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Elghannam M, Useini D, Moustafine V, Bechtel M, Naraghi H, Strauch JT, Haldenwang PL. Minimally Invasive versus Conventional Aortic Root Surgery: Results of an Intermediate-Volume Center. Thorac Cardiovasc Surg 2024; 72:118-125. [PMID: 37040869 DOI: 10.1055/a-2041-3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND We evaluate the outcome of aortic root surgery via an upper J: -shaped mini-sternotomy (MS) versus full sternotomy (FS) in an intermediate-volume center. METHODS Between November 2011 and February 2019, 94 consecutive patients underwent aortic root surgery: 62 (66%) patients were operated via a J: -shaped MS (group A) and 32 (34%) patients via FS (group B). The primary endpoints were mortality, major adverse cardiac and cerebral events (MACCE), and reoperation in a 2-year follow-up. The secondary endpoints were perioperative complications and patient's satisfaction with the procedural results. RESULTS Valve sparing root replacement (David procedure) was performed in 13 (21%) of the MS and 7 (22%) of the FS patients. The Bentall procedure in MS versus FS was 49 (79%) versus 25 (78%), respectively. Both groups presented similar mean operation, cardiopulmonary bypass, and cross-clamp times. Postoperative bleeding was 534 ± 300 and 755 ± 402 mL (p = 0.01) in MS and FS, respectively, erythrocyte concentrate substitution was 3 ± 3 and 5.3 ± 4.8 (p = 0.018) in MS and FS, respectively, and pneumonia rates were 0 and 9.4% (p = 0.03) in MS and FS, respectively. The 30-day mortality was 0% in both groups, whereas MACCE was 1.6 and 3% (p = 0.45) in MS and FS, respectively. After 2 years, the mortality and MACCE were 4.6 and 9.5% (p = 0.11) and 4.6 and 0% (p = 0.66) in MS and FS, respectively. The number of patients who were satisfied with the surgical cosmetic results in groups A and B was 53 (85.4%) and 26 (81%), respectively. CONCLUSION Aortic root surgery via MS is a safe alternative to FS even in an intermediate-volume center. It offers a shorter recovery time and similar midterm results.
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Affiliation(s)
- Mahmoud Elghannam
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Justus T Strauch
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Nordrhein-Westfalen, Germany
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Schlömicher M, Useini D, Haldenwang PL, Naraghi H, Moustafine V, Bechtel M, Strauch JT. Outcomes in Patients with Left Bundle Branch Block after Rapid Deployment Aortic Valve Replacement. Thorac Cardiovasc Surg 2023; 71:528-534. [PMID: 35108737 DOI: 10.1055/s-0042-1742361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Increased rates of postoperative left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) frequently occur after implantation of rapid deployment valves. The impact of LBBB on follow-up outcomes remains controversial. So far, no data regarding long-term outcomes exist. AIM The aim of this study was to analyze the impact of LBBB on postoperative outcomes after rapid deployment aortic valve replacement (RDAVR). METHODS A total of 620 consecutive patients without preexisting LBBB or PPI who underwent rapid deployment AVR between March 2012 and September 2019 were included. New-onset LBBB was defined as any new LBBB that persisted at hospital discharge. The median follow-up time for clinical data was 1.7 years post-RDAVR. RESULTS At discharge, new-onset LBBB was seen in 109 patients (17.5%). There were no differences between the LBBB groups and no-LBBB groups regarding baseline characteristics. At a median follow-up of 1.7 years, no difference was found between LBBB groups and no-LBBB groups concerning all-cause mortality (12.8 vs. 11.7%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.74-1.53; p = 0.54). Nevertheless, new-onset LBBB was associated with significant higher pacemaker implantation rates at follow-up (10.1 vs. 6.3%; HR: 3.58; 95% CI: 1.89-6.81 p < 0.001). CONCLUSION After a median follow-up of 1.7 years, new-onset LBBB was not associated with increased mortality. Nevertheless, higher pacemaker implantation rates were observed in patients with new-onset LBBB after RDAVR.
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Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Taghiyev ZT, Bechtel M, Schlömicher M, Useini D, Taghi HN, Moustafine V, Strauch JT. Early-Term Results of Rapid-Deployment Aortic Valve Replacement versus Standard Bioprosthesis Implantation Combined with Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2023; 71:519-527. [PMID: 35151232 DOI: 10.1055/s-0042-1742686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Aortic stenosis is highly prevalent among patients with concomitant coronary artery disease. Surgical aortic valve replacement with coronary artery bypass grafting is usually the treatment of choice for patients with severe aortic stenosis and significant coronary disease. The aim of this study was to evaluate the outcome and hemodynamic results of the implantation of rapid-deployment valves (Rapid-Deployment Edwards Intuity Valve System [RDAVR]) versus conventional sutured valves (CSAVR) in combined surgery. METHODS Between January 2012 and January 2017, 120 patients underwent replacement via RDAVR and 133 patients underwent replacement using CSAVR with concomitant coronary bypass grafting. Clinical and echocardiographic data were compared. RESULTS The mean age was 76 ± 7 for RDAVR patients and 74 ± 6 years for CSAVR patients (p = 0.054); 48% in the RDAVR group were female versus 17% in the CSAVR group (p <0.002). Other characteristics such as diabetes mellitus, body-mass index, chronic obstructive pulmonary disease, nicotine consumption, and extracardiac arteriopathy were similar. Coronary three-vessel disease was more common in the RDAVR group (42.5 vs. 27.8%, p = 0.017). Both mean EuroSCORE II (6.6 ± 5.4 vs. 4.3 ± 3.0, p = 0.001) and STS score (5.4 ± 4.4 vs. 3.4 ± 2.4, p = 0.001) were significantly higher in the RDAVR group. Mean cross-clamp time (82 ± 25 vs. 100 ± 30 minutes, p < 0.001) and cardiopulmonary bypass time (119 ± 38 vs. 147 ± 53 minutes, p < 0.001) were shorter with RDAVR. The mean number of bypass grafts, length of hospital and ICU stays, and mechanical ventilation time were not statistically significant different. Hospital mortality was 2.5% for RDAVR and 9.7% for CSAVR (p = 0.019). There was a similar rate of stroke (5.8 vs. 6.0%, p = 0.990) and postoperative delirium (14.1 vs. 15.8%, p = 0.728). Mean gradients were 8.2 ± 4.1 mm Hg in the RDAVR group vs. 11.3 ± 4.6 mm Hg in the CSAVR group (p = 0.001) at discharge. CONCLUSION RDAVR combined with coronary artery bypass grafting (CABG) can be performed extremely safely. Cross-clamp and cardiopulmonary bypass times can be significantly reduced with rapid deployment aortic valve system in the scenario of combined CABG. RDAVR resulted in lower gradients than CSAVR in patients implanted with prostheses of the same size.
