department of Cardiac Surgery, Medical Faculty and Rheinisch-Westfälische Technische Hochschule (RWTH) University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jörg Schröder
- Department of Cardiology, Medical Faculty and RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Ehrenfels MA, Fretter C, von Stein J, Körber MI, Wienemann H, Baldus S, Pfister R, Iliadis C. Role of preexisting right ventricular remodeling in symptoms and prognosis after transcatheter tricuspid valve repair. Clin Res Cardiol 2024:10.1007/s00392-024-02428-z. [PMID: 38446149 DOI: 10.1007/s00392-024-02428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is associated with chronic volume overload and right ventricular remodeling (RVR). Transcatheter tricuspid valve repair (TTVr) reduces TR and can improve quality of life (QoL), but the role of preprocedural RVR on TTVr outcomes remains unclear. AIMS To investigate the role of RVR on outcomes after TTVr for severe TR. METHODS Consecutive patients undergoing TTVr (61% edge-to-edge vs. 39% direct annuloplasty) for severe TR were retrospectively compared by preexisting RVR which was defined as dilation of RV mid-level diameter (> 35 mm) according to guidelines. QoL was evaluated using NYHA class, Minnesota Living with Heart Failure Questionnaire (MLHFQ), 36-Item Short Form Health Survey (SF-36), and 6-min walking distance (6MWD) 1-month after TTVr. Mid-term mortality and heart failure (HF) hospitalization were assessed through 1 year. RESULTS RVR was present in 137 of 223 patients (61%). Symptoms and QoL improved equally in both groups: ≥ 1 NYHA class (57% vs. 65% of patients with vs. without RVR, respectively), 6MWD (36% vs. 34%), MLHFQ (81% vs. 69%), and SF-36 (68% vs. 65%) improvement. One-year mortality and HF hospitalization were significantly higher in patients with RVR (24% and 30%, respectively) than in patients without (8% and 13%, both p < 0.05). In multivariable analysis, RVR was independently associated with mortality (HR 2.3, 95%CI (1.0-5.0), p = 0.04) and the combined endpoint of mortality or rehospitalization (HR 2.0, 95%CI (1.1-3.8), p = 0.03). CONCLUSIONS TTVr was associated with significant QoL improvement after 1 month, irrespective of RVR. Despite increased mortality and rehospitalization for heart failure, TTVr in the presence of RVR still provides substantial symptomatic benefit for patients with severe TR.
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Affiliation(s)
- Marc-André Ehrenfels
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Caroline Fretter
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jennifer von Stein
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hendrik Wienemann
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Stephan Baldus
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
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Gietzen T, Althoff J, Ochs L, Gerçek M, von Stein J, Hasse C, Iliadis C, Friedrichs K, Rudolph V, Baldus S, Pfister R, Körber MI. Incidence and clinical impact of renal failure and bleeding following transcatheter tricuspid valve annuloplasty. Clin Res Cardiol 2024:10.1007/s00392-024-02388-4. [PMID: 38358419 DOI: 10.1007/s00392-024-02388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Bleeding is the most common complication after percutaneous leaflet-based tricuspid valve repair and associated with acute kidney injury (AKI) and adverse outcome. TTVA with the Cardioband system is a technically more complex procedure; however, frequency and prognostic impact of postinterventional bleeding and renal complications have not been thoroughly examined. AIMS This study was performed to determine the incidence and clinical impact of bleeding complications (MVARC criteria) and acute kidney injury (KDIGO criteria) following transcatheter tricuspid valve annuloplasty (TTVA). METHODS In a bi-center retrospective analysis of patients undergoing TTVA between 2018 and 2022, we examined frequency, predictors, and clinical impact of bleeding and renal failure. RESULTS In 145 consecutive patients, the incidence of any MVARC bleeding was 20.7% (n = 30), whereas major MVARC bleeding occurred in 6.9% (n = 10). The incidence of AKI was 18.6% (n = 27). Risk factors for bleeding events included low baseline hemoglobin and elevated baseline creatinine levels. Risk factors for AKI included diabetes mellitus, arterial hypertension, high body mass index, and elevated baseline creatinine levels. Neither procedure duration nor amount of contrast media was associated with AKI or bleeding. Both bleeding and AKI led to a longer hospital stay. At 3 months, 10.0% (n = 3) of patients with bleeding and 7.8% (n = 9) of patients without bleeding complications died (p = 0.70). Additionally, mortality rate was 7.4% (n = 2) in patients with AKI compared to 8.5% (n = 10) without AKI (p = 0.83). CONCLUSION While about a fifth of patients undergoing TTVA suffered from postinterventional AKI or bleeding, none of these complications was associated with higher mortality at short-term follow-up. One important risk factor for both complications was chronic renal dysfunction, indicating a high-risk patient population. The most frequent bleeding localizations were the femoral access site, pericardial hemorrhage, and the esophagus, which need explicit attention in periprocedural management.
