1
|
Vij V, Cruz-González I, Galea R, Piayda K, Nelles D, Vogt L, Gloekler S, Fürholz M, Meier B, Räber L, O'Hara G, Arzamendi D, Agudelo V, Asmarats L, Freixa X, Flores-Umanzor E, De Backer O, Sondergaard L, Nombela-Franco L, McInerney A, Salinas P, Korsholm K, Nielsen-Kudsk JE, Afzal S, Zeus T, Operhalski F, Schmidt B, Montalescot G, Guedeney P, Iriart X, Miton N, Saw J, Gilhofer T, Fauchier L, Veliqi E, Meincke F, Petri N, Nordbeck P, Gonzalez-Ferreiro R, Bhatt DL, Laricchia A, Mangieri A, Omran H, Schrickel JW, Rodes-Cabau J, Nickenig G, Sievert H, Sedaghat A. Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT registry. Clin Res Cardiol 2023; 112:1790-1799. [PMID: 37294311 PMCID: PMC10697873 DOI: 10.1007/s00392-023-02237-w] [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: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. AIMS This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. METHODS The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. RESULTS Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). CONCLUSION Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.
Collapse
Affiliation(s)
- Vivian Vij
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | | | | | - Dominik Nelles
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lara Vogt
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | | | | | | | - Gilles O'Hara
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Ole De Backer
- Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Lars Sondergaard
- Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | - Shazia Afzal
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Boris Schmidt
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany
| | - Gilles Montalescot
- ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | - Paul Guedeney
- ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | | | | | | | | | | | | | | | - Nils Petri
- University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Alessandra Laricchia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Jan Wilko Schrickel
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Alexander Sedaghat
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Rhein-Ahr-Cardio, Bad Neuenahr-Ahrweiler, Germany.
| |
Collapse
|
2
|
Murtaza G, K Turagam M, Dar T, Akella K, Yarlagadda B, Gloekler S, Meier B, Saw J, Kim JS, Lim HE, Fabian N, Gabriels J, V Boersmaj L, J Swaans M, Tantary M, Llah ST, Tzikas A, Gopinathannair R, Lakkireddy D. Left Atrial Appendage Occlusion Device Embolization (The LAAODE Study): Understanding the Timing and Clinical Consequences from a Worldwide Experience. J Atr Fibrillation 2021; 13:2516. [PMID: 34950344 DOI: 10.4022/jafib.2516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/25/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/10/2022]
Abstract
Background Left atrial appendage occlusion device embolization (LAAODE) is rare but can have substantial implications on patient morbidity and mortality. Hence, we sought to perform an analysis to understand the timing and clinical consequences of LAAODE. Methods A comprehensive search of PubMed and Web of Science databases for LAAODE cases was performed from October 2nd, 2014 to November 1st, 2017. Prior to that, we included published LAAODE cases until October 1st, 2014 reported in the systematic review by Aminian et al. Results 103 LAAODE cases including Amplatzer cardiac plug (N=59), Watchman (N=31), Amulet (N=11), LAmbre (N=1) and Watchman FLX (N=1) were included. The estimated incidence of device embolization was 2% (103/5,000). LAAODE occurred more commonly in the postoperative period compared with intraoperative (61% vs. 39%). The most common location for embolization was the descending aorta 30% (31/103) and left atrium 24% (25/103) followed by left ventricle 20% (21/103). Majority of cases 75% (77/103) were retrieved percutaneously. Surgical retrieval occurred most commonly for devices embolized to the left ventricle, mitral apparatus and descending aorta. Major complications were significantly higher with postoperative LAAODE compared with intraoperative (44.4% vs. 22.5%, p=0.03). Conclusions LAAODE is common with a reported incidence of 2% in our study. Post-operative device embolization occurred more frequently and was associated with a higher rate of complications than intraoperative device embolizations. Understanding the timings and clinical sequelae of DE can aid physicians with post procedural follow-up and also in the selection of patients for these procedures.