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Affiliation(s)
- Zulfugar T Taghiyev
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi Taghi
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus T Strauch
- Department of Cardiothoracic SurgeryRuhr-University Hospital Bergmannsheil, Bochum, Germany
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Loesaus S, Zahn PK, Bechtel M, Strauch JT, Buchwald D, Baumann A, Berres DM. Nucleated red blood cells are a predictor of mortality in patients under extracorporeal membrane oxygenation. Eur J Med Res 2023; 28:270. [PMID: 37550743 PMCID: PMC10405375 DOI: 10.1186/s40001-023-01243-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The presence of Nucleated Red Blood Cells (NRBCs) in critically ill patients is associated with higher mortality and poor prognosis. Although patients on extracorporeal support such as veno-venous or veno-arterial extracorporeal membrane oxygenation (VV/VA-ECMO) are severely ill, NRBCs have rarely been investigated regarding their predictive value so far. METHODS As part of a retrospective study, we examined all cardiothoracic surgery patients from July 2019 to September 2020 who received ECMO treatment during their inpatient stay. The aim of this study was to investigate the occurrence of NRBCs during ECMO support in terms of their predictive value for mortality. RESULTS In total 30 patients (age at admission: 62.7 ± 14.3 year; 26 male; ECMO duration: 8.5 ± 5.1 days; ICU duration: 18.0 ± 14.5 days) were included. 16 patients (53.3%) died during their inpatient stay. There were no significant differences in demographic characteristics between VA- or VV- ECMO patients. NRBCs occurred in all patients while under ECMO support. NRBC value was significant higher in those who died (2299.6 ± 4356.6 µl) compared to the surviving patients (133.6 ± 218.8 µl, p < 0.001). Univariate analysis found that patients with a cutoff value of ≥ 270 NRBCs/µl during ECMO support were 39 times more likely to die (OR 39.0, 95% CI 1.5-997.5, p < 0.001). 12 out of 13 patients (92.3%) with ≥ 270 NRBCs/µl died. The area under the curve (AUC) of the receiver operating characteristic curve was 0.85 (95% CI 0.69-0.96) with a sensitivity of 75.0% and a specificity of 92.9%. CONCLUSION NRBCs appear to be an accurate biomarker for mortality in patients with ECMO support. They may be helpful in deciding if therapy becomes futile. Trial registration DRKS00023626 (December 20th 2020).
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Affiliation(s)
- Sebastian Loesaus
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Ruhr- University Hospital Bergmannsheil, Bürkle-de-la-Camp- Platz 1, 44789, Bochum, Germany.
| | - Peter Konrad Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Ruhr- University Hospital Bergmannsheil, Bürkle-de-la-Camp- Platz 1, 44789, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz-1, 44789, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz-1, 44789, Bochum, Germany
| | - Dirk Buchwald
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz-1, 44789, Bochum, Germany
| | - Andreas Baumann
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Ruhr- University Hospital Bergmannsheil, Bürkle-de-la-Camp- Platz 1, 44789, Bochum, Germany
| | - Dinah Maria Berres
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz-1, 44789, Bochum, Germany
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Luta A, Useini D, Buchwald D, Bechtel M, Moustafine V, Schlömicher M, Strauch J, Haldenwang P. Early Results of Aortic Arch Treatment Using the Hybrid AMDS Aortic Dissection Stent. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. Luta
- Ruhr-University of Bochum, Bochum, Deutschland
| | - D. Useini
- Ruhr-University of Bochum, Bochum, Deutschland
| | - D. Buchwald
- Ruhr-University of Bochum, Bochum, Deutschland
| | - M. Bechtel
- Ruhr-University of Bochum, Bochum, Deutschland
| | | | | | - J. Strauch
- Ruhr-University of Bochum, Bochum, Deutschland
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Useini D, Schlömicher M, Beluli B, Christ H, Ewais E, Haldenwang P, Patsalis P, Moustafine V, Bechtel M, Strauch J. Transapical-transcatheter aortic valve implantation using the Edwards SAPIEN 3 valve. J Cardiovasc Surg (Torino) 2021; 62:609-617. [PMID: 35037446 DOI: 10.23736/s0021-9509.21.11523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Scarcely any data has been published on the mid-term effect of transapical-transcatheter aortic valve implantation (TA-TAVI) using the Edwards SAPIEN 3 valve (S3; Edwards Lifesciences Corp., Irvine, CA, USA). We present mid-term clinical and echocardiographic outcomes after TA-TAVI utilizing S3. METHODS Between 02/2014-06/2017, 122 elderly patients with severe aortic stenosis underwent TA-TAVI utilizing S3 at our institution. We conducted clinical and echocardiographic follow-up. The mean follow-up was 15 months. All end-point-related outcomes were adjudicated according to Valve Academic Research Consortium-2 definitions. RESULTS The STS-score of the entire cohort was 6.26±4.6. More than one-third of the patients exhibited severe peripheral artery disease. The 30-d all-cause mortality, all-stroke rate, and myocardial infarction of the entire cohort were 4.1%, 1.6%, and 0.8% respectively. Median survival time of the entire cohort was 35 months. The cumulative mid-term myocardial infarction and stroke rate was 2.6% and 3.5%, respectively. The postoperative moderate/severe paravalvular leakage occurred in 1.6% of cases. At discharge, one-year and two-year postprocedure peak/mean gradients were 16.6±8.3/ 9±5.1 mmHg, 18±6.9/ 10±4.5 mmHg, and 22.2±5.4/ 12.8±4.6 mmHg, respectively. The rate of new pacemaker cases was 14.1%. Acute kidney injury network 2/3 appears, as an independent predictor of mortality. CONCLUSIONS We observed very promising early and mid-term clinical outcomes with a high degree of device success and good hemodynamic performance after TA-TAVI using the S3 in the intermediate risk patient profile.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany -
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Elias Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Useini D, Schlömicher M, Haldenwang P, Naraghi H, Moustafine V, Bechtel M, Strauch J. Early Results after Aortic Valve Replacement Using Last Generation Bioprosthetic Aortic Valve. Heart Surg Forum 2021; 24:E598-E962. [PMID: 34962472 DOI: 10.1532/hsf.4189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Few data are available about the newest generation surgical bioprosthesis. We aimed to evaluate early clinical and hemodynamic outcomes after using the INSPIRIS RESILIA aortic valve (Edwards Lifesciences, Irvine, California, USA). METHODS Between July 2018 and April 2021, 80 patients underwent aortic valve replacement receiving the INSPIRIS RESILIA aortic valve at our institution. Primary outcomes were the composite of early mortality, stroke, and myocardial infarction. Secondary outcomes were hemodynamic performances of the valve, paravalvular leakage, and new pacemaker implantation. RESULTS The mean age of the study population was 60.6 ± 8.3 years. The mean Society of Thoracic Surgery-Predicted Risk of Mortality score was 2.9 ± 1.7%. In 43.7% of the patients, concomitant surgery was performed. The in-hospital mortality, all-stroke, and myocardial infarction rates were 2.5%, 1.2%, and 1.2%, respectively. No valve was explanted and no redo was performed. The mean postoperative trans-prosthetic gradient at discharge was 10.2 ± 4.1 mm Hg. There was no need for new pacemaker implantation. We registered only two cases with minimal (trace) paravalvular leakage. CONCLUSION The use of the INSPIRIS RESILIA aortic valve in a young, low-risk population is safe and associated with very good early clinical and hemodynamic outcomes.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