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Affiliation(s)
- Thorsten Gietzen
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Jan Althoff
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Muhammed Gerçek
- Clinic of General and Interventional Cardiology/Angiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jennifer von Stein
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Caroline Hasse
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Friedrichs
- Clinic of General and Interventional Cardiology/Angiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic of General and Interventional Cardiology/Angiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Schäfer M, Nöth H, Metze C, Iliadis C, Körber MI, Halbach M, Baldus S, Pfister R. Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair. Clin Res Cardiol 2024:10.1007/s00392-024-02397-3. [PMID: 38358418 DOI: 10.1007/s00392-024-02397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Frailty is common in elderly and multimorbid patients and associated with increased vulnerability to stressors. METHODS In a single centre study frailty according to Fried criteria was assessed in consecutive patients before transcatheter mitral and tricuspid valve repair. Postprocedural infections, blood transfusion and bleeding and renal failure were retrospectively assessed from records. Median follow-up time for survival was 560 days (IQR: 363 to 730 days). RESULTS 90% of 626 patients underwent mitral valve repair, 5% tricuspid valve repair, and 5% simultaneous mitral and tricuspid valve repair. 47% were classified as frail. Frailty was associated with a significantly increased frequency of bleeding (16 vs 10%; p = 0.016), blood transfusions (9 vs 3%; p = < 0.001) and infections (18 vs 10%; p = 0.006), but not with acute kidney injury (20 vs 20%; p = 1.00). Bleeding and infections were associated with longer hospital stays, with a more pronounced effect in frail patients (interaction test p < 0.05, additional 3.2 and 4.1 days in frail patients, respectively). Adjustment for the occurrence of complications did not attenuate the increased risk of mortality associated with frailty (HR 2.24 [95% CI 1.62-3.10]; p < 0.001). CONCLUSIONS Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.
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Affiliation(s)
- Matthieu Schäfer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany.
| | - Hannah Nöth
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Clemens Metze
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Maria Isabel Körber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Marcel Halbach
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
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Ochs L, Körber MI, Wienemann H, Tichelbäcker T, Iliadis C, Metze C, Brüwer M, Schmidt T, Omran H, Fortmeier V, Friedrich K, Rudolph V, Baldus S, Pfister R. Comparison of transcatheter leaflet-approximation and direct annuloplasty in tricuspid regurgitation. Clin Res Cardiol 2024; 113:126-137. [PMID: 37642720 PMCID: PMC10808287 DOI: 10.1007/s00392-023-02287-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Transcatheter repair emerges as a treatment option in patients with tricuspid regurgitation (TR) and high surgical risk. AIMS This study aimed to compare leaflet-based and annuloplasty-based transcatheter repair in patients with TR. METHODS In a retrospective analysis consecutive patients undergoing either transcatheter edge-to-edge repair (TEER) or direct annuloplasty (AP) for relevant TR at 2 centers were compared with respect to baseline characteristics, procedural efficacy and safety (death, myocardial infarction, procedure or device-related cardiothoracic surgery, or stroke at 30 days). RESULTS 161 patients (57% female, median age 79 [75-82] years) with comparable clinical baseline characteristics in the TEER (n = 87) and AP (n = 74) group were examined. Baseline TR grade was significantly less severe in the TEER compared to the AP group (torrential 9.2 vs. 31.1%, p = 0.001). Technical success and improvement of TR grades were not significantly different across groups. In analysis matched for baseline TR severity, reduction of TR grade to less than moderate was significantly more common in the AP group (47.8 vs. 26.1%, p = 0.031). Major or more severe bleeding occurred in 9.2% of TEER and 20.3% of AP patients (p = 0.049) without any fatal bleedings. Major adverse events (MAE) were similar across groups with four patients (4.7%) in the TEER group and five patients (6.9%) in the AP group (p = 0.733) and 6-month survival did not differ significantly. CONCLUSIONS Differences observed between patients treated with TEER and AP provide first evidence for tailoring distinct transcatheter treatment techniques to individual patient characteristics.