Collapse
Affiliation(s)
- Ghulam Murtaza
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | - Mohit K Turagam
- Department of Cardiology, Garden City Hospital, Garden City, Michigan
| | - Tawseef Dar
- Massachusetts General Hospital, Boston, Massachusetts
| | - Krishna Akella
- Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | | | - Steffen Gloekler
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hong-Euy Lim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Nietlispach Fabian
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - James Gabriels
- Department of Cardiology, Northwell Health, North Shore University Hospital, NY, USA
| | - Lucas V Boersmaj
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Apostolos Tzikas
- AHEPA University Hospital, Thessaloniki, Greece; Interbalkan European Medical Center, Thessaloniki, Greece
| | | | | |
Collapse
|
3
|
Kleinecke C, Buffle E, Link J, Häner J, Sedaghat A, Galea R, Streit SR, Windecker S, Meier B, Gloekler S. Amplatzer left atrial appendage closure: Single versus combined procedures. Catheter Cardiovasc Interv 2021; 97:E973-E981. [PMID: 32930492 DOI: 10.1002/ccd.29271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/27/2020] [Accepted: 08/31/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study compares procedural and late clinical outcomes of left atrial appendage closure (LAAC) with Amplatzer devices as a single versus a combined procedure with other structural or coronary interventions. BACKGROUND Multiple cardiac conditions are frequent among elderly patients and invite simultaneous treatment to ensure a favorable patient outcomes. METHODS 559 consecutive patients (73.3 ± 11.1 years) underwent LAAC with Amplatzer devices at two centres (Bern and Zurich university hospitals, Switzerland) either as a single procedure or combined with other interventions. The primary safety endpoint was a composite of major peri-procedural complications and major bleeding at follow-up, the primary efficacy endpoint included stroke, systemic embolism, and cardiovascular/unexplained death. All event rates are reported per 100 patient-years. RESULTS In 263 single and 296 combined procedures with percutaneous coronary interventions (47.6%), closure of an atrial septal defect (8.4%) or a patent foramen ovale (36.5%), transcatheter aortic valve implantation (10.1%), mitral clipping (4.1%), atrial fibrillation ablation (8.8%), or another procedure (3.0%) were analyzed. Device success (96.6% [single] vs. 99.0% [combined], p = .08) did not differ between the groups. After a mean follow-up of 2.6 ± 1.5 vs. 2.5 ± 1.5 years and a total of 1,422 patient-years, the primary efficacy (40/677, 5.9% [single] vs. 37/745, 5.0% [combined]; HR, 1.2, 95% CI, 0.8-1.9, p = .44), as well as the primary safety endpoint (25/677, 3.7% vs 28/745, 3.8%; HR, 1.0, 95% CI, 0.6-1.8, p = .89) were comparable. CONCLUSIONS LAAC with Amplatzer devices combined with structural, coronary, and electrophysiological procedures offers procedural feasibility and safety, as well as long-term efficacy.
Collapse
Affiliation(s)
- Caroline Kleinecke
- Cardiology, Klinikum Lichtenfels, Lichtenfels, Germany.,Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
| | - Eric Buffle
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Juergen Link
- Department of Anesthesiology, Dreifaltigkeits-Hospital, Wesseling, Germany
| | - Jonas Häner
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | | | - Roberto Galea
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Samuel R Streit
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland.,Cardiology, Klinikum Hochrhein, Waldshut-Tiengen, Germany
| |
Collapse
|
4
|
Häner JD, Fürholz M, Kleinecke C, Galea R, Streit SR, Fankhauser M, Cherni T, Valgimigli M, Windecker S, Meier B, Gloekler S. Impact of individual stroke risk on outcome after Amplatzer left atrial appendage closure in patients with atrial fibrillation. Catheter Cardiovasc Interv 2021; 97:E1002-E1010. [PMID: 33022121 DOI: 10.1002/ccd.29318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate periprocedural and long-term outcome of left atrial appendage closure (LAAC) using Amplatzer occluders with respect to individual pre-procedural stroke risk. BACKGROUND LAAC is a proven strategy for prevention from stroke and bleeding in patients with nonvalvular atrial fibrillation not amenable to oral anticoagulation. Whether individual pre-procedural stroke risk may affect procedural and long-term clinical outcome after LAAC is unclear. METHODS Multicenter study of consecutive patients who underwent Amplatzer-LAAC. Using pre-procedural CHADS2 score, outcomes were compared between a low (0-2 points) and a high stroke risk group (3-6 points). RESULTS Five hundred consecutive patients (73.9 ± 10.1 years) who underwent Amplatzer-LAAC. Two hundred and forty eight had preprocedural CHADS2 score ≤ 2 points (low-risk group) and the remaining 252 patients had 3-6 points (high-risk group). Periprocedural complication rates (6.0% vs. 5.6%, p = .85), procedural success (LAAC without major periprocedural or device-related complications or major para-device leaks: 89.4% vs. 87.9%, p = .74), and 30-day-mortality (2.4% vs. 2.6%, p = .77) were comparable. After 1,346 patient-years (PY), the long-term composite efficacy endpoint (stroke, systemic embolism, cardiovascular, and unexplained death) was reached in 23/653 (3.5/100 PY) versus 52/693 (7.5/100 PY); HR = 2.13; 95%-CI, 1.28-3.65, p = .002) with stroke rates 67% and 68% lower than anticipated by preprocedural CHADS2 score. Combined safety endpoint (major periprocedural complications and major, life-threatening or fatal bleedings) occurred in 22/653 (3.4/100 PY) versus 28/693 (4.0/100 PY); HR = 1.20; 95%-CI, 0.66-2.20, p = .52). CONCLUSIONS Compared with patients at low risk of stroke, LAAC with Amplatzer devices is associated with similar safety and efficacy in high-risk patients in our study.