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Useini D, Schlömicher M, Bechtel M, Strauch J. Surgical Resection of Very Small Multiple Papillary Fibroelastomas of the Aortic Valve. Heart Views 2021; 22:220-223. [PMID: 34760056 PMCID: PMC8574090 DOI: 10.4103/heartviews.heartviews_208_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/08/2021] [Indexed: 12/02/2022] Open
Abstract
Papillary fibroelastomas (PFEs) in multiple presentations on the aortic valve surface are extremely rare tumors that can cause sudden major cardio-cerebral adverse events. The treatment of these tumors varies from conservative care strategy to curative surgical resection. The bigger the tumor size, the bigger seems the tendency toward surgical treatment concepts. Here, we present the case of a completely healthy young woman who suffered sudden myocardial infarction and occlusion of the circumflex artery caused by very small multiple PFEs of the aortic valve. The patient underwent cardiac surgery for resection at our institution. The surgical approach appears to be recommended as a solitary reasonable treatment option once multiple PFEs have been detected.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Useini D, Beluli B, Christ H, Schlömicher M, Ewais E, Patsalis P, Haldenwang P, Naraghi H, Moustafine V, Bechtel M, Strauch J. Transapical transcatheter aortic valve implantation in patients with aortic diseases. Eur J Cardiothorac Surg 2021; 59:1174-1181. [PMID: 33709139 DOI: 10.1093/ejcts/ezab050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Patients scheduled for transcatheter aortic valve implantation (TAVI) treatment frequently present with concomitant aortic diseases, in which case they are usually considered to be at high interventional risk and, in particular, unable to undergo the transfemoral TAVI approach. Since the establishment of the 'transfemoral first' strategy for TAVI, there has been an evidence gap with regard to the outcomes of such patients. We aimed to evaluate the mid-term outcomes after transapical TAVI in patients with diverse aortic diseases. METHODS Fifty-five consecutive elderly patients (78.4 years; standard deviation: 8.6 years) at intermediate surgical risk with severe aortic stenosis and aortic diseases (porcelain aorta 36%, ascending aneurysm 15%, descending aneurysm 26%, type-B dissection 4%, aortic thrombus 7%, Leriche syndrome 4%, aortic kinking 11%, aortic ulcer 2%, previous aortic operation 20%, aortic elongation/tortuosity 4%) underwent transapical TAVI treatment between January 2011 and November 2019 at our institution. We used the second-and third-generation self- and balloon-expanding valves. The follow-up time was 92.6 patient-years. RESULTS The Society of Thoracic Surgery-Predicted Risk of Mortality score was 7% (standard deviation: 4%). The 30-day mortality and all-stroke rates were 6% and 4%, respectively. The median survival time was 24.9 months (95% confidence interval 17.6-32.3). The median time of freedom from a composite of death and cardio-cerebral adverse events was 24.3 months (95% confidence interval 11.9-36.8). The rate of moderate/severe paravalvular leakage was 2%. The pacemaker rate was 10%. No early or late aortic syndrome occurred. CONCLUSIONS Transapical TAVI is a safe method and shows very promising early and mid-term outcomes, without early/late aortic syndrome, in patients with aortic diseases for whom transfemoral TAVI as the first-line transcatheter method might be contraindicated or not feasible.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Elias Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Useini D, Beluli B, Christ H, Schlömicher M, Ewais E, Haldenwang P, Patsalis P, Moustafine V, Bechtel M, Strauch J. Transcatheter aortic valve replacement using the SAPIEN 3 valve versus surgical aortic valve replacement using the rapid deployment INTUITY valve: Midterm outcomes. J Card Surg 2021; 36:610-617. [PMID: 33386755 DOI: 10.1111/jocs.15275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/18/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Little data have been published on the midterm effect of transapical/transfemoral-transcatheter aortic valve replacement (TA-/TF-TAVR) using the Edwards SAPIEN 3 valve (S3). We aimed to compare the outcomes after TA-/TF-TAVR utilizing the S3 (TA-/TF-S3) valve with those after surgical aortic valve replacement utilizing the rapid deployment Edwards INTUITY valve (RD-SAVR). METHODS Between March 2012 and April 2018, 122 patients with aortic stenosis underwent TA-S3, 77 patients underwent TF-S3 and 182 patients underwent RD-SAVR through partial sternotomy at our institution. We conducted clinical and echocardiographic midterm follow-ups. The primary outcomes of the study were the incidence of new pacemakers permanent pacemaker implantation (PPI), the occurrence of paravalvular leakage (PVL) and the hemodynamic performance of the valves. RESULTS All study groups were at intermediate surgical risk. The 30-day all-cause mortality and stroke rates in the TA-S3, TF-S3, and RD-SAVR groups were 4.1% and 1.6%, 3.9% and 2.6%, and 3.8% and 2.2%, respectively. The RD-SAVR group had significantly smaller PVL and PPI rates than did the TA-/TF-S3 group (p < .0001). At the discharge, the one-year postprocedure mean gradients were 9 ± 5.1/10 ± 4.5 mmHg, 11 ± 4.1/12 ± 3.8 mmHg, and 10.1 ± 4.3/10.4 ± 2.6 mmHg in the TA-S3, TF-S3, and RD-SAVR groups, respectively. Midterm valve thrombosis, Re-TAVR/SVAR were low and similar among the study groups, whereas endocarditis was higher in the TAVR group. CONCLUSION RD-SAVR was superior to TA-/TF-S3 in the PVL and PPI rates. We observed similar early outcomes and valve hemodynamics. The endocarditis was higher in the TAVR group.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Department of Medical Statistics, Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Elias Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Luta A, Elghannam M, Schlömicher M, Useini D, Moustafine V, Bechtel M, Buchwald D, Christ H, Strauch J, Haldenwang P. Extent of Aortic Arch Repair in Acute Aortic Type A Dissection: How Far Should We Go? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schlömicher M, Haldenwang P, Useini D, Naraghi H, Moustafine V, Bechtel M, Strauch J. Does Left Bundle Branch Block Affect Mortality after Rapid Deployment AVR? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Elghannam M, Useini D, Naraghi H, Moustafine V, Bechtel M, Christ H, Strauch J, Haldenwang PL. Minimally Invasive versus Conventional Aortic Root Surgery: Mid-Term Results in a 2-Year Follow-up. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Useini D, Christ H, Schlömicher M, Haldenwang PL, Naraghi H, Moustafine V, Bechtel M, Strauch J. Third Generation Balloon-Expandable Transcatheter Valves versus Rapid Deployment Surgical Valves. