Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs

BACKGROUND

Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear.

OBJECTIVE

To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function.

DESIGN

Prospective cohort study.

SETTING

241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019.

SUBJECTS

Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2.

METHODS

Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected.

RESULTS

Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001).

CONCLUSIONS

There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.

Therapy limitation in octogenarians in German intensive care units is associated with a longer length of stay and increased 30 days mortality: A prospective multicenter study

PURPOSE

The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting.

METHODS

German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality.

RESULTS

415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82-88] vs. 83 [IQR 81-86] years p < .001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p < .0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04-1.46 p = .02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p < .001) and length of stay (144 [IQR 72-293] versus 96 [IQR 47.25-231.5] hours, p = .026).

CONCLUSION

In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.

Prolonged mechanical ventilation after left ventricular assist device implantation: risk factors and clinical implications

Aims

Unsuccessful weaning from ventilator after major cardiovascular procedures has been shown to be associated with increased post‐operative morbidity and mortality. Our study aimed to identify predictors and clinical implications of prolonged mechanical ventilation (PMV) after left ventricular assist device (LVAD) implantation.

Methods and results

We analysed the data of patients receiving a continuous‐flow LVAD in our centre from December 2010 to September 2017. PMV was defined by a duration of invasive ventilation of >7 days after LVAD implantation. Multivariable logistic regression analysis was performed for predictors of PMV. Survival was estimated by the Kaplan–Meier method. During the study period, 156 patients received a continuous‐flow LVAD in our centre. Seventeen patients were excluded due to early death (<7 days), and 139 patients were enrolled in the study (mean age: 58 years; male: 84%). The median duration of mechanical ventilation post‐operatively was 94 h (range: 5 to 4192 h). PMV was observed in 43% of patients. Patients on PMV were characterized by a more severe disease state at baseline, compared with the group of early extubation, as reflected by their Interagency Registry for Mechanically Assisted Circulatory Support level (Level 1–3: 72 vs. 49%, P = 0.008). Patients on PMV exhibited higher pulmonary wedge pressures (25 vs. 21 mmHg, P = 0.04), lower estimated glomerular filtration rate (53 vs. 60 mL/min/1.73 m², P = 0.02), lower haemoglobin (10.6 vs. 11.6 g/dL, P = 0.02), and lower platelet counts (189 vs. 240/nL, P = 0.02). Previous sternotomy was more frequent in the PMV group (32 vs. 13%, P = 0.006). Higher rates of preoperative circulatory support (30 vs. 11.4%, P = 0.006), dialysis (31.7 vs. 10.1%, P = 0.001), and invasive ventilation (35 vs. 7.6%, P < 0.001) were reported for the PMV group. Logistic regression analysis revealed that estimated glomerular filtration rate [odds ratio (OR) 0.977, confidence interval (CI) 0.955–0.999, P = 0.038], platelet count (OR 0.994, CI 0.989–0.998, P = 0.008), and previous sternotomy (OR 5.079, CI 1.672–15.427, P = 0.004) were independent predictors of PMV. PMV was accompanied by longer intensive care unit (24 vs. 4 days, P < 0.001) and hospital stay (47 vs. 32 days, P = 0.003). Survival analysis revealed a profound increase in mortality at 180‐day post‐implantation in the PMV group (62 vs. 10%, log‐rank: P < 0.001).

Conclusions

Prolonged mechanical ventilation affects nearly half of patients after LVAD implantation. Previous sternotomy, renal function, and platelet counts are associated with increased risk for PMV. PMV is accompanied by decreased survival at 180‐day post‐implantation and longer hospitalizations.

Diagnostic Work-Up of Pulmonary Hypertension - Think About Shunt Flow! A Case Report

BACKGROUND The diagnostic work-up and treatment of pulmonary hypertension can be complex. Pulmonary arterial hypertension (PAH), pulmonary hypertension second to lung or heart diseases and thromboembolic pulmonary hypertension, and other rare causes of pulmonary hypertension such as congenital heart diseases must be considered in the differential diagnostic work-up. CASE REPORT We report on a patient who has been treated for PAH over many years. At the age of 65, progressive symptoms required a complete re-evaluation. Here, a complex shunt vitium with a partial anomalous pulmonary venous return (PAPVR) and a sinus venosus defect (SVD) was diagnosed. CONCLUSIONS PAPVR is a rare congenital heart disease that is often associated with an SVD. It is usually diagnosed during childhood but may also be detected in adult patients who develop pulmonary hypertension and dyspnea as primary symptoms. The initial predominant left-to-right shunting associated with this disease may be undetected for years, with a slow development of right heart failure with right heart volume overload and pulmonary hypertension. Early detection is important, with a subsequent surgical intervention.