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Affiliation(s)
- Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tobias Tichelbäcker
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Clemens Metze
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Monique Brüwer
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Hazem Omran
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kai Friedrich
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Curio J, Kuhn EW, Körber MI, Baldus S, Khan JM, Adam M. Electrosurgical laceration and stabilisation of three clip devices (ELASTA-Clip) to enable transcatheter mitral valve implantation. EUROINTERVENTION 2023; 19:744-745. [PMID: 37982165 PMCID: PMC10658197 DOI: 10.4244/eij-d-23-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Jonathan Curio
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Elmar W Kuhn
- Department of Heart Surgery, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, D.C., USA
- Department of Interventional Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, USA
| | - Matti Adam
- Department of Cardiology, Heart Center Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Wienemann H, Mauri V, Ochs L, Körber MI, Eghbalzadeh K, Iliadis C, Halbach M, Wahlers T, Baldus S, Adam M, Kuhn E. Contemporary treatment of mitral valve disease with transcatheter mitral valve implantation. Clin Res Cardiol 2023; 112:571-584. [PMID: 36107228 PMCID: PMC10159974 DOI: 10.1007/s00392-022-02095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) with self-expanding (SAV) or balloon-expandable (BAV) valves are rising as promising treatment options for high-risk patients with symptomatic mitral valve (MVD) disease unsuitable for alternative treatment options. AIMS The aim of this study was to examine the clinical, procedural and outcome parameters of patients undergoing SAV or BAV for MVD. METHODS In this observational and single-center case series, fifteen consecutive patients treated with the Tendyne Mitral Valve System (SAV) and thirty-one patients treated with SAPIEN prosthesis (BAV) were included. RESULTS The patients (aged 78 years [interquartile range (IQR): 65.5 to 83.1 years], 41% women, EuroSCORE II 10.3% [IQR: 5.5 to 17.0%] were similar regarding baseline characteristics, despite a higher rate of prior heart valve surgery and prevalence of MV stenosis in the SAV-group. At discharge, the SAV-group had a mean transvalvular gradient of 4.2 mmHg, whereas the BAV-group had a mean transvalvular gradient of 6.2 mmHg. None or trace paravalvular leakage (PVL) was assessed in 85% in SAV-group and 80% in the BAV-group. 320 day all-cause and cardiac mortality rates were comparable in both groups (SAV: 26.7% vs BAV: 20%, p = 0.60). Four deaths occurred early in the SAV-group until 32 days of follow-up. CONCLUSIONS In high-risk patients with MVD, TMVI presents a promising treatment option with encouraging mid-term outcomes and good valve durability. TMVI either with BAV or SAV may be developed to an established treatment option.
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Affiliation(s)
- Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany.
| | - Victor Mauri
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Marcel Halbach
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Elmar Kuhn
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
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Körber MI, Roder F, Gerçek M, Koell B, Kalbacher D, Iliadis C, Brüwer M, Friedrichs KP, Rudolph V, Baldus S, Pfister R. Leaflet Morphology and its Implications for Direct Transcatheter Annuloplasty of Tricuspid Regurgitation. JACC Cardiovasc Interv 2023; 16:693-702. [PMID: 36990560 DOI: 10.1016/j.jcin.2023.01.364] [Citation(s) in RCA: 2] [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: 05/25/2022] [Revised: 01/09/2023] [Accepted: 01/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Leaflet morphology has been associated with treatment success in edge-to-edge repair of tricuspid regurgitation (TR), but the impact on annuloplasty is unclear. OBJECTIVES The authors sought to examine the association of leaflet morphology with efficacy and safety of direct annuloplasty in TR. METHODS The authors analyzed patients who underwent catheter-based direct annuloplasty with the Cardioband at 3 centers. Leaflet morphology was assessed according to number and location of leaflets by echocardiography. Patients with simple morphology (2 or 3 leaflets) were compared with complex morphology (>3 leaflets). RESULTS The study included 120 patients (median age 80 years) with ≥severe TR. A total of 48.3% of patients had a 3-leaflet morphology, 5% a 2-leaflet morphology, and 46.7% had >3 tricuspid leaflets. Baseline characteristics did not differ relevantly between groups except for a higher incidence of torrential TR grade (50 vs 26.6%) in complex morphologies. Postprocedural improvement of 1 (90.6% vs 92.9%) and 2 (71.9% vs 67.9%) TR grades was not significantly different between groups, but patients with complex morphology had more often residual TR ≥3 at discharge (48.2 vs 26.6%; P = 0.014). This difference did not remain significant (P = 0.112) after adjusting for baseline TR severity, coaptation gap, and nonanterior jet localization. Safety endpoints including complications of the right coronary artery, and technical success did not show significant differences. CONCLUSIONS Efficacy and safety of transcatheter direct annuloplasty using Cardioband are not affected by leaflet morphology. Assessment of leaflet morphology should be part of procedural planning in patients with TR and might help to individually tailor repair techniques to patient anatomy.
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Affiliation(s)
- Maria Isabel Körber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany.