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Useini D, Beluli B, Christ H, Mügge A, Patsalis P, Schlömicher M, Haldenwang P, Bechtel M, Strauch J. Oversized versus Non-oversized Prosthesis: Midterm Outcomes after Transcatheter Aortic Valve Replacement Using SAPIEN 3 Valve. Thorac Cardiovasc Surg 2020; 69:445-454. [PMID: 32688405 DOI: 10.1055/s-0040-1713168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A certain degree of prosthesis oversizing is recommended for the SAPIEN 3 (S3; Edwards Lifesciences Corp., Irvine, California, United States) to ensure device success. We aimed to investigate midterm outcomes in patients who received oversized (OS) S3 valve after transapical-transcatheter aortic valve replacement (TA-TAVR). METHODS Out of 122 patients with aortic stenosis who underwent TA-TAVR using S3 at our institution, 42 received OS prosthesis. We used computed tomography (CT) derived effective diameter to assess oversizing. We defined oversizing if the labeled diameter of the selected valve for implantation was ≥2 mm bigger than the effective annulus diameter calculated by the annulus area. We conducted a midterm follow-up and compared the OS cohort with the non-OS (nOS) cohort. RESULTS The study groups showed similar risk score and age (STS [Society of Thoracic Surgery] score: 5.4 ± 3; mean age: 80.7 ± 5.7). The 30-day mortality was 7.1% in OS versus 2.4% in nOS. The 30-day all-stroke was 2.4% in OS versus 0% in nOS. The 1- and 3-year all-cause mortality were 28.5 and 42.8% in OS versus 21.9 and 26.8% in nOS, respectively. Midterm freedom from death and from cardiocerebral events was similar in both groups. Moderate/severe paravalvular leakage occurred in 0% in OS versus 5.4% in nOS. The postdilation rate was 7.1% in OS versus 15.3% in nOS. The rate of new permanent pacemaker implantation (PPI) was 15.7% in OS versus 9.3% in nOS. The STS score was detected as an independent predictor of mortality. CONCLUSION Oversizing reduces the risk of device failure and intraprocedural postdilation but increases the risk of PPI. Early and midterm morbidity and mortality after OS and nOS with S3 are comparable.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Hildegard Christ
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital of Cologne, Cologne, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Polykarpos Patsalis
- Department of Cardiology and Angiology, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Schlömicher M, Bechtel M, Useini D, Naraghi H, Haldenwang PL, Moustafine V, Strauch JT. Single-Center Outcomes with Rapid Deployment Aortic Valve Replacement. Thorac Cardiovasc Surg 2020; 69:405-411. [PMID: 32674180 DOI: 10.1055/s-0040-1713660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Rapid-deployment valves can reduce procedural times and may facilitate minimally invasive surgery. In our institution, more than 500 patients underwent rapid deployment aortic valve replacement (AVR). METHODS A total of 510 patients underwent rapid deployment AVR between March 2012 and September 2017, of whom 270 patients underwent isolated AVR and 240 underwent AVR with concomitant procedures. The cumulative follow-up time was 1,444 patient-years, the median follow-up time 2.8 years, respectively RESULTS: An early all-cause mortality of 3.5% (n = 18) was seen with a cumulative survival of 91.9 ± 2.2% after 12 months. Mean cross-clamp times were 37 ± 19 minutes for isolated AVR and 93 ± 29 minutes for AVR with concomitant procedures. The rate of new pacemaker implantation was 7.8% (n = 40). No case of structural degeneration occurred in the follow-up. Three (0.6%) cases of endocarditis were registered. CONCLUSIONS Rapid deployment AVR can be performed safely with low complication rates and good hemodynamic results. Therefore, the relevance in aortic valve surgery can be stressed.
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Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
| | - Justus T Strauch
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil, Bochum, Germany
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Useini D, Beluli B, Schlömicher M, Haldenwang P, Bechtel M, Strauch J. Valve-in-Valve After Edwards INTUITY Valve Implantation in Small Aortic Annulus. Ann Thorac Surg 2020; 110:e189-e192. [PMID: 32114049 DOI: 10.1016/j.athoracsur.2020.01.029] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/10/2020] [Indexed: 11/24/2022]
Abstract
The Edwards INTUITY aortic valve has in recent years played a significant role in facilitating surgical aortic valve replacement. Owing to the excellent hemodynamic characteristics and relatively new usage of this bioprosthetic aortic valve, the structural valve deterioration is an extremely rare complication; therefore, the treatment options of degenerated INTUITY valve with stenotic features have not been studied. We report the feasibility and safety of transcatheter valve-in-valve treatment for degenerated, stenotic INTUITY valve using the balloon expanding transcatheter aortic valve SAPIEN 3 in a small aortic annulus.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.
| | - Blerta Beluli
- Department of Internal Medicine, St. Anna Hospital, Herne, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Haldenwang P, Luta A, Sikole M, Elghannam M, Useini D, Schlömicher M, Moustafine V, Christ H, Bechtel M, Strauch J. Distal Arch and Proximal Descending Aorta Treatment in Aortic Dissection: Treat First what Kills First! Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schlömicher M, Haldenwang P, Naraghi H, Useini D, Moustafine V, Bechtel M, Strauch J. Conduction Disorders Associated with Rapid Deployment AVR. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Useini D, Taghiyev Z, Bechtel M, Strauch J. Triple-Rule-Out Computed Tomography Scanning for the Diagnosis of a Mediastinal Tumor. Thorac Cardiovasc Surg Rep 2019; 8:e30-e32. [PMID: 31637152 PMCID: PMC6801126 DOI: 10.1055/s-0039-1697602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/30/2019] [Indexed: 10/28/2022] Open
Abstract
Thymomas are rare tumors that commonly lie in the anterior mediastinum. The arteries supplying thymomas branch from the internal thoracic arteries and their collaterals. This report presents a patient with huge mediastinal thymoma, whose sensational vascularization is ensured directly by a single dominant tributary branch of the left internal thoracic artery. After initially performed computed tomography angiography, the tumor was suspect to be vascularized from the right coronary artery. Triple-rule-out computed tomography scan was a key step for accurate radiologic diagnosis.
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Affiliation(s)
- Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Zulfugar Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Schlömicher M, Bechtel M, Taghiyev Z, Naraghi H, Haldenwang PL, Moustafine V, Strauch JT. Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery. Thorac Cardiovasc Surg 2019; 68:595-601. [PMID: 31003239 DOI: 10.1055/s-0039-1685178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures METHODS: Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years. RESULTS The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively. CONCLUSIONS Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.