Investigation of geographic origin of wine from border regions: Potential limitations and possibilities of different analytical methods and combinations of methods to identify the correct side of the border

In the presented project the investigation on discrimination of geographic origin of wine in from border areas is carried out. Authentic wine samples from the border areas of Austria, Czech Republic, Slovakia (and from Serbia) are investigated and compared by applying different physico-chemical methods (e.g. IRMS, NMR, ICP-MS, ICP-OES, EPR, HPLC, UV-VIS, etc.). The comparison of the data sets from the participating countries and the different applied methods will show, to which extent a differentiation can still be achieved in the border areas of the respective countries, which methods prove most efficient and sensitive and if a combination of methods will lead to an increased sensitivity. Furthermore, we also investigate the causes for the potential differentiation, which might be environmentally determined, due to different agricultural and/or enological practices. Results from the first investigated vintage 2016 show a good separation of the respective geographic origins by isotope ratios and element concentrations as well as by other parameters. The relevant parameters for differentiation now have to be critically evaluated to exclude potential lab influences.

Investigation of geographic origin of wine from border regions: Results from investigation of two vintages

Investigation on discrimination of geographic origin in border areas is carried out by investigating and comparing authentic wine samples from the border areas of Austria, Czech Republic, Slovakia (and from Serbia) by applying different physico-chemical methods (e.g. IRMS, NMR, ICP-MS, ICP-OES, EPR, HPLC, UV-VIS, etc…). The comparison of the data sets from the participating countries and the different applied methods demonstrates, to which extent a differentiation can still be achieved in the border areas of the respective countries, which methods prove most efficient and sensitive and if a combination of methods leads to an increased sensitivity. Furthermore, we also investigate the potential causes for the differentiation, as the environment, different agricultural practices or enology. Analysis of two consecutive vintages shows significant variations between the two years, complicating direct comparison of regions beyond individual vintages. Still, several parameters are identified enabling correct and complete differentiation. However, some of them have been found to represent lab effects, whereas others are interpreted as resulting from different agricultural practices or environmentally driven. Only the latter two ones, if consistent, can be used for discrimination of geographic origin.

Microbial diversity in grape musts from Austrian and South African grape varieties and regions

Vitis vinifera is one of the most widely planted crops and holds important economic value in South Africa and Austria. Grapes obtained from this plant harbour a complex fungal community which plays a crucial role in the wine fermentation process and influences wine flavour and aroma. For many years the contributions of the natural yeasts has been eclipsed by the use of active dry yeast (ADY) inoculant, mainly of the species Saccharomyces cerevisiae. However, recent studies show a growing interest in deciphering the natural microbial diversity and in promoting its persistence during fermentation in order to enhance wine typicity. The current preliminary study aims to provide a first broad assessment of the fungal community fingerprint of different grape varietals from different wine producing areas in Austria and South Africa through Automated Ribosomal Intergenic Spacer Analysis (ARISA). The ARISA profiles separated the samples according to country of origin, and suggested some regional and varietal separation within each country. Future work will evaluate the contribution of these fungal communities to wine chemical composition and sensorial distinctness.

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

The precise sizing of the stent graft in thoracic endovascular aortic repair (TEVAR) affects aortic remodeling and hence, further outcome. Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diameter assessment, and is especially useful when computed tomography (CT) image quality is poor. IVUS, however, is not routinely utilized due to cost inefficiency. We investigated the impact of IVUS-assisted stent graft sizing on aortic remodeling in TEVAR. In this single-center retrospective study we evaluated patients with Type B aortic dissection undergoing both CT and IVUS before TEVAR. We assessed the aortic diameter at the level of the left subclavian artery via both methods before stent implantation and analyzed due to which method the implanted stent graft was chosen, retrospectively. To determine the degrees of aortic remodeling involved, we evaluated true lumen and false lumen diameters, and total aortic remodeling in CT. We analyzed 45 patients with Type B aortic dissection undergoing TEVAR. The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor.

Impact of Preoperative Anemia and Postoperative Hemoglobin Drop on the Incidence of Acute Kidney Injury and In-Hospital Mortality in Patients With Type B Acute Aortic Syndromes Undergoing Thoracic Endovascular Aortic Repair

BACKGROUND

The impact of preoperative anemia and postoperative hemoglobin (Hb) drop on the incidence of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR) for type B acute aortic syndromes (AAS) as well as their prognostic value is unknown.