Collapse
Affiliation(s)
- Jonas D Häner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel R Streit
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mate Fankhauser
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Takwa Cherni
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.,Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Sedaghat A, Vij V, Al-Kassou B, Gloekler S, Galea R, Fürholz M, Meier B, Valgimigli M, O'Hara G, Arzamendi D, Agudelo V, Asmarats L, Freixa X, Flores-Umanzor E, De Backer O, Søndergaard L, Nombela-Franco L, McInerney A, Korsholm K, Nielsen-Kudsk JE, Afzal S, Zeus T, Operhalski F, Schmidt B, Montalescot G, Guedeney P, Iriart X, Miton N, Saw J, Gilhofer T, Fauchier L, Veliqi E, Meincke F, Petri N, Nordbeck P, Rycerz S, Ognerubov D, Merkulov E, Cruz-González I, Gonzalez-Ferreiro R, Bhatt DL, Laricchia A, Mangieri A, Omran H, Schrickel JW, Rodes-Cabau J, Nickenig G. Device-Related Thrombus After Left Atrial Appendage Closure: Data on Thrombus Characteristics, Treatment Strategies, and Clinical Outcomes From the EUROC-DRT-Registry. Circ Cardiovasc Interv 2021; 14:e010195. [PMID: 34003661 DOI: 10.1161/circinterventions.120.010195] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
| | - Vivian Vij
- University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.)
| | - Baravan Al-Kassou
- University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.)
| | - Steffen Gloekler
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Roberto Galea
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Monika Fürholz
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Bernhard Meier
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Marco Valgimigli
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.).,Cardiocentro Ticino, Lugano, Switzerland (M.V.)
| | - Gilles O'Hara
- Quebec Heart & Lung Institute, Laval University, Canada (G.O., L.A., J.R.-C.)
| | - Dabit Arzamendi
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (D.A., V.A., L.A.)
| | - Victor Agudelo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (D.A., V.A., L.A.)
| | - Lluis Asmarats
- Quebec Heart & Lung Institute, Laval University, Canada (G.O., L.A., J.R.-C.).,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (D.A., V.A., L.A.)
| | | | | | - Ole De Backer
- Rigshospitalet Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | - Lars Søndergaard
- Rigshospitalet Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | | | - Angela McInerney
- Hospital Clinico San Carlos Madrid, Spain (L.N.-F., A. McInerney)
| | | | | | - Shazia Afzal
- University Hospital Düsseldorf, Germany (S.A., T.Z.)
| | - Tobias Zeus
- University Hospital Düsseldorf, Germany (S.A., T.Z.)
| | - Felix Operhalski
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany (F.O., B.S.)
| | - Boris Schmidt
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany (F.O., B.S.)
| | - Gilles Montalescot
- Surbonne University Pitié-Salpêtrière Hospital (AP-HP) Paris, France (G.M., P.G.)
| | - Paul Guedeney
- Surbonne University Pitié-Salpêtrière Hospital (AP-HP) Paris, France (G.M., P.G.)
| | | | - Noelie Miton
- University Hospital Bordeaux, France (X.I., N.M.)
| | | | | | | | - Egzon Veliqi
- St. Georg Hospital Hamburg, Germany (E.V., F.M.)
| | | | - Nils Petri
- University Hospital Würzburg, Germany (N.P., P.N.)
| | | | - Szymon Rycerz
- Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany (S.R.)
| | - Dmitrii Ognerubov
- Russian Cardiology Research and Production Complex, Moscow (D.O., E.M.)
| | - Evgeny Merkulov
- Russian Cardiology Research and Production Complex, Moscow (D.O., E.M.)
| | | | | | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital Harvard Medical School, Boston (D.L.B.)
| | | | | | | | | | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Canada (G.O., L.A., J.R.-C.)
| | - Georg Nickenig
- University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.)
| |
Collapse
|
6
|
Kleinecke C, Allakkis W, Buffle E, Liu XX, Mohrez Y, Gloekler S, Brachmann J, Schnupp S, Achenbach S, Yu J. Impact of conscious sedation and general anesthesia on periprocedural outcomes in Watchman left atrial appendage closure. Cardiol J 2021; 28:519-527. [PMID: 33438184 DOI: 10.5603/cj.a2020.0184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transcatheter left atrial appendage closure (LAAC) is performed either in conscious sedation (CS) or general anesthesia (GA), and limited data exist regarding clinical outcomes for the two approaches. The aim of the study was to analyze the effect of CS versus GA on acute outcomes in a large patient cohort undergoing LAAC with a Watchman occluder. METHODS A cohort of 521 consecutive patients underwent LAAC with Watchman occluders at two centers (REGIOMED hospitals, Germany) between 2012 and 2018. One site performed 303 consecutive LAAC procedures in GA, and the other site performed 218 consecutive procedures in CS. The safety endpoint was a composite of major periprocedural complications and postoperative pneumonia. The efficacy endpoint was defined as device success. RESULTS After a 1:1 propensity score matching, 196 (CS) vs. 115 (GA) patients could be compared. In 5 (2.6%) cases CS was converted to GA. The primary safety endpoint (3.5% [CS] vs. 7.0% [GA], p = 0.18) and its components (major periprocedural complications: 2.5% vs. 3.5%, p = 0.73; postoperative pneumonia: 2.6% vs. 4.3%, p = 0.51) did not differ between the groups. Also, device success was comparable (96.9% vs. 93.9%, p = 0.24). CONCLUSIONS In patients undergoing LAAC with the Watchman device, conscious sedation and general anesthesia showed comparable device success rates and safety outcomes. The type of anesthesia for LAAC may therefore be tailored to patient comorbidities, operator experience, and hospital logistics.
Collapse
Affiliation(s)
- Caroline Kleinecke
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany.
| | - Wasim Allakkis
- Department of Cardiology, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Eric Buffle
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Xiao-Xia Liu
- Department of Cardiology, REGIOMED Klinikum Coburg, Coburg, Germany.,Department of Cardiology, Beijing Anzhen Hospital, Beijing, China
| | - Yamen Mohrez
- Department of Cardiology, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Steffen Gloekler
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | | | - Steffen Schnupp
- Department of Cardiology, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany
| | - Jiangtao Yu
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany.,Department of Cardiology, Klinikum Koblenz-Montabaur, Koblenz, Germany
| |
Collapse
|
7
|
Gloekler S, Fürholz M, de Marchi S, Kleinecke C, Streit SR, Buffle E, Fankhauser M, Häner JD, Nietlispach F, Galea R, Windecker S, Meier B. Left atrial appendage closure versus medical therapy in patients with atrial fibrillation: the APPLY study. EUROINTERVENTION 2020; 16:e767-774. [DOI: 10.4244/eij-d-20-00201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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]
|
8
|
Kleinecke C, Gloekler S, Meier B. Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation: an update on patient outcomes. Expert Rev Cardiovasc Ther 2020; 18:517-530. [DOI: 10.1080/14779072.2020.1794820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Caroline Kleinecke
- Cardiology, Internal Medicine Department, Klinikum Lichtenfels, Lichtenfels, Germany
| | - Steffen Gloekler