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Affiliation(s)
- Markus Schlömicher
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Matthias Bechtel
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Zulfugar Taghiyev
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Hamid Naraghi
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Peter Lukas Haldenwang
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Vadim Moustafine
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Justus T Strauch
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
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Useini D, Haldenwang L, Schlömicher M, Taghiyev Z, Ewais E, Naraghi H, Moustafine V, Christ H, Bechtel M, Strauch T. Oversized Versus Not Oversized: 3-Year Outcomes after Transapical Transcatheter Aortic Valve Implantation with Sapien 3 Valve. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D. Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - L. Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - M. Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Z. Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - E. Ewais
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - H. Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - V. Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - H. Christ
- University Cologne, Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | - M. Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - T. Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Schlömicher M, Bechtel M, Moustafine V, Haldenwang L, Taghiyev Z, Strauch T. Rapid Deployment Aortic Valve Replacement: Outcomes after More Than 500 Implants. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - M. Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - V. Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - L. Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Z. Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - T. Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Bonaros N, Laborde F, Pfeiffer S, Misfeld M, Tan E, Zembala M, Casselman F, Harringer W, Andreas M, Oberwalder P, Bechtel M, Goisis G, Chiaro M, Haverich A. P761Sutureless valve implantation for surgical treatment of low flow low gradient aortic stenosis. Results from the CAVALIER-Trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p761] [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: 11/14/2022] Open
Affiliation(s)
- N Bonaros
- Innsbruck Medical University, Innsbruck, Austria
| | - F Laborde
- Institut Mutualiste Montsouris, Cardiac Surgery, Paris, France
| | - S Pfeiffer
- Klinikum Nürnberg - Süd, Nürnberg, Cardiac Surgery, Nurnberg, Germany
| | - M Misfeld
- Heart Center of Leipzig, Cardiac Surgery, Leipzig, Germany
| | - E Tan
- Heart Center of Leipzig, Cardiac Surgery, Leipzig, Germany
| | - M Zembala
- Silesian Center for Heart Diseases (SCHD), Cardiac Surgery, Zabrze, Poland
| | - F Casselman
- Olv Hospital Aalst, Cardiac Surgery, Aalst, Belgium
| | - W Harringer
- Klinikum Braunschweig, Cardiac Surgery, Braunschweig, Germany
| | - M Andreas
- Medical University of Vienna, Cardiac Surgery, Vienna, Austria
| | - P Oberwalder
- Medical University of Graz, Cardiac Surgery, Graz, Austria
| | - M Bechtel
- BG University Hospital Bergmannsheil, Bochum, Germany
| | | | | | - A Haverich
- Hannover Medical School, Cardiac Surgery, Hannover, Germany
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Gotzmann M, Grabbe S, Schöne D, von Frieling-Salewsky M, Dos Remedios CG, Strauch J, Bechtel M, Dietrich JW, Tannapfel A, Mügge A, Linke WA. Alterations in Titin Properties and Myocardial Fibrosis Correlate With Clinical Phenotypes in Hemodynamic Subgroups of Severe Aortic Stenosis. JACC Basic Transl Sci 2018; 3:335-346. [PMID: 30062220 PMCID: PMC6059007 DOI: 10.1016/j.jacbts.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/18/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/09/2023]
Abstract
The extent of myocardial fibrosis and the degree of isoform-expression and phosphorylation changes in cardiomyocyte titin were unknown in different hemodynamic subgroups of AS, including “paradoxical” low-flow, low-gradient AS with preserved ejection fraction. Hemodynamic subtypes of AS were found to exhibit increased cardiac fibrosis, titin-isoform transition toward more compliant N2BA variants, and both total and site-specific titin (N2Bus) hypophosphorylation compared with donor heart controls. A significant shift toward N2BA titin appeared in “paradoxical” AS, whereas alterations in total-titin phosphorylation and cardiac fibrosis were similar in all hemodynamic subtypes of AS, suggesting increased myocardial passive stiffness. The unfavorable prognosis of “paradoxical” AS could be explained by the pronounced myocardial remodeling, which is no less severe than in other AS subtypes.
Titin-isoform expression, titin phosphorylation, and myocardial fibrosis were studied in 30 patients with severe symptomatic aortic stenosis (AS). Patients were grouped into “classical” high-gradient, normal-flow AS with preserved ejection fraction (EF); “paradoxical” low-flow, low-gradient AS with preserved EF; and AS with reduced EF. Nonfailing donor hearts served as controls. AS was associated with increased fibrosis, titin-isoform switch toward compliant N2BA, and both total and site-specific titin hypophosphorylation compared with control hearts. All AS subtypes revealed titin and matrix alterations. The extent of myocardial remodeling in “paradoxical” AS was no less severe than in other AS subtypes, thus explaining the unfavorable prognosis.
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Affiliation(s)
- Michael Gotzmann
- Department of Cardiology, Marien Hospital Witten, Ruhr University Bochum, Bochum, Germany
| | - Susanne Grabbe
- Cardiology and Angiology, Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Dominik Schöne
- Cardiology and Angiology, Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | | | | | - Justus Strauch
- Department of Cardiac and Thoracic Surgery, Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiac and Thoracic Surgery, Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Johannes W Dietrich
- Department of Internal Medicine, Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | | | - Andreas Mügge
- Cardiology and Angiology, Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Wolfgang A Linke
- Institute of Physiology II, University of Münster, Münster, Germany
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Schlömicher M, Taghiyev Z, AlJabery Y, Haldenwang PL, Zumholz M, Sikole M, Useini D, Naraghi H, Moustafine V, Bechtel M, Strauch JT. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes†. Eur J Cardiothorac Surg 2018; 54:354-360. [DOI: 10.1093/ejcts/ezy023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/07/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Zulfugar Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Yazan AlJabery
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Michael Zumholz
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Magdalena Sikole
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Elghannam M, Haldenwang PL, Bechtel M, Moustafine V, Minorics C, Buchwald D, Strauch J. Minimally Invasive Aortic Root Surgery: Mid-term Results in a 2-year Follow-up. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Elghannam
- Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Bochum, Germany
| | - P.-L. Haldenwang
- Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Bochum, Germany
| | - M. Bechtel
- Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Bochum, Germany
| | - V. Moustafine
- Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Bochum, Germany
| | - C. Minorics
- Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Bochum, Germany
| | - D. Buchwald
- Kardiotechnic, Bergmannsheil Bochum, Bochum, Germany
| | - J. Strauch
- Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Bochum, Germany
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Useini D, Haldenwang P, Schlömicher M, Taghiyev Z, Moustafine V, Christ H, Bechtel M, Strauch J. Mid-term Outcome of TA-TAVI for Aortic Stenosis and Porcelain Aorta and a Systematic Review: TF or TA-TAVI for Aortic Stenosis and Porcelain Aorta? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. Useini
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - P. Haldenwang
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - M. Schlömicher
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - Z. Taghiyev
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - V. Moustafine
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | | | - M. Bechtel
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - J. Strauch
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
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Haldenwang P, Elghannam M, Schlömicher M, Bechtel M, Moustafine V, Christ H, Strauch J. Advantages and Limitations of Ascending Aortic Surgery via an Upper Partial Sternotomy. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | - M. Bechtel
- BGU Bergmannsheil Bochum, CTS, Bochum, Germany
| | | | - H. Christ
- Institut für Medizinische Statistik und Bioinformatik, University of Cologne, Cologne, Germany
| | - J. Strauch
- BGU Bergmannsheil Bochum, CTS, Bochum, Germany
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Stegmeier P, Schlömicher M, Laczkovics A, Strauch J, Bechtel M. Déjà vu? Evidence for Thrombocytopenia following Implantation of the Perceval S Aortic Bioprosthesis. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P. Stegmeier
- Clinic for Cardiothoracic Surgery, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - M. Schlömicher
- Clinic for Cardiothoracic Surgery, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - A. Laczkovics
- Clinic for Cardiothoracic Surgery, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - J.T. Strauch
- Clinic for Cardiothoracic Surgery, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - M. Bechtel
- Clinic for Cardiothoracic Surgery, Uniklinik Bergmannsheil Bochum, Bochum, Germany
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Taghiyev Z, Bechtel M, Schlömicher M, Useini D, Naraghi Taghi Off H, Moustafine V, Strauch J. Early-term Results of Rapid-Deployment Aortic Valve Replacement versus Sutured Bioprostheses Implantation in Combined Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Z. Taghiyev
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - M. Bechtel
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - M. Schlömicher
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - D. Useini
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - H. Naraghi Taghi Off
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - V. Moustafine
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - J.T. Strauch
- Herz- und Thoraxchirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
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Useini D, Haldenwang P, Schlömicher M, Taghiyev Z, Moustafine V, Christ H, Bechtel M, Strauch J. Three-Year Single-Center Outcomes of Transapical Aortic Valve Implantation using the Edwards Sapien 3 Valve. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. Useini
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - P. Haldenwang
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - M. Schlömicher
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - Z. Taghiyev
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - V. Moustafine
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | | | - M. Bechtel
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
| | - J.T. Strauch
- Herz und Thoraxchirurgie, Uniklinik Bergmannsheil Bochum, Bochum, Germany
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Bechtel M, Schlömicher M, Moustafine V, Strauch JT. Rapid deployment aortic valve replacement in the setting of concomitant mitral valve procedures. Eur J Cardiothorac Surg 2017; 51:792-793. [PMID: 27744323 DOI: 10.1093/ejcts/ezw327] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/25/2016] [Indexed: 11/12/2022] Open
Abstract
The technique of rapid deployment aortic valve implantation in patients with concomitant mitral valve surgery is described and the outcome of our first 25 patients reported.