METHODS

This retrospective study included 144 patients with type B AAS undergoing TEVAR at our center. Preoperative anemia was classified as no/mild (Hb ≥ 12.0 g/dL in men; ≥11.3 g/dL in women), moderate (Hb 10.80-11.99 g/dL in men; 10.23-11.29 g/dL in women), and severe (<10.80 g/dL in men; <10.23 g/dL in women). Postoperative Hb drop was classified as mild (<2 g/dL), moderate (2-4 g/dL), and severe (>4 g/dL). End points of the study were postoperative AKI and in-hospital mortality.

RESULTS

Postoperative AKI was higher in the severe and moderate anemia groups than the no/mild anemia group (63.2%, 52.0%, and 31.0%, respectively, P = .01). In-hospital mortality and AKI were higher in patients with severe postoperative Hb drop (40.9% and 86.4%) than patients with moderate (6.9% and 36.2%) and mild (4.7% and 25.0%) postoperative Hb drop (both P < .001). Postoperative Hb drop (odds ratio [OR]:1.67, P = .036), postoperative Hb levels (OR: 0.57, P = .025), and mesenteric ischemia (OR: 4.65, P = .044) were identified as independent predictors of in-hospital mortality. Preoperative Hb (OR: 0.26, P = .001), postoperative Hb drop (OR: 4.34, P < .001), contrast medium (OR: 1.82, P = .004), and diabetes mellitus (OR: 3.79, P = .001) were independent predictors of AKI. At follow-up, anemia and postoperative Hb drop were not associated with increased mortality.

CONCLUSION

Preoperative Hb and postoperative Hb drop were significant risk factors for AKI. Postoperative Hb drop and Hb levels predicted in-hospital mortality.

Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer

Purpose: To analyze an 11-year single-center experience of treating complicated penetrating aortic ulcer (PAU) using thoracic endovascular aortic repair (TEVAR). Methods: This study included 63 consecutive patients (mean age 69.1±11.5 years; 40 men) with complicated PAU (42 symptomatic, 22 with rupture) who underwent TEVAR between 2002 and 2013. The PAUs were located in the aortic arch (n=11), the descending thoracic aorta (n=43), and the thoracoabdominal aorta (n=9). Results: TEVAR was performed within 14 days of diagnosis in 33 (52.3%) cases (19 ruptures treated immediately); the other 30 (47.6%) patients had an average interval between diagnosis and intervention of 40±39 days. Technical success was 98.4% (62/63). One patient had a type I endoleak after stent-graft repair of a PAU in the aortic arch without great vessel transposition; another procedure was required for carotid-subclavian bypass and proximal stent-graft extension. No patient experienced spinal cord ischemia after TEVAR. Five (7.9%) patients died in-hospital; 3 had severe cardiac complications, 1 died from complications of aortic rupture, and the other succumbed to septic shock. Mean follow-up was 45.6±47.2 months, during which 12 (19.0%) patients needed a secondary intervention because of late endoleaks (n=4, 6.3%) or new complications due to disease progression. Multivariate analysis indicated that a PAU depth >15 mm was an independent predictor of mortality (hazard ratio 6.92, p=0.03). In the biomarker analysis, symptomatic patients had significantly higher D-dimer and troponin levels compared to asymptomatic patients [559.5±460.7 vs 283.2±85.2 µg/L (p=0.016) and 0.22±0.61 vs 0.02±0.03 ng/mL (p=0.04), respectively]. Conclusion: Patients with PAU suffer from underlying severe atherosclerotic disease and have a significant number of cardiovascular comorbidities that lead to relevant mortality and morbidity after TEVAR. As a PAU diameter >15 mm represented high risk for disease progression, these patients may be candidates for early intervention. D-dimer levels may help identify patients at risk and with progression of PAU.

A novel mutation within a transmembrane helix of the bile salt export pump (BSEP, ABCB11) with delayed development of cirrhosis

BACKGROUND & AIMS

The bile salt export pump (BSEP, ABCB11) is essential for bile salt secretion at the canalicular membrane of liver cells. Clinical phenotypes associated with BSEP mutations are commonly categorized as benign recurrent intrahepatic cholestasis (BRIC-2) or progressive familial intrahepatic cholestasis (PFIC-2).

METHODS

The molecular basis of BSEP-associated liver disease in a sibling pair was characterized by immunostaining, gene sequencing, bile salt analysis and recombinant expression in mammalian cells and yeast for localization and in vitro activity studies respectively.

