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Jost E, Remmersmann L, Silaschi M, Bakhtiary F, Heinze I, Luetkens J, Ayub TH, Strizek B, Merz WM, Kosian P. Infective Endocarditis Requiring Mitral Valve Replacement During Second Trimester of Pregnancy. JACC Case Rep 2024; 29:102344. [PMID: 38666000 PMCID: PMC11041825 DOI: 10.1016/j.jaccas.2024.102344] [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: 10/12/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Infective endocarditis requiring mitral valve replacement during pregnancy is a rare event. We present a case of infective endocarditis of the mitral valve during second trimester and report maternal and perinatal outcomes. Prompt identification and interdisciplinary treatment is crucial; maternal and fetal follow-up including serial fetal neurosonography is recommended.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Laura Remmersmann
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Ingo Heinze
- Department of Anesthesia and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Julian Luetkens
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Tiyasha H. Ayub
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Bakhtiary F, Silaschi M, El-Sayed Ahmad A, Salamate S, Meuris B. Multicentre experience of sutureless prostheses inside degenerated stentless aortic valves and bioroots. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae088. [PMID: 38696749 DOI: 10.1093/icvts/ivae088] [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] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/30/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES Patients with failed stentless aortic prostheses are a challenging population to treat, as reoperative procedures may be complex and catheter-based treatments are associated with a high rate of procedural events. Reoperative surgery using sutureless valves may be an alternative. METHODS In this multicentre experience, we assess outcomes of 17 patients who underwent reoperative surgery using the Perceval valve (Corcym UK Limited, London, UK) inside Freestyle prosthesis (Medtronic Inc., Dublin, Ireland) or bioroots from 2018 to 2023. RESULTS Mean age was 71.1 ± standard deviation 15.1 years and mean EuroSCORE II was 13.5 ± 15.8%, Society of Thoracic Surgeons Score was 5.9 ± 11.7%. Mean transvalvular gradient at baseline was 25.3 ± 19.9 mmHg and left ventricular ejection fraction was 53.5 ± standard deviation 8.5%. In 70.6% (12/17), moderate or severe aortic regurgitation was present. Implant success was 100%. Aortic cross-clamp time was 44.5 ± standard deviation 23.6 min. No patient needed a pacemaker and no mild paravalvular regurgitation occurred. Mean gradient was 12.5 ± 4.7 mmHg; 30-day mortality was 5.9% (1/17). CONCLUSIONS Rate of mortality was lower than predicted by EuroSCORE II in these high-risk patients and haemodynamic outcomes were favourable. Heart teams should consider this treatment concept when discussing patients with failed stentless valves or bioroots.
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Affiliation(s)
- Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Saad Salamate
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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Hamiko M, Salamate S, Nassari MA, Spaeth A, Sirat S, Doss M, Amer M, Silaschi M, Ahmad AES, Bakhtiary F. Totally Endoscopic Replacement of the Ascending Aorta and the Aortic Root including the Aortic Valve via Right Mini-Thoracotomy: A Multicenter Study. J Clin Med 2024; 13:2648. [PMID: 38731177 DOI: 10.3390/jcm13092648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Recently, minimally invasive access via right anterolateral mini-thoracotomy (RAMT) has been gaining popularity in cardiac surgery. This approach is also an option for surgeons performing aortic surgery. The aim of this study is to present our surgical method, highlighting the total endoscopic minimally invasive approach via RAMT for replacement of the ascending aorta (AAR) with or without involvement of the aortic root and the aortic valve. Methods: Clinical data of 44 patients from three participating institutions with AAR with or without involvement of the aortic valve or aortic root via RAMT between April 2017 and February 2024 were retrospectively analyzed. According to surgical procedure, patients were divided into two groups, in the AAR and in the Wheat/Bentall group with concomitant valve or root replacement. Operative time, length of ventilation, perioperative outcome, length of intensive care unit (ICU) as well as postoperative hospital stay, and mid- and long-term results were retrospectively analyzed. Results: Mean age was 61.4 ± 10.7 years old with a frequency of male gender of 63.6%. Mean cardiopulmonary bypass (CBP) time and aortic cross-clamping time was 94.9 ± 32.5 min and 63.8 ± 25.9 min, respectively. CPB and aortic clamp time were significantly lower in AAR group. In the first 24 h, the mean drainage volume was 790.3 ± 423.6 mL. Re-thoracotomy due to bleeding was zero. Sternotomy was able to be avoided in all patients. Patients stayed 35.9 ± 23.5 h at ICU and were discharged 7.8 ± 3.0 days following surgery from hospital. Mean ventilation time was 5.8 ± 7.6 h. All patients survived and 30-day mortality was 0.0%. At a median follow-up time of 18.2 months, all patients were alive. The results were similar in both groups. Conclusions: The full endoscopic RAMT approach with 3D visualization is a safe, feasible and promising technique that can be transferred in the field of aortic surgery without compromising surgical quality, postoperative outcomes, or patient safety when performed by an experienced team in a high-volume center.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Maedeh Ayay Nassari
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Andre Spaeth
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Sami Sirat
- Department of Cardiac Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany
| | - Mirko Doss
- Department of Cardiac Surgery, Helios Hospital Siegburg, 53721 Siegburg, Germany
| | - Mohamed Amer
- Department of Cardiac Surgery, Helios Hospital Wuppertal, 42283 Wuppertal, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Silaschi M, Cattelaens F, Alirezaei H, Vogelhuber J, Sommer S, Sugiura A, Schulz M, Tanaka T, Sudo M, Zimmer S, Nickenig G, Weber M, Bakhtiary F, Wilde N. Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally Invasive Mitral Valve Surgery: An Observational Study. J Clin Med 2024; 13:1372. [PMID: 38592259 PMCID: PMC10932335 DOI: 10.3390/jcm13051372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Minimally invasive mitral valve surgery (MIC-MVS) has been established as preferred treatment of mitral regurgitation (MR), but mitral transcatheter edge-to-edge valve repair (M-TEER) is routinely performed in patients at high surgical risk and is increasingly performed in intermediate risk patients. Methods: From 2010 to 2021, we performed 723 M-TEER and 123 isolated MIC-MVS procedures. We applied a sensitivity analysis by matching age, left ventricular ejection fraction (LVEF), EuroSCORE II and etiology of MR. Results: Baseline characteristics showed significant differences in the overall cohort (p < 0.01): age 78.3 years vs. 61.5 years, EuroSCORE II 5.5% vs. 1.3% and LVEF 48.4% vs. 60.4% in M-TEER vs. MIC-MVS patients. Grade of MR at discharge was moderate/severe in 24.5% (171/697) in M-TEER vs. 6.5% (8/123) in MIC-MVS (p < 0.01). One-year survival was 91.5% (552/723) in M-TEER vs. 97.6% (95/123) in MIC-MVS (p = 0.04). A matching with 49 pairs (n = 98) showed comparable survival during follow-up, but a numerically higher mean mitral valve gradient of 4.1 mmHg (95% CI: 3.6-4.6) vs. 3.4 mmHg (95% CI: 3.0-3.8) in M-TEER (p = 0.04). Conclusions: Patients undergoing M-TEER had lower one-year survival than MIC-MVS, but differences disappeared after matching. Reduction in MR was less effective in M-TEER patients and postprocedural mitral valve gradients were higher.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Franca Cattelaens
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Hossien Alirezaei
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Johanna Vogelhuber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Susanne Sommer
- Department of Cardiac Surgery, Bundeswehrzentralkrankenhaus Koblenz, 56072 Koblenz, Germany;
| | - Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Max Schulz
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Mitsumasa Sudo
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Bonn, 53127 Bonn, Germany; (M.S.); (F.C.); (H.A.); (F.B.)
| | - Nihal Wilde
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; (J.V.); (A.S.); (M.S.); (T.T.); (M.S.); (S.Z.); (G.N.); (M.W.)