- Cardiology, Internal Medicine Department, Klinikum Hochrhein, Waldshut-Tiengen, Germany and Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Liu XX, Kleinecke C, Busch S, Allakkis W, Mohrez Y, Cheikh-Ibrahim M, Mahnkopf C, Brachmann J, Schnupp S, Gloekler S, Yu J, Ma C. Propensity-matched comparison of antiplatelet versus anticoagulant after left atrial appendage closure with the Watchman. Pacing Clin Electrophysiol 2020; 43:1242-1251. [PMID: 32779203 DOI: 10.1111/pace.14032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder remains uncertain. This study retrospectively compared clinical outcomes of a 3-month dual antiplatelet therapy (DAPT group) and a protocol of anticoagulation plus aspirin for 45 days followed by DAPT for 6 months (ACT group) after LAAC with the Watchman device. METHODS Of two Watchman registries (Coburg and Lichtenfels hospitals, Germany), 220 and 304 consecutive patients with successful LAAC were included. Patients in Coburg hospital received DAPT while they received ACT in Lichtenfels. After a 1:1 propensity score matching, 174 (DAPT) versus 174 (ACT) patients were compared by use of the primary efficacy endpoint of thromboembolic events and cardiovascular/unexplained death, the primary safety endpoint of nonprocedural related major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. RESULTS The mean age 77.5 ± 7.2 (DAPT) versus 77.3 ± 7.1 (ACT) years, CHA2 DS2 -VASc score 4.6 ± 1.5 versus 4.7 ± 1.6, and HAS-BLED score 3.3 ± 0.8 versus 3.3 ± 0.8 were similar. After 12 months, the clinical efficacy (13/174, 7.4% [DAPT] vs 11/174, 6.3% [ACT]; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.38-1.86; P = .66) and safety (6/174, 3.4% vs 8/174, 4.5%; HR, 0.86; 95% CI, 0.29-2.56; P = .79) as well as the combined hazard endpoint (18/174, 10.3% vs 18/174, 10.3%; HR,1.01; 95% CI, 0.53-1.95; P = .97) were comparable. CONCLUSIONS This study suggests comparable efficacy and safety of 3-month DAPT versus 6 weeks ACT plus aspirin following LAAC with the Watchman.
Collapse
Affiliation(s)
- Xiao-Xia Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Caroline Kleinecke
- Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany
| | - Sonia Busch
- Department of Cardiology, Klinikum Coburg, Coburg, Germany
| | - Wasim Allakkis
- Department of Cardiology, Klinikum Coburg, Coburg, Germany
| | - Yamen Mohrez
- Department of Cardiology, Klinikum Coburg, Coburg, Germany
| | | | | | | | | | - Steffen Gloekler
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Jiangtao Yu
- Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany.,Clinic for General Internal Medicine and Cardiology, Marienhof Katholisches Klinikum, Koblenz. Montabaur, Koblenz, Germany
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| |
Collapse
|
10
|
Kleinecke C, Fuerholz M, Buffle E, de Marchi S, Schnupp S, Brachmann J, Nietlispach F, Fankhauser M, Streit SR, Windecker S, Meier B, Gloekler S. Transseptal puncture versus patent foramen ovale or atrial septal defect access for left atrial appendage closure. EUROINTERVENTION 2020; 16:e173-e180. [PMID: 31449043 DOI: 10.4244/eij-d-19-00442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the periprocedural and late clinical outcomes of left atrial appendage closure (LAAC) with AMPLATZER devices by access through transseptal puncture (TSP) versus a patent foramen ovale (PFO) or an atrial septal defect (ASD). METHODS AND RESULTS Between 2009 and 2018, 578 consecutive patients underwent LAAC via TSP or PFO/ASD access in three centres. After a 3:1 propensity score matching, 246 (TSP) versus 91 (PFO/ASD) patients were compared using the primary efficacy endpoint of all-cause stroke, systemic embolism and cardiovascular/unexplained death and the primary safety endpoint of major periprocedural complications and major bleedings at follow-up. Mean age was 75.2±8.7 (TSP) vs 74.4±10.9 (PFO/ASD) years, CHA2DS2-VASc score 4.5±1.6 vs 4.3±1.4 and HAS-BLED score 3.3±1.0 vs 3.3±0.9. Device success (97.6% vs 97.8%, p=0.90) was similar. After 2.5±1.4 vs 2.6±1.6 years, clinical efficacy (46/603, 7.6% [TSP] vs 21/233, 9.0% [PFO/ASD], hazard ratio [HR] 1.2; 95% confidence interval [CI]: 0.69-0.85, p=0.54) and safety (24/603, 4.0% vs 11/233, 4.7%; HR 1.4; 95% CI: 0.52-3.6, p=0.49) did not differ. CONCLUSIONS Use of a PFO/ASD access for LAAC with AMPLATZER devices offers similar periprocedural and late clinical outcomes to TSP. Simultaneous PFO/ASD closure for an additional protective benefit does not increase risk.