| | - Fabian Roder
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Benedikt Koell
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Daniel Kalbacher
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
| | - Monique Brüwer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
| | - Kai Peter Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
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9
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Baldus S, Schofer N, Hausleiter J, Friedrichs K, Lurz P, Luedike P, Frerker C, Nickenig G, Lubos E, Pfister R, Körber MI, Kalbacher D, Näbauer M, Besler C, Mahabadi AA, Weber M, Zdanyte M, Ren CB, Geisler T. Transcatheter valve repair of tricuspid regurgitation with the PASCAL system: TriCLASP study 30-day results. Catheter Cardiovasc Interv 2022; 100:1291-1299. [PMID: 36378678 DOI: 10.1002/ccd.30450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/11/2022] [Revised: 08/17/2022] [Accepted: 10/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is independently associated with increased morbidity and mortality. Percutaneous transcatheter approaches may offer an alternative for patients not amenable to surgery. METHODS TriCLASP is a prospective, single-arm, multicenter European post-market clinical follow-up study (NCT04614402) to evaluate the safety and performance of the PASCAL system (Edwards Lifesciences) in patients with severe or greater TR. At 30 days, a composite of major adverse events (MAEs) adjudicated by a clinical events committee, echocardiographic parameters adjudicated by core laboratory, and clinical, functional, and quality-of-life measures were evaluated. RESULTS Mean age of the 74 enrolled patients was 80.3 years, with 58.1% female, 90.5% systemic hypertension, and 77.0% in New York Heart Association (NYHA) class III/IV. Mean Society for Thoracic Surgeons score (MV repair) was 9.0%. TR severity was significantly reduced at discharge (p < 0.001) and sustained at 30 days (p < 0.001), and 90.0% of patients achieved ≤moderate TR. The composite MAE rate at 30 days was 3.0%, including 4 events in 2 patients: cardiovascular mortality 1.5%, stroke 1.5%, renal complications requiring unplanned dialysis or renal replacement therapy 1.5%, and severe bleeding 1.5%. There were no nonelective tricuspid valve reinterventions, major access site and vascular complications, major cardiac structural complications, or device embolizations. NYHA class I/II was achieved in 55.8%, 6-minute walk distance improved by 38.2 m (p < 0.001), and Kansas City cardiomyopathy questionnaire scores improved by 13.4 points (p < 0.001). CONCLUSION Experience with the PASCAL transcatheter valve repair system in a European post-market setting confirms favorable safety and effectiveness at 30 days. TR significantly reduced, and clinical, functional, and quality-of-life outcomes significantly improved. This study is ongoing. Clinical Trial Registration: The study is ongoing and registered on ClinicalTrials.gov as NCT04614402. The current analysis is an interim report.
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Affiliation(s)
- Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - P Lurz
- Herzzentrum Leipzig, Leipzig, Germany
| | - Philipp Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | | | - G Nickenig
- Universitätsklinikum Bonn, Bonn, Germany
| | - Edith Lubos
- Katholisches Marienkrankenhaus, Hamburg, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - M I Körber
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - C Besler
- Herzzentrum Leipzig, Leipzig, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | | | - M Zdanyte
- University Hospital Tübingen, Tübingen, Germany
| | - C B Ren
- Cardialysis, Rotterdam, The Netherlands
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10
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Körber MI, Rudolph V. Funktionelle Trikuspidalklappeninsuffizienz – Klinische und echokardiografische Parameter für die Auswahl von Patient und Verfahren. Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1912-5094] [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: 11/06/2022]
Abstract
ZusammenfassungDie sekundäre Trikuspidalklappeninsuffizienz (TI) ist ein häufiger Klappenfehler und führt oft erst in fortgeschrittenen Stadien zu Symptomen. Die Prognose von betroffenen Patienten ist
eingeschränkt und die perioperative Letalität bei konventioneller Chirurgie der isolierten TI hoch, sodass kathetergestützte Verfahren einen enormen technischen Fortschritt in den letzten
Jahren gemacht haben. Zudem hat die anatomische und auch klinische Patientenauswahl an Bedeutung gewonnen, da sowohl in der klinischen Präsentation als auch in der individuellen Anatomie der
Trikuspidalklappe eine große Variabilität herrscht. Klinisch ist bzw. sind insbesondere das Vorhandensein einer (präkapillären) pulmonalen Hypertonie oder fortgeschrittene Stadien des
Rechtsherz-Remodelings mit einer reduzierten Prognose nach kathetergestützten Eingriffen assoziiert. Zudem sind relevante Komorbiditäten und funktionelle Fitness/Gebrechlichkeit zu
evaluieren. Echokardiografisch ist die funktionelle TI durch eine Anulus- und/oder rechtsventrikuläre bzw. rechtsatriale Dilatation gekennzeichnet, welche zu Koaptationsdefekten der
Trikuspidalklappensegel und einer Zügelung der Segel („Tethering“) führen können. Die Ausprägung dieser Parameter sowie die Anulusgröße, der Schweregrad der TI und das Vorhandensein von
transvalvulären Sonden im Bezug zur Trikuspidalklappe sind die wichtigsten echokardiografischen Parameter, die in die Patientenauswahl einfließen müssen.