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Sugiura A, Tanaka T, Kavsur R, Öztürk C, Silaschi M, Goto T, Weber M, Zimmer S, Nickenig G, Vogelhuber J. Refining accuracy of RV-PA coupling in patients undergoing transcatheter tricuspid valve treatment. Clin Res Cardiol 2024; 113:177-186. [PMID: 38010521 PMCID: PMC10808486 DOI: 10.1007/s00392-023-02339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Assessing right ventricular (RV) function is paramount for risk stratification, which remains challenging in patients with tricuspid regurgitation (TR). We assessed RV-pulmonary artery (PA) coupling and its predictability of outcomes after transcatheter tricuspid valve repair (TTVR). METHODS Study participants comprised patients undergoing transcatheter tricuspid valve repair to treat symptomatic TR from June 2015 to July 2021. We calculated an RV-PA coupling ratio using a formula, which is dividing tricuspid annular plane systolic excursion (TAPSE) by echocardiographically estimated (ePASP) or invasively measured PASP (iPASP) at baseline. The primary outcome was all-cause mortality or heart failure rehospitalization within one year. RESULTS The study participants (n = 206) were at high surgical risk (EuroSCORE II: 7.4 ± 4.8%). The primary outcome occurred in 57 patients within one year. The c-statistics for the outcome were 0.565 (95% CI 0.488-0.643) for TAPSE/ePASP and 0.695 (95% CI 0.631-0.759) for TAPSE/iPASP. The correlation between the ePASP and iPASP was attenuated in patients with massive/torrential TR compared to those with severe TR (interaction p = 0.01). In the multivariable Cox proportional model, TAPSE/iPASP was inversely associated with the risk of the primary outcome (per 0.1-point increase: adjusted-HR 0.67, 95% CI 0.56-0.82, p < 0.001), independent of baseline demographics. According to the TAPSE/iPASP quartiles (i.e., ≤ 0.316; 0.317-0.407; 0.408-0.526; ≥ 0.527), the event-free survival was 43.4%, 48.3%, 77.9%, and 85.4% at one year after TTVR. CONCLUSION RV-PA coupling predicts one-year mortality and heart failure rehospitalization after TTVR in patients with TR. The predictability is improved if invasively-measured PA pressure is included.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Sudo M, Shamekhi J, Aksoy A, Al-Kassou B, Tanaka T, Silaschi M, Weber M, Nickenig G, Zimmer S. A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2024; 113:58-67. [PMID: 37178161 PMCID: PMC10808226 DOI: 10.1007/s00392-023-02220-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR. METHODS A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years. RESULTS Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05-1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22-3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01). CONCLUSION Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR.
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Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Wilde N, Tanaka T, Vij V, Sugiura A, Sudo M, Eicheler E, Silaschi M, Vogelhuber J, Bakhtiary F, Nickenig G, Weber M, Zimmer S. Characteristics and outcomes of patients undergoing transcatheter mitral valve replacement with the Tendyne system. Clin Res Cardiol 2024; 113:1-10. [PMID: 36645506 PMCID: PMC10808407 DOI: 10.1007/s00392-023-02155-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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) has emerged as alternative to transcatheter edge-to-edge repair (TEER) for treatment of mitral regurgitation (MR); however, the role of TMVR with the Tendyne system among established treatments of MR is not well defined. We assessed characteristics and outcomes of patients treated with the Tendyne system in the current clinical practice. METHODS We reviewed patients who underwent cardiac computed tomography and were judged eligible for the Tendyne system. RESULTS A total of 63 patients were eligible for TMVR with the Tendyne system. Of these, 17 patients underwent TMVR, and 46 were treated by TEER. Patients treated with the Tendyne system were more likely to have a high transmitral pressure gradient and unsuitable mitral valve morphology for TEER than those treated with TEER. TMVR with the Tendyne system reduced the severity of MR to less than 1 + in 94.1% of the patients at discharge and achieved a greater reduction in left ventricular (LV) end-diastolic volume at the 30-day follow-up compared with TEER. In contrast, patients treated with the Tendyne system had a higher 30-day mortality than those treated with TEER, while the mortality between 30 days and one year was comparable between Tendyne and TEER. CONCLUSIONS Among patients eligible for the Tendyne system, approximately a quarter of the patients underwent TMVR with the Tendyne system, which led substantial reduction of MR and LV reverse remodeling than TEER. In contrast, the 30-day mortality rate was higher after TMVR with the Tendyne compared to TEER.
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Affiliation(s)
- Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Vivian Vij
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Eva Eicheler
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Wilde N, Silaschi M, Alirezaei H, Vogelhuber J, Sugiura A, Tanaka T, Sudo M, Kavsur R, Cattelaens F, El-Sayed Ahmad A, Doss M, Fehske W, Zimmer S, Nickenig G, Bakhtiary F, Weber M. Transcatheter edge-to-edge valve repair versus minimally invasive beating-heart surgery of the tricuspid valve: an observational study. EUROINTERVENTION 2023; 19:659-661. [PMID: 37403809 PMCID: PMC10591193 DOI: 10.4244/eij-d-23-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Nihal Wilde
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, Bonn, Germany
| | | | | | - Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Mitsumasa Sudo
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Refik Kavsur
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | | | | | - Mirko Doss
- Department of Cardiac Surgery, Helios Hospital Siegburg, Siegburg, Germany
| | - Wolfgang Fehske
- Department of Cardiology, Helios Hospital Siegburg, Siegburg, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
| | | | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, Bonn, Germany
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Kruse J, Silaschi M, Velten M, Wittmann M, Alaj E, Ahmad AES, Zimmer S, Borger MA, Bakhtiary F. Femoral or Axillary Cannulation for Extracorporeal Circulation during Minimally Invasive Heart Valve Surgery (FAMI): Protocol for a Multi-Center Prospective Randomized Trial. J Clin Med 2023; 12:5344. [PMID: 37629384 PMCID: PMC10455070 DOI: 10.3390/jcm12165344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Minimally invasive heart valve surgery via anterolateral mini-thoracotomy with full endoscopic 3D visualization (MIS) has become the standard treatment of patients with valvular heart disease and low operative risk over the past two decades. It requires extracorporeal circulation and cardioplegic arrest. The most established form of arterial cannulation for MIS is through the femoral artery and is used by most surgeons, but it is suspected to increase the risk of stroke through retrograde blood flow. An alternative route of cannulation is the axillary artery, producing antegrade blood flow during extracorporeal circulation. METHODS Femoral or axillary cannulation for extracorporeal circulation during minimally invasive heart valve surgery (FAMI) is a multicenter randomized controlled trial designed to determine whether axillary cannulation is superior to femoral cannulation for the outcome of a manifest stroke within 7 days postoperatively. The target sample size was 848 participants. Patients ≥ 18 years of age, with valvular regurgitation or stenosis scheduled for minimally invasive surgery via anterolateral mini-thoracotomy, were randomized to axillary cannulation (treatment group) or to femoral cannulation (standard care). Patients were followed up for seven days postoperatively. A CT scan was performed pre-operatively to screen patients for vascular calcifications and to assess the safety of femoral cannulation. The standard of care is femoral artery cannulation, but is performed only in patients without significant vascular calcifications or severe kinking of the iliac arteries and in patients with sufficient vessel diameter. The cannulation is performed via Seldinger's technique, and the vessel closed percutaneously using a plug-based vascular closure device. Only patients without significant vascular calcifications are considered for femoral cannulation, as an increased risk of stroke is assumed. In patients with vascular calcifications, axillary cannulation is the standard of care to avoid these risks. Retrospective studies have hinted that, even in patients without vascular calcifications, there may be a lower stroke risk with axillary cannulation compared to femoral cannulation. We present a protocol for a multi-center randomized trial to investigate this hypothesis. DISCUSSION To date, evidence on the best access for peripheral artery cannulation during minimally invasive heart valve surgery has been scarce. Patients may benefit from axillary cannulation for extracorporeal circulation in terms of stroke risk and other neurological and vascular complications, though femoral cannulation is the gold standard. The aim of this study is to determine the risks of peri-operative stroke in a prospective randomized comparison of femoral vs. axillary cannulation.