RESULTS

Benign recurrent intrahepatic cholestasis was considered in a brother and sister who both suffered from intermittent cholestasis since childhood. Gene sequencing of ABCB11 identified the novel missense mutation p.G374S, which is localized in the putative sixth transmembrane helix of BSEP. Liver fibrosis was present in the brother at the age of 18 with progression to cirrhosis within 3 years. Immunofluorescence of liver tissue showed clear canalicular BSEP expression; however, biliary concentration of bile salts was drastically reduced. In line with these in vivo findings, HEK293 cells showed regular membrane targeting of human BSEP(G374S), whereas in vitro transport measurements revealed a strongly reduced transport activity.

CONCLUSIONS

The novel mutation p.G374S impairs transport function without disabling membrane localization of BSEP. While all other known BSEP mutations within transmembrane helices are associated with PFIC-2, the new p.G374S mutation causes a transitional phenotype between BRIC-2 and PFIC-2.

New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair: the European Registry of Endovascular Aortic Repair Complications

OBJECTIVES

To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR).

METHODS

International multicentre registry (European Registry of Endovascular Aortic Repair Complications) between 2001 and 2011 with a total caseload of 2387 TEVAR procedures (17 centres).

RESULTS

Thirty-six patients with a median age of 69 years (IQR 56-75), 25% females and 9 patients (19%) following previous aortic surgery were identified. The incidence of AOF in the entire cohort after TEVAR in the study period was 1.5%. The primary underlying aortic pathology for TEVAR was atherosclerotic aneurysm formation in 53% of patients and the median time to development of AOF was 90 days (IQR 30-150). Leading clinical symptoms were fever of unknown origin in 29 (81%), haematemesis in 19 (53%) and shock in 8 (22%) patients. Diagnosis could be confirmed via computed tomography in 92% of the cases with the leading sign of a new mediastinal mass in 28 (78%) patients. A conservative approach resulted in a 100% 1-year mortality, and 1-year survival for an oesophageal stenting-only approach was 17%. Survival after isolated oesophagectomy was 43%. The highest 1-year survival rate (46%) could be achieved via an aggressive treatment including radical oesophagectomy and aortic replacement [relative risk increase 1.73 95% confidence interval (CI) 1.03-2.92]. The survival advantage of this aggressive treatment modality could be confirmed in bootstrap analysis (95% CI 1.11-3.33).

CONCLUSIONS

The development of AOF is a rare but lethal complication after TEVAR, being associated with the need for emergency TEVAR as well as mediastinal haematoma formation. The only durable and successful approach to cure the disease is radical oesophagectomy and extensive aortic reconstruction. These findings may serve as a decision-making tool for physicians treating these complex patients.

[Prevalence of arterial hypertension in the population of Western Germany: Heinz Nixdorf Recall Study]

Regional disparities in the prevalence of arterial hypertension in Germany have been reported in population-based surveys. An analysis comparing the SHIP study in the north-eastern region of Germany (1997-2001) with the MONICA/KORA-S4 study (1999-2001) in the south-west of Germany showed a significantly higher age-adjusted prevalence in the north-eastern population. The Heinz Nixdorf Recall Study is a population based prospective cohort study designed to assess cross-sectional and longitudinal data of risk factors, subclinical signs of atherosclerosis and cardiovascular endpoints in the Ruhr area of Germany. A total of 4,443 subjects without coronary artery disease aged 45-75 years could be included between 2000 und 2003 and the prevalence of hypertension, defined by JNC-7, was 63% in men and 52% in women. Low rates of hypertension awareness, treatment and control rates in population-based surveys as well as in recently published high risk cohorts with known coronary artery disease in Germany elucidate the need to optimize the strategies of screening, treatment and follow-up in primary and secondary prevention. Coronary artery calcification was demonstrated to be an independent risk factor for cardiovascular endpoints even in the stage of prehypertension. The risk-benefit ratio for an early treatment of these patients could be improved by advanced risk stratification, assessing the level of coronary artery calcification.