Collapse
|
11
|
Schnupp S, Liu X, Buffle E, Gloekler S, Mohrez Y, Cheikh‐Ibrahim M, Allakkis W, Brachmann J, Park J, Kleinecke C. Late clinical outcomes of lambre versus amplatzer occluders for left atrial appendage closure. J Cardiovasc Electrophysiol 2020; 31:934-942. [DOI: 10.1111/jce.14398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/02/2020] [Accepted: 02/06/2020] [Indexed: 12/24/2022]
Affiliation(s)
| | - Xiao‐Xia Liu
- Department of CardiologyThe 4th Hospital of Harbin Medical University Harbin China
- Department of CardiologyAnzhen Hospital, Capital Medical University Beijing China
| | - Eric Buffle
- Department of CardiologyUniversity Hospital of Bern Bern Switzerland
| | - Steffen Gloekler
- Department of CardiologyUniversity Hospital of Bern Bern Switzerland
- Department of CardiologySchwarzwald‐Baar Klinikum Villingen‐Schwenningen Germany
| | - Yamen Mohrez
- Department of CardiologyKlinikum Coburg Coburg Germany
| | | | | | | | - Jai‐Wun Park
- Department of CardiologyCharité Berlin‐University Medicine, Campus Benjamin Franklin Berlin Germany
| | | |
Collapse
|
12
|
Kleinecke C, Yu J, Neef P, Buffle E, de Marchi S, Fuerholz M, Nietlispach F, Valgimigli M, Streit SR, Fankhauser M, Duenninger E, Windecker S, Meier B, Gloekler S. Clinical outcomes of Watchman vs. Amplatzer occluders for left atrial appendage closure (WATCH at LAAC). Europace 2020; 22:916-923. [DOI: 10.1093/europace/euaa001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/05/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Aims
This study compares clinical outcomes of Watchman vs. Amplatzer devices for left atrial appendage closure (LAAC).
Methods and results
Of two real-world registries, the Watchman registry Lichtenfels, Germany, and the Amplatzer registry Bern-Zurich, Switzerland, 303 and 333 consecutive patients, respectively, were included. After a 1:1 propensity score matching, 266 vs. 266 patients were compared by use of the predefined primary efficacy endpoint of stroke, systemic embolism and cardiovascular/unexplained death, the primary safety endpoint of major peri-procedural complications and major bleeding events at follow-up, and the combined hazard endpoint, a composite of all above-mentioned hazards. Mean age was 75.3 ± 7.8 (Watchman) vs. 75.1 ± 9.9 (Amplatzer) years, CHA2DS2-VASc score 4.5 ± 1.7 vs. 4.5 ± 1.5, and HAS-BLED score 3.2 ± 1.0 vs. 3.2 ± 1.0. At a mean follow-up of 2.4 ± 1.3 vs. 2.5 ± 1.5 years and 1.322 patient-years, the primary endpoints of efficacy [40/646, 6.2% [Watchman] vs. 43/676, 6.4% [Amplatzer]; hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.66–1.58; P = 0.92] and safety (33/646, 5.1% vs. 30/676, 4.4%; HR, 0.57; 95% CI, 0.29–1.11; P = 0.10), as well as the combined hazard endpoint (69/646, 10.7% vs. 66/676, 9.8%; HR, 0.80; 95% CI, 0.55–1.12; P = 0.26) were similar for both groups.
Conclusion
This study suggests comparable efficacy and safety of the Watchman and Amplatzer devices.