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Affiliation(s)
- Jacqueline Kruse
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Eissa Alaj
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Michael A. Borger
- Department of Cardiac Surgery, Leipzig Heart Center, 04289 Leipzig, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
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10
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Hamiko M, Jahnel K, Rogaczewski J, Schafigh M, Silaschi M, Spaeth A, Velten M, Roell W, Ahmad AES, Bakhtiary F. The Long-Term Outcome and Quality of Life after Replacement of the Ascending Aorta. J Clin Med 2023; 12:4498. [PMID: 37445533 DOI: 10.3390/jcm12134498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Despite optimal surgical therapy, replacement of the ascending aorta leads to a significant reduction in the quality of life (QoL). However, an optimal result includes maintaining and improving the QoL. The aim of our study was to evaluate the long-term outcome and the QoL in patients with aneurysms in the ascending aorta; (2) Methods: Between 2014 and 2020, 121 consecutive patients who underwent replacement of the ascending aorta were included in this study. Acute aortic pathologies were excluded. A standard short form (SF)-36 questionnaire was sent to the 112 survivors. According to the surgical procedure, patients were divided into two groups (A: supracoronary replacement of the aorta, n = 35 and B: Wheat-, David- or Bentall-procedures, n = 86). The QoL was compared within these groups and to the normal population, including myocardial infarction (MI), coronary artery disease (CAD) and cancer (CAN) patients; (3) Results: 83 patients were males (68.6%) with a mean age of 62.0 ± 12.5 years. Early postoperative outcomes showed comparable results between groups A and B, with a higher re-thoracotomy rate in B (A: 0.0% vs. B: 22.1%, p = 0.002). The 30-day mortality was zero. Overall, mortality during the follow-up was 7.4%. The SF-36 showed a significant decay in both the Physical (PCS) and Mental Component Summary (MCS) in comparison to the normal population (PCS: 41.1 vs. 48.4, p < 0.001; MCS: 42.1 vs. 50.9, p < 0.001) but without significant difference between both groups. Compared to the MI and CAD patients, significantly higher PCS but lower MCS scores were detected (p < 0.05); (4) Conclusions: Replacement of the ascending aorta shows low risk regarding the operative and postoperative outcomes with satisfying long-term results in the QoL. The extent of the surgical procedure does not influence the postoperative QoL.
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Affiliation(s)
- Marwan Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Katja Jahnel
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Julia Rogaczewski
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Myriam Schafigh
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Andre Spaeth
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Wilhelm Roell
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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11
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Schafigh M, Silaschi M, Bakhtiary F. A case of severe mitral annular calcification treated with ultrasonic aspiration and mitral valve replacement through minimally invasive access. Eur Heart J Case Rep 2023; 7:ytad244. [PMID: 37234875 PMCID: PMC10208738 DOI: 10.1093/ehjcr/ytad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Affiliation(s)
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Venusberg Campus 1, Bonn 53127, Germany
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12
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Sudo M, Vij V, Wilde N, Tanaka T, Vogelhuber J, Silaschi M, Weber M, Bakhtiary F, Nickenig G, Zimmer S, Sugiura A. Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation. J Clin Med 2023; 12:jcm12082978. [PMID: 37109312 PMCID: PMC10144978 DOI: 10.3390/jcm12082978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Before the development of transcatheter interventions, patients with mitral regurgitation (MR) and high surgical risk were often conservatively treated and subject to poor prognoses. We aimed to assess the therapeutic approaches and outcomes in the contemporary era. The study participants were consecutive high-risk MR patients from April 2019 to October 2021. Among the 305 patients analyzed, 274 (89.8%) underwent mitral valve interventions, whereas 31 (10.2%) received medical therapy alone. Of the interventions, transcatheter edge-to-edge mitral repair (TEER) was the most frequent (82.0% of overall), followed by transcatheter mitral valve replacement (TMVR) (4.6%). In patients treated with medical therapy alone, non-optimal morphologies for TEER and TMVR were shown in 87.1% and 65.0%, respectively. Patients undergoing mitral valve interventions experienced less frequent heart failure (HF) rehospitalization compared to those with medical therapy alone (18.2% vs. 42.0%, p < 0.01). Mitral valve intervention was associated with a lower risk of HF rehospitalization (HR 0.36 [0.18-0.74]) and an improved New York Heart Association class (p < 0.01). Most high-risk MR patients can be treated with mitral valve interventions. However, approximately 10% remained on medical therapy alone and were considered as unsuitable for current transcatheter technologies. Mitral valve intervention was associated with a lower risk of HF rehospitalization and improved functional status.
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Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
- Department of Cardiology, Division of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Vivian Vij
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, 53179 Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, 53179 Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, Germany
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13
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Nitsch L, Shirvani Samani O, Silaschi M, Schafigh M, Zimmer S, Petzold GC, Kindler C, Bode FJ. Infective endocarditis and stroke: when does it bleed? A single center retrospective study. Neurol Res Pract 2023; 5:13. [PMID: 37020243 PMCID: PMC10077710 DOI: 10.1186/s42466-023-00239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious condition with a high mortality, represents a rare cause of stroke and an increased risk of intracranial hemorrhage. In this single center study, we characterize stroke patients with IE. We were interested in risk factors for intracranial hemorrhage and outcome of patients with intracranial hemorrhage compared to patients with ischemic stroke. METHODS Patients with IE and symptomatic ischemic stroke or intracranial hemorrhage admitted to our hospital between January 2019 and December 2022 were included in this retrospective study. RESULTS 48 patients with IE and ischemic stroke or intracranial hemorrhage were identified. 37 patients were diagnosed with ischemic stroke, 11 patients were diagnosed with intracranial hemorrhage. The intracranial hemorrhage occurred within the first 12 days after admission. We identified Staphylococcus aureus detection and thrombocytopenia as risk factors for hemorrhagic complications. An increased in-hospital mortality in patients with intracranial hemorrhage (63.6% vs. 22%, p = 0.022) was found, whereas patients with ischemic stroke and patients with intracranial hemorrhage do not differ regarding favorable clinical outcome (27% vs. 27.3%, p = 1.0). 27.3% patients with intracranial hemorrhage and 43.2% patients with ischemic stroke underwent cardiac surgery. Overall, 15.7% new ischemic strokes occurred after valve reconstruction, whereas no new intracranial hemorrhage was observed. CONCLUSIONS We found an increased in-hospital mortality in patients with intracranial hemorrhage. Beside thrombocytopenia, we identified S. aureus detection as a risk factor for intracranial hemorrhage.
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Affiliation(s)
- L Nitsch
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - O Shirvani Samani
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - M Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - M Schafigh
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - S Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - G C Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Kindler
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, 53127, Bonn, Germany
| | - F J Bode
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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14
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Schafigh M, Bakhtiary F, Kolck UW, Zimmer S, Greschus S, Silaschi M. Coronary Artery Aneurysm Rupture in a Patient With Polyarteritis Nodosa. JACC Case Rep 2022; 4:1522-1528. [PMID: 36444190 PMCID: PMC9700061 DOI: 10.1016/j.jaccas.2022.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/12/2023]
Abstract
We present the case of a 42-year-old male patient with ST-segment elevation myocardial infarction and pericardial effusion due to rupture of the left anterior descending artery most likely secondary to polyarteritis nodosa. Successful surgery was performed under cardiopulmonary bypass using antegrade and retrograde cardioplegia combined. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Myriam Schafigh
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Germany
| | - Ulrich W. Kolck
- Department of Internal Medicine, Cardiology, Johanniter Waldkrankenhaus Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Germany
| | - Susanne Greschus
- Department of Radiology, Johanniter Waldkrankenhaus Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Germany
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15
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Sugiura A, Sudo M, Al-Kassou B, Shamekhi J, Silaschi M, Wilde N, Sedaghat A, Becher UM, Weber M, Sinning JM, Grube E, Nickenig G, Charitos EI, Zimmer S. Percutaneous trans-axilla transcatheter aortic valve replacement. Heart Vessels 2022; 37:1801-1807. [PMID: 35505257 PMCID: PMC9399016 DOI: 10.1007/s00380-022-02082-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
The left axillary artery is an attractive alternative access route for transcatheter aortic valve replacement (TAVR) and may provide better outcomes compared to other alternatives. Nevertheless, there remain concerns about vascular complications, lack of compressibility, and thorax-related complications. Between March 2019 and March 2021, 13 patients underwent transaxillary TAVR for severe aortic stenosis at the University Hospital Bonn. The puncture was performed with a puncture at the distal segment of the axillary artery through the axilla, with additional femoral access for applying a safety wire inside the axillary artery. Device success was defined according to the VARC 2 criteria. The study participants were advanced in age (77 ± 9 years old), and 54% were female, with an intermediate risk for surgery (STS risk score 4.7 ± 2.0%). The average diameter of the distal segment of the axillary artery was 5.8 ± 1.0 mm (i.e., the puncture site) and 7.6 ± 0.9 mm for the proximal axillary artery. Device success was achieved in all patients. 30-day major adverse cardiac and cerebrovascular events were 0%. With complete percutaneous management, stent-graft implantation was performed at the puncture site in 38.5% of patients. Minor bleeding was successfully managed with manual compression. Moreover, no thorax-related complications, hematomas, or nerve injuries were observed. Percutaneous trans-axilla TAVR was found to be feasible and safe. This modified approach may mitigate the risk of bleeding and serious complications in the thorax and be less invasive than surgical alternatives.