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Affiliation(s)
- Maria Isabel Körber
- Herzzentrum der Universität Köln, Klinik III für Innere Medizin, Köln, Deutschland
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
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11
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Omran H, Pfister R, Ehrenfels MA, Körber MI, Baldus S, Friedrichs K, Rudolph V, Iliadis C. Prognostic Performance of the Surgical TRI-SCORE Risk Score in Patients Undergoing Transcatheter Tricuspid Valve Treatment. JACC Cardiovasc Interv 2022; 15:1996-1998. [DOI: 10.1016/j.jcin.2022.05.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022]
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12
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Tichelbäcker T, Körber MI, Mauri V, Iliadis C, Metze C, Adler C, Baldus S, Rudolph V, Halbach M, Pfister R, Ten Freyhaus H. Prevalence of left ventricular thrombus formation after mitral valve edge-to-edge repair. Sci Rep 2022; 12:9096. [PMID: 35641530 PMCID: PMC9156712 DOI: 10.1038/s41598-022-12944-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/27/2021] [Accepted: 05/19/2022] [Indexed: 12/05/2022] Open
Abstract
The prevalence of left ventricular (LV) thrombus formation following percutaneous mitral valve edge-to-edge repair (TMVR) with the MitraClip system is unclear. Decreased total stroke volume and perfusion of the LV apex after mitral valve repair may facilitate thrombus formation especially in the context of reduced LV function. LV thrombus may cause disabling stroke or other thromboembolic events in this elderly and multimorbid patient cohort. Analyses of the prevalence of and risk factors for left ventricular thrombus formation in patients treated with the MitraClip system due to severe mitral valve regurgitation. All discharge and follow-up transthoracic echocardiographic examinations up to 6 months of 453 consecutive patients treated with the MitraClip system were screened for the presence of LV thrombus. Prevalence of LV thrombus formation was 1.1% (5/453). Importantly, LV thrombi were exclusively found in patients with severely depressed left ventricular systolic function (LV-EF < 30%), comprising a prevalence of 4.4% in this subgroup (5/113). Importantly, two of these patients were under active DOAC therapy with Rivaroxaban and Apixaban, respectively. Apart from LV-EF, we did not identify other factors that might have facilitated LV thrombus formation. LV thrombus formation following percutaneous mitral valve repair occurred exclusively in patients with severely depressed LV-EF. As two patients developed LV thrombus despite of DOAC therapy, anticoagulation with a Vitamin K antagonist should be considered in patients with an indication for oral anticoagulation following TMVR.
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Affiliation(s)
- Tobias Tichelbäcker
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Clemens Metze
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Christoph Adler
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Marcel Halbach
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Henrik Ten Freyhaus
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany. .,Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany.
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13
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Körber MI, Friedrichs KP, Aydin F, Pfister R, Mauri V, Baldus S, Rudolph V, Huntgeburth M. Impact of cleft-like indentations on procedural outcome of percutaneous edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2021; 97:1236-1243. [PMID: 33002279 DOI: 10.1002/ccd.29286] [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: 04/07/2020] [Revised: 08/07/2020] [Accepted: 09/13/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES AND BACKGROUND Percutaneous edge-to-edge mitral valve (MV) repair (PMVR) is broadly applied in high-risk patients with relevant mitral regurgitation (MR). We investigated the incidence of cleft-like indentations (CLI) and their impact on PMVR. METHODS AND RESULTS In a retrospective single center analysis including 263 patients undergoing PMVR with the MitraClip®-system between 11/2012 and 7/2016, MV anatomy was assessed by 3-dimensional transesophageal echocardiography. CLI were present in 37/263 patients (14.1%). Of these, 62.2% had 1 CLI, 27% had 2 CLI, and 10.8% had 3 CLI, mostly concerning segment P2 or P2/3 of the MV. Baseline characteristics were similarly distributed. Interestingly, most patients with CLI suffered from secondary MR (n = 29, 78%). The number of deployed MitraClips was higher in patients with CLI (2 [1.25-2] vs. 2 [1, 2], p = .035), whereas procedural as well as clinical success was similar: MR grade (1.2 vs. 1.5, p = .061), vena contracta width (4.2 vs. 4.5 mm, p = .293), dPmean (4.2 vs. 4.0 mmHg, p = .618) at discharge and NYHA class at 30 days did not differ between groups. Periprocedural complications were rare and equally distributed between groups. At 30 days, MR reduction persisted in patients with CLI (95.8% of these selected patients had a MR grade ≤ 2). CONCLUSIONS CLI of the MV are common in patients undergoing PMVR, also when presenting mainly with secondary MR. While the number of clips needed to address MR is slightly higher in patients with CLI, procedural success rates appear not to be affected. PMVR seems to be a safe treatment option for patients with CLI.
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Affiliation(s)
- Maria Isabel Körber
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Kai Peter Friedrichs
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Fatma Aydin
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Roman Pfister
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Victor Mauri
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Huntgeburth
- Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Medical Faculty, University Hospital of Cologne, Cologne, Germany
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14
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Mauri V, Frohn T, Deuschl F, Mohemed K, Kuhr K, Reimann A, Körber MI, Schofer N, Adam M, Friedrichs K, Kuhn EW, Scholtz S, Rudolph V, Wahlers TCW, Baldus S, Mader N, Schäfer U, Rudolph TK. Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices. Open Heart 2020; 7:openhrt-2019-001164. [PMID: 32393655 PMCID: PMC7223472 DOI: 10.1136/openhrt-2019-001164] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 08/30/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Residual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves. METHODS 642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge. RESULTS PVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR. CONCLUSIONS The susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.