Identification of Marchfeld asparagus using Sr isotope ratio measurements by MC-ICP-MS

This work focuses on testing and application of Sr isotope signatures for the fast and reliable authentication and traceability of Asparagus officinalis originating from Marchfeld, Austria, using multicollector inductively coupled plasma mass spectrometry after optimised Rb/Sr separation. The major sample pool comprises freeze-dried and microwave-digested asparagus samples from Hungary and Slovakia which are compared with Austrian asparagus originating from the Marchfeld region, which is a protected geographical indication. Additional samples from Peru, The Netherlands and Germany were limited in number and allowed therefore only restricted statistical evaluation. Asparagus samples from Marchfeld were harvested within two subsequent years in order to investigate the annual variation. The results show that the Sr isotope ratio is consistent within these 2 years of investigation. Moreover, the Sr isotope ratio of total Sr in soil was found to be significantly higher than in an NH4NO3 extract, reflecting the mobile (bioavailable) phase. The isotope composition in the latter extract corresponds well to the range found in the asparagus samples in Marchfeld, even though the concentration of Sr in asparagus shows no direct correlation to the concentration of Sr in the mobile phase of the soil. The major question was whether the 'Marchfelder Spargel' can be distinguished from samples from the neighbouring countries of Hungary and Slovakia. According to our findings, they can be clearly (100%) singled out from the Hungarian samples and can be distinguished from the Slovakian asparagus samples with a probability of more than 80%.

Multi-element (H,C,N,S) stable isotope characteristics of lamb meat from different European regions

Multi-element (H,C,N,S) stable isotope ratio analysis was tested for its suitability as a means for geographical provenance assignment of lamb meat from several European regions. The defatted dry matter (crude protein fraction) from lamb meat was found to be a suitable probe for "light" element stable isotope ratio analysis. Significant differences were observed between the multi-element isotope ratios of lamb samples from different regions. The mean hydrogen isotopic ratios of the defatted dry matter from lamb were found to be significantly correlated with the mean hydrogen isotopic ratios of precipitation and groundwater in the production regions. Carbon and nitrogen isotopic ratios were influenced by feeding practices and climate. Sulfur isotopic ratios were influenced by geographical location and surface geology of the production region. The results permitted differentiation of lamb meat, from most production regions, by inspection. However, more sophisticated evaluation of the data using multivariate methods, such as linear discriminant analysis, achieved 78% correct classification.

Reduction of bis

The reduction of symmetric, fully-substituted titanocene dichlorides bearing two pendant omega-alkenyl groups, [TiCl2(eta5-C5Me4R)2], R = CH(Me)CH= CH2 (1a). (CH2)2CH=CH2 (1b) and (CH2)3CH=CH2 (1c), by magnesium in tetrahydrofuran affords bis(cyclopentadienyl)titanacyclopentanes [Ti(IV)[eta1:eta1: eta5:eta5-C5Me4CH(Me)CH(Ti)CH2CH(CH2(Ti))CH(Me)C5Me4]] (2a), [Ti(IV)[eta1:eta1:eta5: eta5-C5Me4(CH2)2CH(Ti)(CH2)2CH(Ti)(CH2)2C5Me4]] (2b) and [Ti(IV)[eta1:eta1:eta5:eta5-C5Me4(CH2)2CH(Ti)CH(Me)CH(Me)CH(Ti)(CH2)2C5Me4]](2c), respectively, as the products of oxidative coupling of the double bonds across a titanocene intermediate. For the case of complex 1c, a product of a double bond isomerisation is obtained owing to a preferred formation of five-membered titanacycles. The reaction of the titanacyclopentanes with PbCl2 recovers starting materials 1a from 2a and 1b from 2b, but complex 2c affords, under the same conditions, an isomer of 1c with a shifted carbon - carbon double bond, [TiCl[eta5-C5Me4(CH2CH2CH=CHMe)]2] (1c'). The titanacycles 2a-c can be opened by HCl to give ansa-titanocene dichlorides ansa-[[eta5:eta5-C5Me4CH(Me)CH2CH2CH(Me)CH(Me)C5Me4]TiCl2] (3a), ansa-[[eta5:eta5-C5Me4(CH2)8C5Me4]TiCl2] (3b), along with a minor product ansa-[[eta5:eta5-C5Me4CH2CH=CH(CH2)5C5Me4]TiCl2] (3b'), and ansa-[[eta5:eta5-CsMe4(CH2)3CH(Me)CH(Me)CH=CHCH2C5Me4]TiCl2] (3c), respectively, with the bridging aliphatic chain consisting of five (3a) and eight (3b, 3b' and 3c) carbon atoms. The course of the acidolysis changes with the nature of the pendant group; while the cyclopentadienyl ring-linking carbon chains in 3a and 3b are fully saturated, compounds 3c and 3b' contain one asymetrically placed carbon-carbon double bond, which evidently arises from the beta-hydrogen elimination that follows the HCl addition.