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Affiliation(s)
- Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Mitsumasa Sudo
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ulrich Marc Becher
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Efstratios I Charitos
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
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Sugiura A, Silaschi M, Weber M, Nickenig G, Zimmer S. TCTAP C-173 Iliac Stent Dislocation During Transcatheter Aortic Valve Replacement: Do Not Push Me Out. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.03.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Diab M, Lehmann T, Bothe W, Akhyari P, Platzer S, Wendt D, Deppe AC, Strauch J, Hagel S, Günther A, Faerber G, Sponholz C, Franz M, Scherag A, Velichkov I, Silaschi M, Fassl J, Hofmann B, Lehmann S, Schramm R, Fritz G, Szabo G, Wahlers T, Matschke K, Lichtenberg A, Pletz MW, Gummert JF, Beyersdorf F, Hagl C, Borger MA, Bauer M, Brunkhorst FM, Doenst T. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation 2022; 145:959-968. [PMID: 35213213 DOI: 10.1161/circulationaha.121.056940] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [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] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiac surgery often represents the only treatment option in patients with infective endocarditis (IE). However, IE surgery may lead to a sudden release of inflammatory mediators, which is associated with postoperative organ dysfunction. We investigated the effect of hemoadsorption during IE surgery on postoperative organ dysfunction. METHODS This multicenter, randomized, nonblinded, controlled trial assigned patients undergoing cardiac surgery for IE to hemoadsorption (integration of CytoSorb to cardiopulmonary bypass) or control. The primary outcome (change in sequential organ failure assessment score [ΔSOFA]) was defined as the difference between the mean total postoperative SOFA score, calculated maximally to the 9th postoperative day, and the basal SOFA score. The analysis was by modified intention to treat. A predefined intergroup comparison was performed using a linear mixed model for ΔSOFA including surgeon and baseline SOFA score as fixed effect covariates and with the surgical center as random effect. The SOFA score assesses dysfunction in 6 organ systems, each scored from 0 to 4. Higher scores indicate worsening dysfunction. Secondary outcomes were 30-day mortality, duration of mechanical ventilation, and vasopressor and renal replacement therapy. Cytokines were measured in the first 50 patients. RESULTS Between January 17, 2018, and January 31, 2020, a total of 288 patients were randomly assigned to hemoadsorption (n=142) or control (n=146). Four patients in the hemoadsorption and 2 in the control group were excluded because they did not undergo surgery. The primary outcome, ΔSOFA, did not differ between the hemoadsorption and the control group (1.79±3.75 and 1.93±3.53, respectively; 95% CI, -1.30 to 0.83; P=0.6766). Mortality at 30 days (21% hemoadsorption versus 22% control; P=0.782), duration of mechanical ventilation, and vasopressor and renal replacement therapy did not differ between groups. Levels of interleukin-1β and interleukin-18 at the end of integration of hemoadsorption to cardiopulmonary bypass were significantly lower in the hemoadsorption than in the control group. CONCLUSIONS This randomized trial failed to demonstrate a reduction in postoperative organ dysfunction through intraoperative hemoadsorption in patients undergoing cardiac surgery for IE. Although hemoadsorption reduced plasma cytokines at the end of cardiopulmonary bypass, there was no difference in any of the clinically relevant outcome measures. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03266302.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Thomas Lehmann
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany (W.B., F.B.)
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, Germany (P.A., A.L.)
| | - Stephanie Platzer
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Germany (D.W.)
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Germany (A.-C.D., T.W.)
| | - Justus Strauch
- Department of Cardiac and Thoracic Surgery, Bergmannsheil University Hospitals, Bochum, Germany (J.S.)
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control (S.H., M.W.P.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Albrecht Günther
- Department of Neurology (A.G.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Critical Care Medicine (C.S., M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I (M.F.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - André Scherag
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Institute of Medical Statistics, Computer and Data Sciences (A.S.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Ilia Velichkov
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Miriam Silaschi
- Clinic and Polyclinic for Cardiac Surgery, University Hospital Bonn, Germany (M.S.)
| | - Jens Fassl
- Institute for Cardiac Anesthesiology, Dresden Heart Center, University Hospital at the Technical University Dresden, Germany (J.F.)
| | - Britt Hofmann
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany (B.H., G.S.)
| | - Sven Lehmann
- Department of Cardiac Surgery, Heart Center Leipzig, Germany (S.L., M.A.B.)
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (R.S., J.F.G.)
| | - Georg Fritz
- Department of Anesthesiology, Intensive Care and Pain Therapy, Heart Center Brandenburg, Immanuel Clinic Bernau, Germany (G. Fritz)
| | - Gabor Szabo
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), Halle, Germany (B.H., G.S.)
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Germany (A.-C.D., T.W.)
| | - Klaus Matschke
- Department of Cardiac Surgery, Heart Center Dresden, Germany (K.M.)
| | - Artur Lichtenberg
- Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, Germany (P.A., A.L.)
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control (S.H., M.W.P.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (R.S., J.F.G.)
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany (W.B., F.B.)
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Germany (C.H.).,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (C.H.)
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, Germany (S.L., M.A.B.)
| | - Michael Bauer
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Department of Anesthesiology and Critical Care Medicine (C.S., M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Frank M Brunkhorst
- Center for Sepsis Control and Care (M.D., T.L., S.P., A.S., M.B., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany.,Center for Clinical Studies (T.L., S.P., A.S., F.M.B.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery (M.D., G. Faerber, I.V., T.D.), Jena University Hospital-Friedrich Schiller University of Jena, Germany
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Oezkur M, Reda S, Rühl H, Theuerkauf N, Kreyer S, Duerr GD, Charitos E, Silaschi M, Medina M, Zimmer S, Putensen C, Treede H. Role of acquired von Willebrand syndrome in the development of bleeding complications in patients treated with Impella RP devices. Sci Rep 2021; 11:23722. [PMID: 34887445 PMCID: PMC8660831 DOI: 10.1038/s41598-021-02833-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/16/2021] [Indexed: 11/09/2022] Open
Abstract
Axial flow pumps are standard treatment in cases of cardiogenic shock and high-risk interventions in cardiology and cardiac surgery, although the optimal anticoagulation strategy remains unclear. We evaluated whether laboratory findings could predict bleeding complications and acquired von Willebrand syndrome (avWS) among patients who were treated using axial flow pumps. We retrospectively evaluated 60 consecutive patients who received Impella devices (Impella RP: n = 20, Impella CP/5.0: n = 40; Abiomed Inc., Danvers, USA) between January 2019 and December 2020. Thirty-two patients (53.3%) experienced major or fatal bleeding complications (Bleeding Academic Research Consortium score of > 3) despite intravenous heparin being used to maintain normal activated partial thromboplastin times (40–50 s). Extensive testing was performed for 28 patients with bleeding complications (87.5%). Relative to patients with left ventricular support, patients with right ventricular support were less likely to develop avWS (87.5% vs. 58.8%, p = 0.035). Bleeding was significantly associated with avWS (odds ratio [OR]: 20.8, 95% confidence interval [CI]: 3.3–128.5; p = 0.001) and treatment duration (OR: 1.3, 95% CI 1.09–1.55; p = 0.003). Patients with avWS had longer Impella treatment than patients without avWS (2 days [1–4.7 days] vs. 7.3 days [3.2–13.0 days]). Bleeding complications during Impella support were associated with avWS in our cohort, while aPTT monitoring was not sufficient to prevent bleeding complications. A more targeted anticoagulation monitoring might be needed for patients who receive Impella devices.
