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Funk A, Kilger E, Vlachea P, Höchter DJ. [Use of an intra-aortic balloon pump to improve cerebral oxygen saturation after resuscitation in a cardiac surgical intervention]. Anaesthesiologie 2023; 72:878-882. [PMID: 37855946 PMCID: PMC10692251 DOI: 10.1007/s00101-023-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Anja Funk
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Erich Kilger
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - Polyxeni Vlachea
- Klinik für Herzchirurgie, LMU Klinikum, Klinikum der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland
| | - Dominik J Höchter
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Belyaev S, Herrmann FEM, Dashkevich A, Wenke K, Vlachea P, von der Linden J, Banafsche R, Hagl C, Juchem G. Evaluation of a rapid deployment prosthesis strategy for the treatment of aortic valve endocarditis. Eur J Cardiothorac Surg 2022; 61:1109-1115. [DOI: 10.1093/ejcts/ezac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/22/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to evaluate the surgical outcome of patients suffering from native aortic valve (NVE) or prosthetic aortic valve endocarditis (PVE) treated with the EDWARDS INTUITY Elite rapid-deployment valve prosthesis.
METHODS
Between February 2019 and June 2020, 25 patients suffering from NVE (n = 9; 36%) and PVE (n = 16; 64%) of the aortic valve received an INTUITY valve at our institution. Preoperative, operative and follow-up data were collected.
RESULTS
In our cohort, the mean EuroSCORE II was 13.4%. Eleven patients (44%) received concomitant aortic root patch plasty. Four patients (16%) received coronary artery bypass graft surgery, 3 patients (12%) received mitral valve repair and 2 patients (8%) underwent replacement of the ascending aorta. The cardiopulmonary bypass and aortic cross-clamp times were 124 ± 56 and 75 ± 39 min, respectively. The mean intensive care unit stay was 5 days. The mean size of the implanted prostheses was 25 ± 2 mm and the mean prosthesis transvalvular gradient 3 months after surgery was 9 ± 4 mmHg. During follow-up, no case of recurrent endocarditis occurred, 1 patient died of multisystem organ failure which had already been present preoperatively.
CONCLUSIONS
Surgery for NVE and PVE of the aortic valve may be safely performed using the EDWARDS INTUITY Elite valve system. This procedure could be well implemented in cases with extensive infection, fragile root tissue and root abscesses requiring root reconstruction. In our institution, the rapid-deployment aortic valve replacement strategy has become an important tool in the armamentarium of the surgical endocarditis treatment.
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Affiliation(s)
- Sergey Belyaev
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | | | - Alexey Dashkevich
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Klaus Wenke
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Polyxeni Vlachea
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | | | - Ramin Banafsche
- Department of Vascular Surgery, Ludwig Maximilian University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, University Hospital, LMU Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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Guenther SPW, Hornung R, Joskowiak D, Vlachea P, Feil K, Orban M, Peterss S, Born F, Hausleiter J, Massberg S, Hagl C. Extracorporeal life support in therapy-refractory cardiocirculatory failure: looking beyond 30 days. Interact Cardiovasc Thorac Surg 2020; 32:607-615. [PMID: 33347585 DOI: 10.1093/icvts/ivaa312] [Citation(s) in RCA: 4] [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: 09/11/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Venoarterial extracorporeal life support (ECLS) has emerged as a potentially life-saving treatment option in therapy-refractory cardiocirculatory failure, but longer-term outcome is poorly defined. Here, we present a comprehensive follow-up analysis covering all major organ systems. METHODS From February 2012 to December 2016, 180 patients were treated with ECLS for therapy-refractory cardiogenic shock or cardiac arrest. The 30-day survival was 43.9%, and 30-day survivors (n = 79) underwent follow-up analysis with the assessment of medium-term survival, quality of life, neuropsychological, cardiopulmonary and end-organ status. RESULTS After a median of 1.9 (1.1-3.6) years (182.4 patient years), 45 of the 79 patients (57.0%) were alive, 35.4% had died and 7.6% were lost to follow-up. Follow-up survival estimates were 78.0% at 1, 61.2% at 3 and 55.1% at 5 years. NYHA class at follow-up was ≤II for 83.3%. The median creatinine was 1.1 (1.0-1.4) mg/dl, and the median bilirubin was 0.8 (0.5-1.0) mg/dl. No patient required dialysis. Overall, 94.4% were free from moderate or severe disability, although 11.1% needed care. Full re-integration into social life was reported by 58.3%, and 39.4% were working. Quality of life was favourable for mental components, but a subset showed deficits in physical aspects. While age was the only peri-implantation parameter significantly predicting medium-term survival, adverse events and functional status at discharge or 30 days were strong predictors. CONCLUSIONS This study demonstrates positive medium-term outcome with high rates of independence in daily life and self-care but a subset of 10-20% suffered from sustained impairments. Our results indicate that peri-implantation parameters lack predictive power but downstream morbidity and functional status at discharge or 30 days can help identify patients at risk for poor recovery.
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Affiliation(s)
- Sabina P W Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Roman Hornung
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian-University, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Polyxeni Vlachea
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Katharina Feil
- Department of Neurology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Martin Orban
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Jörg Hausleiter
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Steffen Massberg
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
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Mueller C, Sipahi N, Buchholz S, Vlachea P, Hagl C, Juchem G. Change of Paradigm? Ten-year Outcome of Aortic Pericardial Tissue Valves in Patients Younger than 50 Years of Age - is the „Bio“-Trend Justified? Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571507] [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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