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Affiliation(s)
- Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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Schlömicher M, Bechtel M, Taghiyev Z, Al-Jabery Y, Lukas Haldenwang P, Moustafine V, Thomas Strauch J. The Use of Rapid Deployment Valves in Combined Aortic and Mitral Valve Surgery. Innovations 2017. [DOI: 10.1177/155698451701200307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Markus Schlömicher
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Zulfugar Taghiyev
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Yazan Al-Jabery
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Lukas Haldenwang
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Thomas Strauch
- From the Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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Swol J, Fülling Y, Ull C, Bechtel M, Schildhauer TA. 48 h cessation of mechanical ventilation during venovenous extracorporeal membrane oxygenation in severe trauma: a case report. J Artif Organs 2017; 20:280-284. [PMID: 28251431 DOI: 10.1007/s10047-017-0949-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/01/2017] [Indexed: 11/30/2022]
Abstract
A 32-year-old motorcyclist who was hit by a tram subsequently presented with blunt force thoracic trauma, a pelvic fracture and a penetrating injury to the left lower extremity. Coagulopathy persisted following surgery of the leg and pelvic vascular intervention. Bedside thoracotomy was performed to treat pneumothorax and pneumopericardium. Severe hypoxemia secondary to lung failure ensued, which required venovenous extracorporeal membrane oxygenation (VV ECMO) support. On the third day after the trauma, ultra-protective mechanical ventilation was not possible due to non-existent lung compliance; thus, the ventilator was disconnected, and the T-piece was connected to the blocked tracheal tube left in the airway. Gas exchange occurred via VV ECMO separately. After 48 h of cessation of ventilator support, the patient was weaned from sedation. At this time, respiratory effort was observed, and assisted ventilation was initiated. The patient ultimately recovered and experienced an excellent outcome. The clinical significance of zero end-expiratory pressure (ZEEP) and the complete cessation of open lung strategy during ECMO remains controversial. In cases of reduced lung compliance, if VV ECMO can facilitate adequate gas exchange, the discontinuation of ventilation is an option that can be used to prevent ventilator-induced lung damage and to allow the lungs to rest. VV ECMO is feasible as lung support with no mechanical ventilation in case of severe lung failure after major trauma.
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Affiliation(s)
- Justyna Swol
- Clinic for General-, Visceral-, Vascular- and Pediatric Surgery, University Hospital Wuerzburg, Oberdürrbacherstr. 6, 97080, Wuerzburg, Germany.
| | - Yann Fülling
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil GmbH Bochum, Bochum, Germany
| | - Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil GmbH Bochum, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil GmbH Bochum, Bochum, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil GmbH Bochum, Bochum, Germany
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Bechtel M, Haldenwang P, Strauch J. Effect of Rigidity of Mitral Annuloplasty Rings on Balloon Expansion during In vitro Valve-in-Ring Procedures. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Bechtel
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Klinik für Herz- und Thoraxchirurgie, Bochum, Germany
| | - P.L. Haldenwang
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Klinik für Herz- und Thoraxchirurgie, Bochum, Germany
| | - J.T. Strauch
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Klinik für Herz- und Thoraxchirurgie, Bochum, Germany
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Schlömicher M, Haldenwang P, Taghiyev Z, Markthaler L, Moustafine V, Bechtel M, Strauch J. Intermediate Results after Minimal Access Rapid Deployment Aortic Valve Replacement: Clinical and Echocardiographic Outcomes. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Schlömicher
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - P.L. Haldenwang
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - Z. Taghiyev
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - L. Markthaler
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - V. Moustafine
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - M. Bechtel
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - J.T. Strauch
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
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Schlömicher M, Taghiyev Z, Haldenwang P, Naraghi H, Moustafine V, Bechtel M, Strauch J. Cerebrovascular Complications in Minimal Access Aortic Valve Surgery. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Schlömicher
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - Z. Taghiyev
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - P.L. Haldenwang
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - H. Naraghi
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - V. Moustafine
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - M. Bechtel
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
| | - J.T. Strauch
- BG-Universitätsklinikum Bergmannsheil / Ruhr Universität Bochum, Klinik für Herz-Thoraxchirurgie, Bochum, Germany
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Schlömicher M, Taghiyev Z, Al-Jabery Y, Lukas Haldenwang P, Markthaler L, Moustafine V, Maria Laczkovics A, Thomas Strauch J, Bechtel M. Aortic Valve Replacement with the Labcor TLPB Supra Porcine Bioprosthesis: Intermediate Clinical and Echocardiographic Outcomes. J Heart Valve Dis 2017; 26:90-97. [PMID: 28544836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Labcor TBLP Supra™ prosthesis is a second-generation tissue valve that has evolved from the Labcor TBLP™ prosthesis, first introduced in 1984. The Supra prosthesis is a triple-composite porcine valve, with no specific anticalcification treatment being used in its production other than standard tissue fixation with 0.4% glutaraldehyde. To date, more than 100,000 Supra valves have been implanted, mainly in South America. Despite this remarkably high number of implants, only marginal data exist concerning durability and safety issues. Hence, the study aim was to analyze short-term and intermediate outcomes relating to the clinical and hemodynamic performance of the Supra valve, as well as complication rates METHODS: A follow up study was initiated to evaluate outcomes and durability of the Labcor Supra prosthesis. Between September 2004 and October 2010, a total of 331 patients (mean age 75.8 ± 7.2 years; mean logistic EuroSCORE 8.5 ± 2.3%) underwent aortic valve replacement using the Supra porcine bioprosthesis. RESULTS The 30-day mortality rate was 4.8% (n = 16). The overall actuarial five-year survival was 72.3 ± 4.9%, and eight-year survival was 60.4 ± 5.6%. Actuarial freedom from reoperation was 96.3 ± 2.4% after five years, and 92.5 ± 3.5% after eight years. Actuarial freedom from structural valve deterioration (SVD) was 99.7 ± 0.3% at five years, and 97.2 ± 0.8% at eight years; actuarial freedom from thromboembolism was 97.5 ± 1.0% and 95.7 ± 1.6% at these times. Actuarial freedom from event rates for endocarditis were 99.5 ± 0.3% and 96.8 ± 0.6%, and 96.1 ± 0.9% and 93.0 ± 1.4% for reoperation CONCLUSIONS: No evidence was found of increased rates of SVD. All parameters studied were comparable to those examined for other second-generation porcine prostheses. Further long-term follow up investigations are required however, for the final judgment of this prosthesis.