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Affiliation(s)
- Mehmet Oezkur
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany. .,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Sara Reda
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Heiko Rühl
- Department of Haematology, University Hospital of Bonn, Bonn, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Stefan Kreyer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Georg Daniel Duerr
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Efstratios Charitos
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Marta Medina
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Hospital of Bonn, Bonn, Germany.,Department of Cardiovascular Surgery, University Hospital Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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19
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Silaschi M, Eckert L, Hofmann B, Oezkur M, Charitos E, Sedding D, Treede H. Durability of Transcatheter Aortic Valves Beyond 5 Years: A Retrospective Single-Center Analysis. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705481] [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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20
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Adermann L, Hofmann B, Khizaneishvili L, Oezkur M, Sedding D, Wilbring M, Treede H, Silaschi M. Long-Term Pacemaker Dependency after Permanent Pacemaker Implantation Secondary to Heart Valve Surgery. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705424] [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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21
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Gotzmann M, Wilbring M, Charitos E, Treede H, Silaschi M. Hemodynamic Comparison of Sutureless and Rapid-Deployment Valves with Conventional Bioprostheses. Thorac Cardiovasc Surg 2019; 68:584-594. [PMID: 30900219 DOI: 10.1055/s-0039-1683426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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 Sutureless and rapid-deployment bioprostheses (RPDs) are advantageous due to shorter aortic cross-clamp times (ACCs); however, few studies have investigated hemodynamic outcomes in comparison to conventional bioprostheses (CBs). METHODS All patients receiving the Perceval (LivaNova, London, United Kingdom) and Intuity (Edwards Lifesciences, Irvine, California, United States) valves from February 2016 to December 2017 were included (n = 61). For controls, patients who underwent aortic valve replacement using CB from 2015 to 2018 (n = 743) were propensity-matched (n = 108). Primary end points were mean gradient at discharge, true internal diameter (ID) after implantation, and paravalvular leakage. Secondary end points were ACCs, cardiopulmonary bypass times (CPBTs), mortality, and pacemaker implantation. RESULTS Age was 73.2 years (standard deviation [SD]: 7.6) in the RPD group and 72.9 years (SD: 7.3) in the CB group (p = 0.827). Median logistic EuroSCORE II was 3.4% (Q1: 2; IQ3: 5.3) and 3% (Q1: 1.9; IQ3: 5.6; p = 0.599). While ACCs and CPBT were shorter in RPDs (97 [SD: 31.4] vs. 125.4 minutes [SD: 62.1], p = 0.003; and 76.1 [SD: 25.7] vs. 89.7 minutes [SD: 34.3], p = 0.022), procedural times were similar (p = 0.257). True ID was 21.97 mm (SD: 1.79) in RPDs and 20.15 mm (SD: 1.70) in CB (p < 0.001).RPDs and CB resulted in comparable mean gradients (12.8 mm Hg [SD: 6.4] vs. 13.8 mm Hg [SD: 5.6]; p = 0.387) and rate of paravalvular regurgitation. There were no differences in the rates of pacemaker implantation and mortality.In a subanalysis of RPDs, mean gradient was 15.48 mm Hg (SD: 7.51) in Perceval (n = 21) and 10.79 mm Hg (SD: 4.78) in Intuity (n = 33; p = 0.010). CONCLUSIONS RPDs provided comparable hemodynamic performance, although implanted valves were larger in true ID. Whether this provides superior hemodynamic performance during exercise and longer durability needs further investigation. Among RPDs, the Intuity valve provided lower mean gradients at rest than Perceval valve.
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Affiliation(s)
- Max Gotzmann
- Department of Cardiac Surgery, Mid-German Heart Center, Halle (Saale), Germany
| | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Efstratios Charitos
- Department of Cardiac Surgery, Mid-German Heart Center, Halle (Saale), Germany
| | - Hendrik Treede
- Department of Cardiac Surgery, Mid-German Heart Center, Halle (Saale), Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Mid-German Heart Center, Halle (Saale), Germany
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22
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Yoon SH, Bleiziffer S, Latib A, Eschenbach L, Ancona M, Vincent F, Kim WK, Unbehaum A, Asami M, Dhoble A, Silaschi M, Frangieh AH, Veulemans V, Tang GH, Kuwata S, Rampat R, Schmidt T, Patel AJ, Nicz PFG, Nombela-Franco L, Kini A, Kitamura M, Sharma R, Chakravarty T, Hildick-Smith D, Arnold M, de Brito FS, Jensen C, Jung C, Jilaihawi H, Smalling RW, Maisano F, Kasel AM, Treede H, Kempfert J, Pilgrim T, Kar S, Bapat V, Whisenant BK, Van Belle E, Delgado V, Modine T, Bax JJ, Makkar RR. Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2019; 12:182-193. [DOI: 10.1016/j.jcin.2018.12.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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23
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Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Dhoble A, Schofer N, Eschenbach L, Bansal E, Murdoch DJ, Ancona M, Schmidt T, Yzeiraj E, Vincent F, Niikura H, Kim WK, Asami M, Unbehaun A, Hirji S, Fujita B, Silaschi M, Tang GHL, Kuwata S, Wong SC, Frangieh AH, Barker CM, Davies JE, Lauten A, Deuschl F, Nombela-Franco L, Rampat R, Nicz PFG, Masson JB, Wijeysundera HC, Sievert H, Blackman DJ, Gutierrez-Ibanes E, Sugiyama D, Chakravarty T, Hildick-Smith D, de Brito FS, Jensen C, Jung C, Smalling RW, Arnold M, Redwood S, Kasel AM, Maisano F, Treede H, Ensminger SM, Kar S, Kaneko T, Pilgrim T, Sorajja P, Van Belle E, Prendergast BD, Bapat V, Modine T, Schofer J, Frerker C, Kempfert J, Attizzani GF, Latib A, Schaefer U, Webb JG, Bax JJ, Makkar RR. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J 2018; 40:441-451. [DOI: 10.1093/eurheartj/ehy590] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [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: 08/07/2018] [Accepted: 09/06/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sung-Han Yoon
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Brian K Whisenant
- Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, UT, USA
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | - Abhijeet Dhoble
- Department of Cardiology, University of Texas Health Science Center, 6431 Fannin St., MSB 1.224, Houston, TX, USA
| | - Niklas Schofer
- Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Lena Eschenbach
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Eric Bansal
- The Valve and Structural Heart Interventional Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Dale J Murdoch
- Department of Cardiology, St Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Marco Ancona
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, San Raffaele Hospital, Milan, Italy
| | - Tobias Schmidt
- Department of Cardiology, Asklepios Klink St. Georg, Lohmuehlenstrasse 5, Hamburg, Germany
| | - Ermela Yzeiraj
- Hamburg University Cardiovascular Center, Hamburg, Germany
| | - Flavien Vincent
- Department of Cardiology/Cardiac Surgery, CHU Lille, INSERM U1011-EGID, Institut Pasteur de Lille, Lille, France
| | - Hiroki Niikura
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th St, Minneapolis, MN, USA
| | - Won-Keun Kim
- Department of Cardiology/Cardiac Surgery, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, D-61231 Bad Nauheim, Germany
| | - Masahiko Asami
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, CH-3010 Bern, Switzerand
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Augustenburger Platz 1, and DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women’s Hospital, 15 Francis Street, Boston, MA, USA
| | - Buntaro Fujita
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube Str. 40, Halle, Germany
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, 1190 Fifth Avenue, GP2W, Box 1028, New York, NY, USA
| | - Shingo Kuwata
- University Heart Center, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - S Chiu Wong
- Greenberg Division of Cardiology, New York-Presbyterian Hospital, Weil Cornell Medicine, New York, NY, USA
| | - Antonio H Frangieh
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Colin M Barker
- Department of Cardiology, Houston Methodist Hospital, Smith 1901, 6550 Fannin Street, Houston, TX, USA
| | - James E Davies
- Division of Cardiac and Thoracic Surgery, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Florian Deuschl
- Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Profesor Martin Lagos s/n, Madrid, Spain
| | - Rajiv Rampat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Jean-Bernard Masson
- Division of Cardiology, Centre Hospitalier de l’université de Montreal, 1051 Sanguinet, Montreal, Quebec, Canada