Collapse
Affiliation(s)
- Caroline Kleinecke
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Jiangtao Yu
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Philip Neef
- Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Eric Buffle
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Stefano de Marchi
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Monika Fuerholz
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
- Cardiovascular Center Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland
| | - Marco Valgimigli
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Samuel R Streit
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Mate Fankhauser
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Erich Duenninger
- Department of Cardiology, REGIOMED Klinikum Lichtenfels, Lichtenfels, Germany
| | - Stephan Windecker
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Schwarzwald-Baar Klinikum, Klinikstraße 11, 78052 Villingen-Schwenningen, Germany
| |
Collapse
|
13
|
Cruz-González I, González-Ferreiro R, Freixa X, Gafoor S, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Kanagaratnam P, Nietlispach F, Gloekler S, Aminian A, Danna P, Rezzaghi M, Stock F, Stolcova M, Paiva L, Costa M, Millán X, Ibrahim R, Tichelbäcker T, Schillinger W, Park JW, Sievert H, Meier B, Tzikas A. Cierre de la orejuela izquierda por ictus pese a la anticoagulación oral (ictus resistente): resultados del registro Amplatzer Cardiac Plug. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
deMarchi SF, Gassmann C, Traupe T, Gloekler S, Cook S, Vogel R, Gysi K, Seiler C. Coronary wave intensity patterns in stable coronary artery disease: influence of stenosis severity and collateral circulation. Open Heart 2019; 6:e000999. [PMID: 31749972 PMCID: PMC6827744 DOI: 10.1136/openhrt-2018-000999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023] Open
Abstract
Objective Wave intensity analysis is a method that allows separating pulse waves into components generated proximally and in the periphery of arterial trees, as well as characterising them as accelerating or decelerating. The early diastolic suction wave (eaDSW) is one of the most prominent wave events in the coronaries. The aim of this study was to determine whether (1) microvascular dilatation directly influences its energy, (2) stenosis severity can be assessed proximal to stenoses, (3) distal pulse wave entrapment exists in the presence of stenoses and (4) coronary collaterals influence wave entrapment. Methods In 43 coronary artery disease patients, Doppler flow velocity and pressure measurements were performed in a proximal coronary segment at rest, in a distal segment at rest, during adenosine-induced hyperaemia and during balloon occlusion. Wave energies were calculated as the area under the wave intensity curves. Results The eaDSW energy showed a significant increase during hyperaemia, but did not differ between proximal and distal segments. There was no significant correlation between eaDSW energy and coronary stenosis severity. Pulse wave entrapment could not be observed consistently in the distal segments. Consequently, the effect of coronary collaterals on pulse wave entrapment could not be studied. Conclusions Microvascular dilation in the coronary circulation increases distal eaDSW energy. However, it does not show any diagnostically useful variation between measurement sites, various stenosis degrees and amount of collateral flow. The assessment eaDSW and its reflections were not useful for the quantification of coronary stenosis severity or the collateral circulation in clinical practice.
Collapse
Affiliation(s)
| | | | - Tobias Traupe
- Cardiology, University Hospital Bern, Bern, Switzerland
| | | | - Stéphane Cook
- Cardiology, University Hospital Bern, Bern, Switzerland
| | - Rolf Vogel
- Cardiology, University Hospital Bern, Bern, Switzerland
| | - Kurt Gysi
- Cardiology, University Hospital Bern, Bern, Switzerland
| | | |
Collapse
|
15
|
Kleinecke C, Cheikh‐Ibrahim M, Schnupp S, Fankhauser M, Nietlispach F, Park J, Brachmann J, Windecker S, Meier B, Gloekler S. Long‐term clinical outcomes of Amplatzer cardiac plug versus Amulet occluders for left atrial appendage closure. Catheter Cardiovasc Interv 2019; 96:E324-E331. [DOI: 10.1002/ccd.28530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/26/2019] [Revised: 08/05/2019] [Accepted: 09/19/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Mate Fankhauser
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland, and Cardiovascular Center ZurichHirslanden Klinik im Park Zurich Switzerland
| | - Jai‐Wun Park
- Department of CardiologyCharité Berlin – University Medicine, Campus Benjamin Franklin Berlin Germany
| | | | - Stephan Windecker
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
| | - Steffen Gloekler
- Cardiology, Cardiovascular DepartmentUniversity Hospital of Bern Bern Switzerland
- Department of Cardiology, Schwarzwald‐Baar Klinikum,Villingen‐SchwenningenGermany, and University of Bern, Faculty of Medicine Bern Switzerland
| |
Collapse
|
16
|
Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schaeufele T, Bekeredjian R, Zuern CS, Geisler T, Klug G, Wahl A, Metzler B, Gawaz M, Windecker S, Mahrholdt H. P2714Time-dependent myocardial necrosis in patients suffering from ST-elevation myocardial infarction without angiographic collateral flow visualized by cardiac magnetic resonance imaging. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1031] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute complete occlusion of a coronary artery results in progressive ischemia, moving from the endocardium to the epicardium (“wavefront”). Dependent on time-to-reperfusion and collateral flow, myocardial infarction (MI) will manifest, with transmural MI portending poor prognosis. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging can detect MI with high diagnostic accuracy. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with STEMI <12 hours of symptom onset.
Purpose
We sought to visualize time-dependent necrosis in a ST-segment elevation myocardial infarction (STEMI) population by LGE-CMR.
Methods
STEMI patients with: single-vessel disease, complete occlusion with Thrombolysis in Myocardial Infarction (TIMI) score 0, absence of collateral flow (Rentrop score 0) and symptom onset <12 hours were consecutively enrolled. By LGE-CMR, area at risk (AAR) and infarct size (IS), myocardial salvage index (MSI), transmurality index, and transmurality grade (0–50%, 51–75%, 76–100%) were determined.