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Affiliation(s)
- Victor Mauri
- Heart Center, University of Cologne, Koln, Germany
| | - Thomas Frohn
- Heart Center, University of Cologne, Koln, Germany
| | - Florian Deuschl
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Kawa Mohemed
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Kathrin Kuhr
- Heart Center, University of Cologne, Koln, Germany
| | | | | | - Niklas Schofer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Matti Adam
- Heart Center, University of Cologne, Koln, Germany
| | - Kai Friedrichs
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Heart Center, University of Cologne, Koln, Germany
| | - Smita Scholtz
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Volker Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Ulrich Schäfer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Tanja K Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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15
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Iliadis C, Metze C, Körber MI, Baldus S, Pfister R. Impact of COAPT trial exclusion criteria in real-world patients undergoing transcatheter mitral valve repair. Int J Cardiol 2020; 316:189-194. [DOI: 10.1016/j.ijcard.2020.05.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 01/10/2023]
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Iliadis C, Metze C, Körber MI, Baldus S, Pfister R. Association of iron deficiency, anaemia, and functional outcomes in patients undergoing edge-to-edge mitral valve repair. ESC Heart Fail 2020; 7:2379-2387. [PMID: 32621385 PMCID: PMC7524056 DOI: 10.1002/ehf2.12778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/18/2019] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/13/2022] Open
Abstract
AIMS Patients undergoing percutaneous mitral valve repair (PMVR) show a substantial heterogeneity of prognostic and symptomatic benefit. Iron deficiency and anaemia are associated with worse outcomes in heart failure patients. We investigated the impact of these comorbidities on functional and clinical outcome after PMVR. METHODS AND RESULTS Iron deficiency and anaemia were prospectively assessed in 130 patients undergoing PMVR with MitraClip. Associations with functional outcomes at 6 weeks [6 min walking distance (6MWD), Short-Form-36 physical component score, and Minnesota Living with Heart Failure Questionnaire score, New York Heart Association class] and long-term clinical outcome were examined. Iron deficiency and anaemia were frequent with 52% and 50%, respectively. Patients with anaemia showed significant worse baseline functional measures, whereas patients with iron deficiency showed only a trend for lower baseline 6MWD. The benefit in functional outcomes after PMVR was notable and did not differ significantly by iron deficiency or anaemia status (range of median changes in 6MWD 35 to 45 m, physical component score 5.6 to 7.2, Minnesota Living with Heart Failure Questionnaire -8.0 to -10.5; improvement of ≥1 New York Heart Association class 69% to 80%). Anaemia was associated with higher risk for the combined endpoint of mortality and heart failure hospitalization (hazard ratio: 2.51; 95% confidence interval: 1.24-5.1; P = 0.01), whereas iron deficiency showed a trend towards more heart failure hospitalizations (hazard ratio: 2.94; 95% confidence interval: 0.94-9.03; P = 0.09). CONCLUSIONS The prevalence of iron deficiency and anaemia is high in patients undergoing MitraClip. Clinical baseline status and long-term outcome were worse particularly in patients with anaemia. However, the functional benefit of PMVR was equal in patients with and without iron deficiency and anaemia.
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Affiliation(s)
- Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Clemens Metze
- Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
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Körber MI, Pfister R, Baldus S. [Interventional Treatment of the Mitral Valve - An Update 2019]. Dtsch Med Wochenschr 2019; 144:1553-1560. [PMID: 31658479 DOI: 10.1055/a-0832-5727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mitral regurgitation (MR) is one of the most common valvular defects in the eldery. In patients suffering from heart failure, secondary MR is common and associated with worse prognosis. Due to the usually very high operative risk these patients are immensely under-treated. This leads to an increased need for interventional treatment strategies. Until now there were no randomized data regarding the prognostic impact of interventional treatment of secondary MR. This article is supposed to sum up evidence derived from recent studies regarding this issue. Finally we will provide an outlook on catheter-based mitral valve prothesis.