| | - Harindra C Wijeysundera
- Division of Cardiology, Sunnybrook Health Science Centre, 2075 Bayview Avenue, Suite A202 Toronto, ON, Canada
| | | | | | - Enrique Gutierrez-Ibanes
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr Esquerdo 46, Madrid, CIBER CV, Spain
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tarun Chakravarty
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Fabio Sandoli de Brito
- Heart Institute of University of Sao Paulo Medical School, Av. Dr. Eneas Carvalho de Aguiar 44, São Paulo, Brazil
| | - Christoph Jensen
- Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen, Essen, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstraβe 5, Düsseldorf, Germany
| | - Richard W Smalling
- Department of Cardiology, University of Texas Health Science Center, 6431 Fannin St., MSB 1.224, Houston, TX, USA
| | - Martin Arnold
- Department of Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Simon Redwood
- Cardiothoracic Department, St Thomas Hospital, Westminster Bridge Rd, London, UK
| | - Albert Markus Kasel
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, Munich, Germany
| | - Francesco Maisano
- University Heart Center, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Hendrik Treede
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube Str. 40, Halle, Germany
| | - Stephan M Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Saibal Kar
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, 15 Francis Street, Boston, MA, USA
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, CH-3010 Bern, Switzerand
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 800 East 28th St, Minneapolis, MN, USA
| | - Eric Van Belle
- Department of Cardiology/Cardiac Surgery, CHU Lille, INSERM U1011-EGID, Institut Pasteur de Lille, Lille, France
| | | | - Vinayak Bapat
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Thomas Modine
- Department of Cardiology/Cardiac Surgery, CHU Lille, INSERM U1011-EGID, Institut Pasteur de Lille, Lille, France
| | | | - Christian Frerker
- Department of Cardiology, Asklepios Klink St. Georg, Lohmuehlenstrasse 5, Hamburg, Germany
| | - Joerg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Augustenburger Platz 1, and DZHK (German Center for Cardiovascular Research), partner site Berlin, Germany
| | - Guilherme F Attizzani
- The Valve and Structural Heart Interventional Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, San Raffaele Hospital, Milan, Italy
| | - Ulrich Schaefer
- Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany
| | - John G Webb
- Department of Cardiology, St Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | - Raj R Makkar
- Department of Interventional Cardiology, Cedars-Sinai Heart Institute, 8700 Beverly Blvd, Los Angeles, CA, USA
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Schneeberger Y, Schaefer A, Schofer N, Silaschi M, Deuschl F, Blankenberg S, Reichenspurner H, Treede H, Schäfer U, Charitos EI, Conradi L. Transcatheter aortic valve implantation utilizing a non-occlusive balloon for predilatation. Int J Cardiol 2018; 275:65-69. [PMID: 30366854 DOI: 10.1016/j.ijcard.2018.10.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/03/2018] [Accepted: 10/17/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Balloon aortic valvuloplasty (BAV) is routinely performed preceding transcatheter aortic valve implantation (TAVI). Among risks inherent in BAV is low cardiac output due to rapid ventricular pacing (RVP), especially in patients with severely impaired left ventricular function. We herein report early experience utilizing a non-occlusive balloon for BAV (TrueFlow™, BARD, Peripheral Vascular, Tempe, AZ, US), which does not require RVP. METHODS Between 11/2016 and 10/2017, 27 consecutive patients received TAVI using a non-occlusive balloon valvuloplasty catheter for predilatation and a self-expandable transcatheter heart valve (77.8% female, 81.7 ± 6.6 years, logEuroSCORE I 15.8 ± 10.3%, STS Prom Score 2.5 ± 0.5%). Hemodynamic measurements and acute outcome data were analyzed according to updated Valve Academic Research Consortium definitions. RESULTS Procedure time, fluoroscopy time and amount of contrast agent were 74.5 ± 17.4 min, 16.7 ± 6.9 min and 156.9 ± 92.7 ml. Device success and early combined safety were 100% and 92.6% (25/27). Effective BAV without RVP after the first inflation was achieved in 92.6% of the patients (25/27). Continuous recording of hemodynamics documented no relevant systemic pressure drop during BAV. Postdilatation with a regular balloon was required in 10/27 patients. No death was observed during 30-day follow-up. Resultant mean transvalvular gradient was 6.0 ± 3.5 mm Hg. In one patient a moderate paravalvular leakage was seen. CONCLUSIONS In this series of TAVI utilizing a novel non-occlusive balloon, safety and efficacy were demonstrated. Adequate predilatation was achieved in all cases without need for RVP and with stable hemodynamics. These results will have to be confirmed in larger patient cohorts.
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Affiliation(s)
- Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Halle (Saale), Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | | | - Hendrik Treede
- Department of Cardiac Surgery, University Hospital Halle (Saale), Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | | | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany
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25
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26
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Silaschi M, Petrov A, Wilbring M, Noutsias M, Treede H, Charitos E. High Risk or Intermediate Risk? The Dilemma of Established Scoring Systems Used in Transcatheter Aortic Valve Implantation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628059] [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. Silaschi
- Department of Cardiac Surgery, Comprehensive Heart Centre Halle (Saale), Halle, Germany
| | - A. Petrov
- Department of Cardiac Surgery, Comprehensive Heart Centre Halle (Saale), Halle, Germany
| | - M. Wilbring
- Department of Cardiac Surgery, Comprehensive Heart Centre Halle (Saale), Halle, Germany
| | - M. Noutsias
- Department of Cardiology, Comprehensive Heart Centre Halle (Saale), Halle, Germany
| | - H. Treede
- Department of Cardiac Surgery, Comprehensive Heart Centre Halle (Saale), Halle, Germany
| | - E. Charitos
- Department of Cardiac Surgery, Comprehensive Heart Centre Halle (Saale), Halle, Germany
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27
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Petrov A, Silaschi M, Treede H, Wilbring M. Primary Cardiac Myolipoma - Initial Description and Further Follow-up. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627844] [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)
- A. Petrov
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herz- und Thoraxchirurgie, Halle, Germany
| | - M. Silaschi
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herz- und Thoraxchirurgie, Halle, Germany
| | - H. Treede
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herz- und Thoraxchirurgie, Halle, Germany
| | - M. Wilbring
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herz- und Thoraxchirurgie, Halle, Germany
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Yoon SH, Schmidt T, Bleiziffer S, Schofer N, Fiorina C, Munoz-Garcia AJ, Yzeiraj E, Amat-Santos IJ, Tchetche D, Jung C, Fujita B, Mangieri A, Deutsch MA, Ubben T, Deuschl F, Kuwata S, De Biase C, Williams T, Dhoble A, Kim WK, Ferrari E, Barbanti M, Vollema EM, Miceli A, Giannini C, Attizzani GF, Kong WK, Gutierrez-Ibanes E, Jimenez Diaz VA, Wijeysundera HC, Kaneko H, Chakravarty T, Makar M, Sievert H, Hengstenberg C, Prendergast BD, Vincent F, Abdel-Wahab M, Nombela-Franco L, Silaschi M, Tarantini G, Butter C, Ensminger SM, Hildick-Smith D, Petronio AS, Yin WH, De Marco F, Testa L, Van Mieghem NM, Whisenant BK, Kuck KH, Colombo A, Kar S, Moris C, Delgado V, Maisano F, Nietlispach F, Mack MJ, Schofer J, Schaefer U, Bax JJ, Frerker C, Latib A, Makkar RR. Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation. J Am Coll Cardiol 2017; 70:2752-2763. [DOI: 10.1016/j.jacc.2017.10.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
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Silaschi M, Conradi L, Wendler O, Schlingloff F, Kappert U, Rastan AJ, Baumbach H, Holzhey D, Eichinger W, Bader R, Treede H. The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation. Catheter Cardiovasc Interv 2017; 91:1345-1351. [DOI: 10.1002/ccd.27370] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/17/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Miriam Silaschi
- Department of Cardiac Surgery; University Hospital Halle (Saale); Halle Saale Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | - Olaf Wendler
- Department of Cardiothoracic Surgery; King's College Hospital London; London United Kingdom
| | | | - Utz Kappert
- Department of Cardiac Surgery; University Heart Center Dresden; Dresden Germany
| | - Ardawan J Rastan
- Department of Cardiac Surgery; Center of Cardiovascular Diseases Rotenburg a. d. Fulda; Rotenburg Germany
| | - Hardy Baumbach