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Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany. Electronic correspondence:
| | - Zulfugar Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Yazan Al-Jabery
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Leif Markthaler
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Axel Maria Laczkovics
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz. 1, 44789 Bochum, Germany
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Schlömicher M, Haldenwang PL, Moustafine V, Wolf B, Zahn P, Bechtel M, Strauch JT. Rapid-Deployment Aortic Valve Replacement after Previous Mechanical Valve Implantation. Thorac Cardiovasc Surg Rep 2016; 5:24-26. [PMID: 28018816 PMCID: PMC5177430 DOI: 10.1055/s-0036-1579681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/15/2016] [Indexed: 11/02/2022] Open
Abstract
Recent studies report a reproducible reduction of myocardial ischemic and cardiopulmonary bypass times along with excellent hemodynamics and low rates of paravalvular leakage for rapid-deployment valves. A 68-year-old female patient with aortic stenosis and a mechanical mitral valve which was implanted in 2006 received rapid-deployment aortic valve replacement. The procedure could be performed with a cross-clamp time of 45 minutes and a cardiopulmonary bypass time of 60 minutes. Postoperative course was uncomplicated and the patient was discharged to the referring hospital on postoperative day 8.
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Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
| | - Britta Wolf
- Department of Anesthesiology, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
| | - Peter Zahn
- Department of Anesthesiology, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr University Hospital Bergmannsheil - Bochum, North Rhine-Westphalia, Germany
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Yamamoto K, Klossek A, Flesch R, Rancan F, Weigand M, Bykova I, Bechtel M, Ahlberg S, Vogt A, Blume-Peytavi U, Schrade P, Bachmann S, Hedtrich S, Schäfer-Korting M, Rühl E. Influence of the skin barrier on the penetration of topically-applied dexamethasone probed by soft X-ray spectromicroscopy. Eur J Pharm Biopharm 2016; 118:30-37. [PMID: 27998691 DOI: 10.1016/j.ejpb.2016.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/06/2016] [Accepted: 12/14/2016] [Indexed: 12/27/2022]
Abstract
The penetration of dexamethasone into human skin ex vivo is reported. X-ray microscopy is used for label-free probing of the drug and quantification of the local drug concentration with a spatial resolution reaching 70±5nm. This is accomplished by selective probing the dexamethasone by X-ray absorption. Varying the penetration time between 10min and 1000min provides detailed information on the penetration process. In addition, the stratum corneum has been damaged by tape-stripping in order to determine the importance of this barrier regarding temporally resolved drug penetration profiles. Dexamethasone concentrations distinctly vary, especially close to the border of the stratum corneum and the viable epidermis, where a local minimum in drug concentration is observed. Furthermore, near the basal membrane the drug concentration strongly drops. High spatial resolution studies along with a de-convolution procedure reveal the spatial distribution of dexamethasone in the interspaces between the corneocytes consisting of stratum corneum lipids. These results on local drug concentrations are interpreted in terms of barriers affecting the drug penetration in human skin.
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Affiliation(s)
- K Yamamoto
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - A Klossek
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - R Flesch
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany
| | - F Rancan
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - M Weigand
- Max-Planck-Institut für Metallforschung, Heisenbergstraβe 3, 70569 Stuttgart, Germany
| | - I Bykova
- Max-Planck-Institut für Metallforschung, Heisenbergstraβe 3, 70569 Stuttgart, Germany
| | - M Bechtel
- Max-Planck-Institut für Metallforschung, Heisenbergstraβe 3, 70569 Stuttgart, Germany
| | - S Ahlberg
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - A Vogt
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - U Blume-Peytavi
- Klinisches Forschungszentrum für Haut- und Haarforschung, Charité Universitätsmedizin, Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - P Schrade
- Abteilung für Elektronenmikroskopie at Campus Virchow Klinikum (CVK), Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S Bachmann
- Abteilung für Elektronenmikroskopie at Campus Virchow Klinikum (CVK), Charité Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - S Hedtrich
- Institut für Pharmazie, Freie Universität Berlin, Königin-Luise-Str. 2+4, 14195 Berlin, Germany
| | - M Schäfer-Korting
- Institut für Pharmazie, Freie Universität Berlin, Königin-Luise-Str. 2+4, 14195 Berlin, Germany
| | - E Rühl
- Physikalische Chemie, Freie Universität Berlin, Takustr. 3, 14195 Berlin, Germany.
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Bartels C, Claeys L, Ktenidis K, Bechtel M, Horsch S. Treatment of Unreconstructible Upper Extremity Arterial Occlusive Disease by Spinal Cord Stimulation. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449603000308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spinal cord stimulation (SCS) of peripheral arterial disease (PAD) of the lower limbs has been shown to be effective for pain reduction, limb salvage, and improvement of blood supply; however, treatment of PAD of the upper extremity by SCS has never been performed. Ten patients with unreconstructible severe PAD of the upper extremity were treated by SCS at the authors' institution. Transcutaneous oxygen tension index (chest TcPo2/hand TcPo2), Doppler wrist pressure index (WPI), capillary microscopy (red blood cell velocity, capillary density), and a patient's pain score graded from 1 to 10 (1 =no pain) were used as follow-up parameters. Pain reduction after SCS was excellent in all patients. TcPo2 index decreased from 1.95 ± 0.87 prior to implantation to 1.5 ± 1.1 at eighteen months. No significant improvement of capillary microscopy parameters or Doppler WPI could be observed. SCS effectively reduced pain and provided limb salvage in patients with severe unreconstructible PAD of the upper extremity; however, reduction of pain was not paralleled by improvement of the studied microcirculatory parameters.