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Frerker C, Schmidt T, Pfister R, Körber MI, Mauri V, Wösten M, Baldus S. [Cardioband®: Where do we stand, who are suitable patients?]. Herz 2019; 44:596-601. [PMID: 31372675 DOI: 10.1007/s00059-019-4839-y] [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] [Indexed: 11/28/2022]
Abstract
Functional mitral regurgitation (FMR) is characterized by a dilatation of the mitral valve annulus resulting in an insufficient adaptation of the anterior and posterior mitral valve leaflets and/or severe tethering of the leaflets due to dilatation of the left ventricle. The Cardioband® system was introduced in 2015 and is a catheter-based direct mitral valve annuloplasty procedure for treatment of FMR. In the European CE approval study 60 patients with moderate or severe FMR were analyzed per protocol. There were no device or procedure-related deaths. The technical success rate of the procedure, defined as successful implantation and tightening was 97%. At 1 year, the overall survival and survival free of hospital readmission for heart failure were 87% and 66%, respectively. Currently, various interventional treatment procedures are available, such as the edge-to-edge technique as well as direct and indirect annuloplasty. In summary, patients with FMR as a result of a dilatation of the mitral valve annulus appear to be suitable for direct annuloplasty with the Cardioband® system.
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Affiliation(s)
- C Frerker
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Schmidt
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M I Körber
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - V Mauri
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M Wösten
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Braun D, Frerker C, Körber MI, Gaemperli O, Patzelt J, Schaefer U, Hammerstingl C, Boekstegers P, Ott I, Ince H, Thiele H, Hausleiter J. Percutaneous Edge-to-Edge Repair of Recurrent Severe Mitral Regurgitation After Surgical Mitral Valve Repair. J Am Coll Cardiol 2019; 70:504-505. [PMID: 28728696 DOI: 10.1016/j.jacc.2017.05.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
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Körber MI, Scherner M, Kuhr K, Kasisada H, Ney S, Pfister R, Rahmanian P, Wippermann J, Wahlers T, Baldus S, Rudolph V. Acute kidney injury following percutaneous edge-to-edge vs. minimally invasive surgical mitral valve repair: incidence, predictors and prognostic value. EUROINTERVENTION 2018; 13:1645-1651. [DOI: 10.4244/eij-d-17-00131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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]
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Körber MI, Silwedel J, Friedrichs K, Mauri V, Huntgeburth M, Pfister R, Baldus S, Rudolph V. Bleeding Complications After Percutaneous Mitral Valve Repair With the MitraClip. Am J Cardiol 2018; 121:94-99. [PMID: 29122275 DOI: 10.1016/j.amjcard.2017.09.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/15/2022]
Abstract
Bleeding after cardiac surgery or cardiovascular interventions is associated with worse patient outcome. Only very limited data are available on the subject of bleeding after percutaneous edge-to-edge mitral valve repair (PMVR). We performed a single center analysis including 347 consecutive patients who underwent PMVR. Bleeding was defined according to the Mitral Valve Academic Research Consortium (MVARC) end point definition. The incidence of MVARC bleeding was 21.6% (n = 75), whereas major MVARC bleeding (hemoglobin decrease ≥3 g/dl) occurred in 7.4% (n = 26). Only 33.3% of all bleeding cases were access site-related. In multivariate regression analyses, independent predictors of MVARC bleeding were the presence of coronary artery disease (2.809, 95% CI 1.123 to 7.022, p = 0.027) and intervention duration (1.010, 95% CI 1.002 to 1.018, p = 0.010). Patients experiencing MVARC bleeding had longer hospital stays (p = 0.026); however, neither major nor extensive MVARC bleeding was associated with increased 30-day or 1-year mortality. A decrease in hemoglobin levels ≥3 g/dl without clinically visible bleeding sign-not considered in the MVARC bleeding definition-occurred in 9.5% of patients. A hemoglobin decrease of ≥4 g/dl had a strong association with worse survival in those patients with obscure bleeding. In conclusion, these data show a relevant incidence of bleeding after PMVR. In contrast to other cardiovascular interventions, the majority of bleedings were not access site-related. Particularly, patients with obscure bleeding, which are not included in the MVARC end point definitions, had worse outcomes and should therefore be considered for a more intensive workup.
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Affiliation(s)
- Maria Isabel Körber
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Julia Silwedel
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Kai Friedrichs
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Victor Mauri
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Michael Huntgeburth
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany
| | - Volker Rudolph
- Department III of Internal Medicine, Heart Center Cologne, University of Cologne, Cologne, Germany.
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Schönwald C, Körber MI, Beutner D, Pfister R, Frank K, Guntinas-Lichius O, Michels G. Short-term and long-term follow-up of pulmonary function in patients with COPD after total laryngectomy: A prospective study. Laryngoscope 2017; 127:2045-2049. [PMID: 28093768 DOI: 10.1002/lary.26484] [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] [Received: 07/08/2016] [Revised: 11/10/2016] [Accepted: 12/05/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There exists no standardized method for examining lung function in laryngectomized patients. STUDY DESIGN AND METHODS We established a base plate adapter (BPA) system for patients after laryngectomy. In 10 patients with chronic obstructive pulmonary disease (COPD), we evaluated pulmonary function before laryngectomy, as well as 2 weeks and 3 months after laryngectomy. RESULTS The BPA system was well tolerated and delivered reliable results comparable to measurements with a mouthpiece. The parameters forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and mean forced expiratory flow between 25% and 75% of forced vital capacity (MFEF25-75 ) changed in the early postoperative examinations (2 weeks postoperative), whereas MFEF25-75 , FEF75 , peak expiratory flow (PEF), and peak inspiratory flow (PIF)) showed differences from baseline in long-term follow-up (3 months postoperative). CONCLUSION We provide a practicable method of lung function testing in laryngectomized patients with COPD that is essential to tailor inhalation therapy despite tracheotomy. Lung function measurements of laryngectomized patients with COPD should be performed under stable clinical conditions a few weeks after surgery. Guidelines of COPD might be complemented considering the subgroup of laryngectomized patients. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2045-2049, 2017.