- Department of Cardiovascular Surgery; Robert-Bosch-Krankenhaus; Stuttgart Germany
| | - David Holzhey
- Department of Cardiac Surgery; Heart Center Leipzig, University of Leipzig; Leipzig Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery; Klinikum München Bogenhausen GmbH; Munich Germany
| | - Ralf Bader
- Department of Cardiac Surgery; Asklepios Klinik St. Georg; Hamburg Germany
| | - Hendrik Treede
- Department of Cardiac Surgery; University Hospital Halle (Saale); Halle Saale Germany
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Silaschi M, Nicou N, Deshpande R, Chaubey S, Baghai M, Dworakowski R, Wendler O. Complicated infective aortic endocarditis: comparison of different surgical strategies. Interact Cardiovasc Thorac Surg 2017; 25:343-349. [PMID: 28498907 DOI: 10.1093/icvts/ivx109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/15/2016] [Accepted: 02/18/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The choice of substitute during aortic valve replacement for infective endocarditis (IE) is still widely debated. We retrospectively reviewed all patients operated for aortic IE and compared groups according to the complexity of IE and substitutes implanted. METHODS From 2000 to 2015, 187 patients were treated using stentless bioprostheses (SBP) as root replacement (n = 30), mechanical prostheses (MP, n = 45) or stented bioprostheses (SP, n = 112) (mean follow-up 4.6 years, survival data 100% complete). RESULTS MP patients were younger (42.5 ± 10.7 vs 57.2 ± 16.9 years [SBP], 59.1 ± 14.1 years [SP], P < 0.01), but rates of intravenous drug use and chronic dialysis were not different. SBP patients more often had root involvement (83.3% vs 33.3% [MP], 25.9% [SP], P < 0.01) and prosthetic valve endocarditis (53.3% vs 6.7% [MP], 12.5% [SP], P < 0.01). In-hospital complications and length of stay were not different. Thirty-day mortality was 13.3% [SBP], 6.7% [MP] and 12.5% [SP] (P = 0.53). Five-year survival tended to be superior in SBP (83.3% vs 77.6% [MP], 67.1% [SP], P = 0.09). In patients with complicated IE (root involvement or prosthetic valve endocarditis, n = 77), SBP had superior long-term survival (86.9% vs 81.3% [MP], 57.2% [SP], PSBP/MP = 0.07, PSBP/SP = 0.05). No early reinfection (<90 days) occurred in SBP vs 4.4% [MP] and 7.1% [SP] (P = 0.29). Reoperation for late reinfection occurred in 6.7% [SBP] vs 11.1% [MP] and 12.5% [SP] (P = 0.65). Prosthesis failure occurred in 3.3% [SBP] and 1.8% [SP] (P = 0.52). CONCLUSIONS Use of SBP provides favourable outcomes in patients with IE with low rates of reinfection and valve deterioration. It seems to be an optimal device in patients with complex IE.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Niki Nicou
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital London, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
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Silaschi M, Nicou N, Eskandari M, Aldalati O, Seguin C, Piemonte T, McDonagh T, Dworakowski R, Byrne J, MacCarthy P, Monaghan M, Wendler O. Dynamic transcatheter mitral valve repair: a new concept to treat functional mitral regurgitation using an adjustable spacer. EUROINTERVENTION 2017; 13:280-283. [DOI: 10.4244/eij-d-16-00970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Silaschi M, Treede H. Transcatheter Aortic Valve Implantation – History, Current Guidelines and Implications for the Future. Med Monatsschr Pharm 2017; 40:205-208. [PMID: 29950755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Degenerative aortic stenosis is a disease of the elderly and of growing importance in an ageing population. Due to the impaired life-expectancy of patients with symptomatic aortic stenosis, valve replacement should be performed. Surgical aortic valve replacement is the gold standard treatment; however, median sternotomy and use of extracorporal circulation is a risk for elderly patients with comorbidities. The introduction of transcatheter aortic valve implantation (TAVI) into clinical practice has revolutionized treatment of aortic stenosis in elderly patients. In most patients, TAVI can be performed through the groin vessels using local anaesthesia. Most patients fully recover within a few days. Current debate focuses on whether TAVI should also be used to treat younger patients as data on long-term durability of these valves is insufficient and there is a remaining risk of paravalvular leackage.
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Silaschi M, Glizevskaja J, Baghai M, Treede H, Desai J, John L, Deshpande R, Wendler O. 25-Year Outcomes and Prognosis of Patients Undergoing Surgery for Native Mitral Stenosis. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598673] [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. Silaschi
- Klinik für Herzchirurgie, Mitteldeutsches Herzzentrum Halle (Saale), Halle (Saale), Germany
| | - J. Glizevskaja
- Department of Cardiothoracic Surgery, King's College Hospital London, London, United Kingdom
| | - M. Baghai
- Department of Cardiothoracic Surgery, King's College Hospital London, London, United Kingdom
| | - H. Treede
- Klinik für Herzchirurgie, Mitteldeutsches Herzzentrum Halle (Saale), Halle (Saale), Germany
| | - J. Desai
- Department of Cardiothoracic Surgery, King's College Hospital London, London, United Kingdom
| | - L. John
- Department of Cardiothoracic Surgery, King's College Hospital London, London, United Kingdom
| | - R. Deshpande
- Department of Cardiothoracic Surgery, King's College Hospital London, London, United Kingdom
| | - O. Wendler
- Department of Cardiothoracic Surgery, King's College Hospital London, London, United Kingdom
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Silaschi M, Westhofen S, Seiffert M, Bicer D, Schofer N, Wilbring M, Deuschl F, Aldalati O, Blankenberg S, Charitos E, MacCarthy P, Reichenspurner H, Schäfer U, Treede H, Conradi L, Wendler O. Treatment of Failing Mitral Bioprostheses and Repair using Annuloplasty Rings: Transcatheter Mitral Valve Implantation versus Re-Operative Surgery. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598867] [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. Silaschi
- Mitteldeutsches Herzzentrum Halle (Saale), Klinik für Herzchirurgie, Halle (Saale), Germany
| | - S. Westhofen
- Universitäres Herzzentrum Hamburg, Klinik für Herzchirurgie, Hamburg, Germany
| | - M. Seiffert
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - D. Bicer
- Mitteldeutsches Herzzentrum Halle (Saale), Klinik für Herzchirurgie, Halle (Saale), Germany
| | - N. Schofer
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - M. Wilbring
- Mitteldeutsches Herzzentrum Halle (Saale), Klinik für Herzchirurgie, Halle (Saale), Germany
| | - F. Deuschl
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - O. Aldalati
- King's College Hospital London, Department of Cardiology, London, United Kingdom
| | - S. Blankenberg
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - E. Charitos
- Mitteldeutsches Herzzentrum Halle (Saale), Klinik für Herzchirurgie, Halle (Saale), Germany
| | - P. MacCarthy
- King's College Hospital London, Department of Cardiology, London, United Kingdom
| | - H. Reichenspurner
- Universitäres Herzzentrum Hamburg, Klinik für Herzchirurgie, Hamburg, Germany
| | - U. Schäfer
- Universitäres Herzzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - H. Treede
- Mitteldeutsches Herzzentrum Halle (Saale), Klinik für Herzchirurgie, Halle (Saale), Germany
| | - L. Conradi
- Universitäres Herzzentrum Hamburg, Klinik für Herzchirurgie, Hamburg, Germany
| | - O. Wendler
- King's College Hospital London, Department of Cardiothoracic Surgery, London, United Kingdom
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Wilbring M, Silaschi M, Charitos E, Metz D, Treede H. Immediate Isolated CABG for Acute Coronary Syndrome: Initial Clinical Outcome. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598766] [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. Wilbring
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herzchirurgie, Halle, Germany
| | - M. Silaschi
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herzchirurgie, Halle, Germany
| | - E. Charitos
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herzchirurgie, Halle, Germany
| | - D. Metz
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herzchirurgie, Halle, Germany
| | - H. Treede
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Herzchirurgie, Halle, Germany