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Affiliation(s)
| | | | | | | | - Svante Horsch
- Department of Vascular Surgery, Khrs. Porz am Rhein, Teaching Hospital, University of Cologne, Cologne, Germany
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Schlömicher M, Haldenwang PL, Reichert J, Moustafine V, Bechtel M, Strauch JT. Chronic pericardial hematoma with suppression of the right ventricle: a rare complication of a coronary artery aneurysm. Thorac Cardiovasc Surg Rep 2015; 3:27-30. [PMID: 25798355 PMCID: PMC4360695 DOI: 10.1055/s-0034-1386720] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/24/2014] [Indexed: 11/02/2022] Open
Abstract
We present a case of a 67-year-old patient referred to our department with a pericardial mass lesion measuring 11 × 4 × 7.5 cm as diagnosed in computed tomography scan. The patient showed a history of progredient dyspnea. Video-assisted thoracoscopy as well as an explorative full sternotomy to resect the mass lesion had been performed at the referring hospital subsequently before admission to our department. Intermittent hemodynamic instability caused the procedure to stop and a transfer to the cardiothoracic surgery department, following which a resternotomy was performed. Inspection of the surgical site and subsequent intraoperative rapid section revealed an old organized and dense pericardial hematoma adherent to the right ventricle. The suspicion of covered coronary artery perforation led to an intraoperative coronary angiography, which revealed a large proximal coronary aneurysm of the right coronary artery and a subtotal stenosis of the circumflex branch. The hematoma could be removed with decompression of the right ventricle under cardiopulmonary bypass conditions. The further postoperative course was uncomplicated with retransfer to the referring hospital on the postoperative day 8.
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Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, RUHR University Bochum, Bochum, North Rhine-Westphalia, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, RUHR University Bochum, Bochum, North Rhine-Westphalia, Germany
| | - Josef Reichert
- Department of Cardiothoracic Surgery, RUHR University Bochum, Bochum, North Rhine-Westphalia, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, RUHR University Bochum, Bochum, North Rhine-Westphalia, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, RUHR University Bochum, Bochum, North Rhine-Westphalia, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, RUHR University Bochum, Bochum, North Rhine-Westphalia, Germany
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Holst T, Reichert J, Haldenwang P, Moustafine V, Bechtel M, Strauch J, Knipp S. Special report: 26-year durability of a bioprosthesis implanted in a 21-year-old patient. Thorac Cardiovasc Surg Rep 2015; 3:3-5. [PMID: 25798348 PMCID: PMC4360689 DOI: 10.1055/s-0034-1364323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/06/2013] [Indexed: 11/17/2022] Open
Abstract
The choice of prosthetic heart valve type is largely dependent upon patient's age at implantation and on what, in his eyes, seems more pertinent: avoidance of complications associated with anticoagulation of mechanical valves or structural valve deterioration of bioprosthetic valves. Long lasting and new promising concepts such as transcatheter aortic valve implantation are promoting the use of bioprosthesis even in younger patients. However, it is up to the individual patient to decide.
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Affiliation(s)
- Torulv Holst
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital, Essen, Germany
| | - Josef Reichert
- Department of Cardiothoracic Surgery, Ruhr-University of Bochum, Bochum, Germany
| | - Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University of Bochum, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University of Bochum, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University of Bochum, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University of Bochum, Bochum, Germany
| | - Stephan Knipp
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital, Essen, Germany
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Schlömicher M, Haldenwang PL, Moustafine V, Bechtel M, Strauch JT. Minimal access rapid deployment aortic valve replacement: Initial single-center experience and 12-month outcomes. J Thorac Cardiovasc Surg 2015; 149:434-40. [DOI: 10.1016/j.jtcvs.2014.09.118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 09/07/2014] [Accepted: 09/27/2014] [Indexed: 01/21/2023]
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Schlömicher M, Haldenwang P, Moustafine V, Bechtel M, Strauch J. 1 Year Results after Minimal Access AVR with the EDWARDS INTUITY Valve System. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bechtel M, Schlömicher M, Haldenwang P, Moustafine V, Wolf B, Strauch J. Use of the Edwards Intuity Valve System in Combined Aortic and Mitral Valve Surgery. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Haldenwang P, Trampisch M, Schlömicher M, Pillokeit N, Rehman A, Garstka N, Bechtel M, Strauch J. Risk factors for acute kidney injury following TA-TAVI or minimally invasive aortic valve replacement: which procedure is less kidney damaging in elderly patients? Thorac Cardiovasc Surg 2014; 62:482-8. [PMID: 25025889 DOI: 10.1055/s-0034-1376201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) represents a major complication following aortic valve replacement in elderly patients. The aim of this study was to determine possible risk factors for AKI and to find the ideal strategy, minimally invasive valve replacement (MIS-AVR) or transapical valve implantation (TA-TAVI), regarding the postoperative renal outcome. METHODS A total of 133 patients (age ≥ 75 years, 67 male) with severe aortic stenosis were included over 2 years: 42% were treated with MIS-AVR, 58% underwent TA-TAVI procedure. AKI was considered as a postprocedural 1.5× increase in creatinine or an increase of > 0.3 mg/dL/48 hours. Group differences were tested with chi-square or t-test. AKI risk assumption was analyzed in multiple multivariate logistic regression models. RESULTS EuroSCORE II-related risk assumption was 8.7 ± 6.9 for TA-TAVI and 4.5 ± 5.7 for MIS-AVR (p < 0.001). The overall 30-day survival rate was 93%. Fifty-eight patients developed a risk for AKI and 13 developed a manifest renal injury/failure. Logistic regression analysis revealed a higher AKI risk for TA-TAVI (odds ratio, OR = 2.58; 95% confidence interval, CI = 1.18, 5.63; p = 0.017). EuroSCORE II (OR = 0.98; 95% CI = 0.92, 1.04; p = 0.433); preoperative creatinine (OR = 1.78; 95% CI = 0.67, 4.77; p = 0.249) and estimated glomerular filtration rate (OR = 1.00; 95% CI = 0.97, 1.02; p = 0.655) had no impact on AKI. A regression model adjusting for the variables age, gender, body mass index (BMI), diabetes, and procedure type revealed a higher AKI rate for male gender (OR = 2.41; 95% CI = 1.13, 5.11; p = 0.022). Operation time and radio-contrast media volume had no influence on the AKI-occurrence. There was no correlation between AKI and early mortality. CONCLUSION A higher risk for AKI after TA-TAVI should be considered in the therapy decision, especially in elderly male patients because MIS-AVR still yields excellent results.
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Affiliation(s)
- Peter Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Nina Pillokeit
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Attik Rehman
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Nathalie Garstka
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Justus Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Bochum, Bochum, Germany
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Schlömicher M, Haldenwang P, Bechtel M, Moustafine V, Strauch J. Initial experience with the Edwards Intuity rapid deployment valve. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Haldenwang PL, Schlömicher M, Pillokeit N, Garstka N, Bechtel M, Strauch J. Occurrence of acute renal failure in elderly patients undergoing TAVI respectively minimal invasive surgical aortic valve replacement (MIS): Which procedure is to prefer? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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