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Affiliation(s)
- Charlotte Schönwald
- Department III of Internal Medicine, University of Cologne, Cologne, Germany
| | - Maria Isabel Körber
- Department III of Internal Medicine, University of Cologne, Cologne, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, University of Cologne, Cologne, Germany
| | - Konrad Frank
- Department III of Internal Medicine, University of Cologne, Cologne, Germany
| | | | - Guido Michels
- Department III of Internal Medicine, University of Cologne, Cologne, Germany
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Körber MI, Köhler T, Weiss V, Pfister R, Michels G. Quality of Basic Life Support - A Comparison between Medical Students and Paramedics. J Clin Diagn Res 2016; 10:OC33-7. [PMID: 27630885 DOI: 10.7860/jcdr/2016/19221.8197] [Citation(s) in RCA: 3] [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: 02/03/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Poor survival rates after cardiac arrest can partly be explained by poor basic life support skills in medical professionals. AIM This study aimed to assess quality of basic life support in medical students and paramedics. MATERIALS AND METHODS We conducted a prospective observational study with 100 early medical students (group A), 100 late medical students (group B) and 100 paramedics (group C), performing a 20-minute basic life support simulation in teams of two. Average frequency and absolute number of chest compressions per minute (mean (±SD)), chest decompression (millimetres of compression remaining, mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching positions between ventilation and chest compression (per 20 minutes) and rate of sufficient compressions (depth ≥50mm) were assessed as quality parameters of CPR. RESULTS In groups A, B and C the rates of sufficiently deep chest compressions were 56%, 42% and 52%, respectively, without significant differences. Male gender and real-life CPR experience were significantly associated with deeper chest compression. Frequency and number of chest compressions were within recommended goals in at least 96% of all groups. Remaining chest compressions were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and 4s/min (±1), which was significantly different across all three groups. CONCLUSION Overall, paramedics tended to show better quality of CPR compared to medical students. Though, chest compression depth as an important quality characteristic of CPR was insufficient in almost 50% of participants, even in well trained paramedics. Therefore, we suggest that an effort should be made to find better ways to educate health care professionals in BLS.
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Affiliation(s)
- Maria Isabel Körber
- Department III of Internal Medicine, University of Cologne , Heart Center, Germany
| | - Thomas Köhler
- Department III of Internal Medicine, University of Cologne , Heart Center, Germany
| | - Verena Weiss
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne , Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, University of Cologne , Heart Center, Germany
| | - Guido Michels
- Department III of Internal Medicine, University of Cologne , Heart Center, Germany
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Körber MI, Staribacher A, Ratzenböck I, Steger G, Mader RM. NFκB-Associated Pathways in Progression of Chemoresistance to 5-Fluorouracil in an In Vitro Model of Colonic Carcinoma. Anticancer Res 2016; 36:1631-1639. [PMID: 27069140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Drug resistance to 5-fluorouracil (5-FU) is a major obstacle in colonic cancer treatment. Activation of nuclear factor-kappa B (NFκB), mitogen-activated protein kinase kinase kinase 8 (MAP3K8) and protein kinase B (AKT) is thought to protect cancer cells against therapy-induced cytotoxicity. MATERIALS AND METHODS Using cytotoxicity assays and immunoblotting, the impact of inhibitory strategies addressing NFκB, AKT and MAP3K8 in chemoresistance was evaluated in a colonic cancer model in vitro. This model consisted of the cell lines SW480 and SW620, and three subclones with increasing degrees of chemoresistance in order to mimic the development of secondary resistance. RESULTS NFκB protein p65 was selectively activated in all resistant cell lines. Consequently, several inhibitors of NFκB, MAP3K8 and AKT effectively circumvented this chemoresistance. As a cellular reaction, NFκB inhibition may trigger a feedback loop resulting in activation of extracellular signal-regulated kinase. The results suggest that chemoresistance to 5-FU in this colonic carcinoma model (cell lines SW480 and SW620) is strongly dependent on NFκB activation. The efficacy of MAP3K8 inhibition in our model potentially uncovers a new mechanism to circumvent 5-FU resistance.
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Affiliation(s)
- Maria Isabel Körber
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Anna Staribacher
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Ina Ratzenböck
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Günther Steger
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Robert M Mader
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
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