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Silaschi M, Barr J, Chaubey S, Nicou N, Srirajaskanthan R, Byrne J, Ramage J, MacCarthy P, Wendler O. Optimized Outcomes Using a Standardized Approach for the Treatment of Patients with Carcinoid Heart Disease. Neuroendocrinology 2017; 104:257-263. [PMID: 27097025 DOI: 10.1159/000446213] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported peri-operative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience. METHODS All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus. RESULTS A total of 11 patients were treated; the median age was 63 years (IQR: 56-70). Ten patients underwent both pulmonary valve replacement (PVR) and tricuspid valve replacement (TVR); 1 patient underwent isolated TVR. One patient had additional aortic valve replacement (AVR), another one coronary artery bypass grafting. Bioprostheses (BP) were used in all patients, stented for TVR and AVR, stentless for PVR. Invasive PV inspection caused unplanned PVR in 3 cases (27.3%). All patients were discharged home. One patient (9.1%), who had had previous TVR by another surgeon, had right heart failure (RHF) during follow-up. One death occurred due to progression of CS (day 346). The carcinoids' primary was resected in 5 patients (45.5%) 10 months (4.5-19.5) after cardiac surgery. CONCLUSION Excellent results were achieved in patients with CHD. PV stenosis can be underestimated by echocardiography; therefore, intraoperative inspection is recommended. Right ventricular geometry should be respected to prevent RHF. BP should be used, as these patients are likely to undergo future non-cardiac surgeries.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Silaschi M, Wendler O, Seiffert M, Castro L, Lubos E, Schirmer J, Blankenberg S, Reichenspurner H, Schäfer U, Treede H, MacCarthy P, Conradi L. Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses. Interact Cardiovasc Thorac Surg 2016; 24:63-70. [DOI: 10.1093/icvts/ivw300] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 12/23/2022] Open
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Silaschi M, Chaubey S, Aldalati O, Khan H, Uzzaman MM, Singh M, Baghai M, Deshpande R, Wendler O. Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short- and Long-Term Outcomes in a Propensity-Matched Cohort. J Am Heart Assoc 2016; 5:JAHA.116.003605. [PMID: 27468927 PMCID: PMC5015286 DOI: 10.1161/jaha.116.003605] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Because of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV‐repair) is the “gold standard” treatment for MV disease, in elderly patients, there is controversy about whether MV‐repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years. Methods and Results Our in‐hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (MV‐repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV‐repair was 7.8 years, close to 8.5 years (95% CI: 8.2–9.4) in the age‐matched UK population (ratio 0.9). Rate of re‐operation for MV‐dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03). Conclusions Excellent outcomes can be achieved after MV surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Omar Aldalati
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | | | - Mrinal Singh
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
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Morawiec B, Muller O, Khatchatourov G, Goy JJ, Qureshi SA, Silaschi M, Wendler O. How should I treat a coronary artery fistula complicated with myocarditis - PCI or surgery? EUROINTERVENTION 2016; 12:e291-4. [PMID: 27290690 DOI: 10.4244/eijv12i2a45] [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: 11/23/2022]
Affiliation(s)
- Beata Morawiec
- Department of Cardiology, University Hospital, Lausanne, Switzerland
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Silaschi M. Ein Jahr als Research Fellow am King’s College Hospital in London. Z Herz- Thorax- Gefäßchir 2016. [DOI: 10.1007/s00398-016-0062-9] [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: 11/29/2022]
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Silaschi M, Khan H, Chaubey S, Deshpande R, Baghai M, Wendler O. 140 Two Decades of Mitral Valve Surgery – Trends and Outcomes in Elderly Patients. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cabaco AR, Aldalati O, Eskandari M, Silaschi M, Alcock E, Byrne J, Wendler O, Monaghan M, Shah A, MacCarthy P, Dworakowski R. 212 Assessment of Left Ventricular Contractile Reserve in Patients with Severe Symptomatic Aortic Stenosis and Preserved Ejection Fraction. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silaschi M, Nicou N, Deshpande R, Baghai M, Dworakowski R, Wendler O. 139 Complicated Infective Aortic Endocarditis: Comparison of Different Surgical Strategies. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silaschi M, Jakaj G, Chaubey S, Baghai M, Deshpande R, John L, Whitaker D, Wendler O. 141 Aortic Root Replacement in Patients with Bicuspid Aortic Valve Disease Does not Increase Operative Risk – A Single Centre Experience. Heart 2016. [DOI: 10.1136/heartjnl-2016-309890.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Silaschi M, Treede H, Rastan AJ, Baumbach H, Beyersdorf F, Kappert U, Eichinger W, Rüter F, de Kroon TL, Lange R, Ensminger S, Wendler O. The JUPITER registry: 1-year results of transapical aortic valve implantation using a second-generation transcatheter heart valve in patients with aortic stenosis. Eur J Cardiothorac Surg 2016; 50:874-881. [PMID: 27242354 DOI: 10.1093/ejcts/ezw170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 12/21/2015] [Accepted: 04/09/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) is an established therapy for patients with aortic stenosis (AS) at high surgical risk. The JenaValve™ is a second-generation, self-expanding transcatheter heart valve (THV), implanted through transapical access (TA). During stent deployment, a specific 'clipping-mechanism' engages native aortic valve cusps for fixation. We present 1-year outcomes of the JUPITER registry, a post-market registry of the JenaValve for TA-TAVR. METHODS The JUPITER registry is a prospective, multicentre, uncontrolled and observational European study to evaluate the long-term safety and effectiveness of the Conformité Européenne-marked JenaValve THV. A total of 180 patients with AS were enrolled between 2012 and 2014. End-points were adjudicated in accordance with the valve academic research consortium document no. 1 definitions. RESULTS The mean age was 80.4 ± 5.9 years and the mean logistic European system for cardiac operative risk evaluation I 21.2 ± 14.7%. The procedure was successful in 95.0% (171/180), implantation of a second THV (valve-in-valve) was performed in 2.2% (4/180) and conversion to surgical aortic valve replacement (SAVR) was necessary in 2.8% (5/180). No annular rupture or coronary ostia obstruction occurred. Two patients required SAVR after the day of index procedure (1.1%). All-cause mortality at 30 days was 11.1% (20/180), being cardiovascular in 7.2% (13/180). A major stroke occurred in 1.1% (2/180) at 30 days, no additional major strokes were observed during 1 year. All-cause mortality after 30 days was 13.1% (21/160) and combined efficacy at 1 year was 80.8% (122/151). At 1-year follow-up, no patient presented with more than moderate paravalvular leakage, while 2 patients (3.2%) showed moderate, 12 (19.0%) mild and 49 (82.4%) trace/none paravalvular regurgitation. CONCLUSIONS In a high-risk cohort of patients undergoing TA-TAVR for AS, the use of the JenaValve THV is safe and effective. In patients at higher risk for coronary ostia obstruction, annular rupture or with limited aortic valve calcification, the JenaValve might be preferable for implantation due to its clipping-mechanism engaging native aortic valve cusps for fixation with reduced radial forces of the self-expanding stent.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
| | - Hendrik Treede
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Ardawan J Rastan
- Department of Cardiac Surgery, Center of Cardiovascular Diseases Rotenburg a. d. Fulda, Rotenburg, Germany
| | - Hardy Baumbach
- Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery Freiburg, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Walter Eichinger
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Florian Rüter
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Thomas L de Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich at Technische Universität München, Munich, Germany
| | - Stephan Ensminger
- Department of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital London, London, UK
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Silaschi M, Wendler O, Castro L, Aldalati O, Reichenspurner H, Blankenberg S, Schaefer U, MacCarthy P, Conradi L. 28 Haemodynamic performance of supra-annular versus intra-annular transcatheter heart valves in failed bioprostheses. Heart 2016. [DOI: 10.1136/heartjnl-2016-309588.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silaschi M, Alcock E, Aldalati O, Keshavarzi F, Rajagopal K, MacCarthy P, Dworakowski R, Wendler O. 24 Spinal analgesia in patients undergoing transapical aortic valve implantation: improved outcomes in a routine cohort. Heart 2016. [DOI: 10.1136/heartjnl-2016-309588.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Silaschi M, Wendler O, Seiffert M, Castro L, Schofer N, Fink A, Reichenspurner H, Blankenberg S, MacCarthy P, Schaefer U, Conradi L. HEMODYNAMIC PERFORMANCE OF TRANSCATHETER HEART VALVES WITH SUPRA-ANNULAR OR INTRA-ANNULAR POSITION FOR TRANSCATHETER AORTIC VALVE-IN-VALVE IMPLANTATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Silaschi M, Khan H, Chaubey S, Deshpande R, Baghai M, Wendler O. Mitral Valve Surgery in Elderly Patients: Trends Over the Last Two Decades. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571733] [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: 10/22/2022]
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