Results
164 patients (54±11 years, 80% male) were included. Receiver-operating-characteristic (ROC)-curve (area under the curve [AUC] = 0.81) indicating transmural necrosis revealed the best diagnostic cut-off for a symptom-to-balloon time of 121 minutes, i.e. patients with >121 minutes demonstrated increased IS, transmurality index, transmurality grade (all p-values <0.01), and decreased MSI (p<0.001) vs. patients with symptom-to-balloon times ≤121 minutes.
Conclusions
In myocardial infarction with no residual antegrade, and no collateral flow, immediate reperfusion is vital. A symptom-to-balloon time of >121 minutes causes a high grade of transmural necrosis. In the present, pure STEMI population, time to reperfusion to salvage myocardium was less than suggested by current guidelines.
Collapse
Affiliation(s)
- S Greulich
- University of Tuebingen, Tuebingen, Germany
| | - A Mayr
- University of Innsbruck, Radiology, Innsbruck, Austria
| | - S Gloekler
- Schwarzwald-Baar Hospital, Cardiology, Villingen-Schwenningen, Germany
| | - A Seitz
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - S Birkmeier
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - T Schaeufele
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - R Bekeredjian
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - C S Zuern
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Geisler
- University of Tuebingen, Tuebingen, Germany
| | - G Klug
- University of Innsbruck, Cardiology, Innsbruck, Austria
| | - A Wahl
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Metzler
- University of Innsbruck, Cardiology, Innsbruck, Austria
| | - M Gawaz
- University of Tuebingen, Tuebingen, Germany
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - H Mahrholdt
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| |
Collapse
|
17
|
Stoller M, Gloekler S, Zbinden R, Tueller D, Eberli F, Windecker S, Wenaweser P, Seiler C. Left ventricular afterload reduction by transcatheter aortic valve implantation in severe aortic stenosis and its prompt effects on comprehensive coronary haemodynamics. EUROINTERVENTION 2019; 14:166-173. [PMID: 29553941 DOI: 10.4244/eij-d-17-00719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 01/09/2023]
Abstract
AIMS In this study we aimed to test the hypothesis that left ventricular (LV) afterload reduction in severe aortic valve stenosis (AS) by transcatheter aortic valve implantation (TAVI) acutely improves coronary haemodynamics. METHODS AND RESULTS This was a prospective, pathophysiologic study in 40 patients with severe AS undergoing TAVI. Endpoints were determined invasively immediately before and after TAVI without altering coronary stenotic lesions if present. Myocardial hyperaemia was induced by intravenous adenosine. The primary study endpoints were coronary flow reserve (thermodilution-derived CFR), and fractional flow reserve (FFR). The secondary study endpoint was coronary collateral flow index (CFI) as obtained during a one-minute coronary balloon occlusion. CFR was 1.9±0.9 before TAVI and 2.0±1.0 after TAVI (p=0.72). FFR was 0.90±0.08 before TAVI and 0.93±0.08 after TAVI (p=0.0021). The TAVI-induced increase in FFR was related to a significant decrease in hyperaemic mean aortic pressure from 71±16 mmHg before TAVI to 67±15 mmHg after TAVI (p=0.0099). Hyperaemic CFI increased from 0.127±0.083 before to 0.146±0.090 after TAVI (p=0.0508). CONCLUSIONS CFR appears not to be acutely affected by LV afterload reduction among patients with severe AS in response to TAVI. However, it acutely improves FFR; this occurs via lowering of mean aortic pressure. Hyperaemic coronary collateral flow index tends to augment in response to TAVI.
Collapse
Affiliation(s)
- Michael Stoller
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Sedaghat A, Vij V, Streit SR, Schrickel JW, Al-Kassou B, Nelles D, Kleinecke C, Windecker S, Meier B, Valglimigli M, Nietlispach F, Nickenig G, Gloekler S. Incidence, predictors, and relevance of acute kidney injury in patients undergoing left atrial appendage closure with Amplatzer occluders: a multicentre observational study. Clin Res Cardiol 2019; 109:444-453. [DOI: 10.1007/s00392-019-01524-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
|
19
|
Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schäufele T, Bekeredjian R, Zuern CS, Seizer P, Geisler T, Müller KAL, Krumm P, Nikolaou K, Klug G, Reinstadler S, Pamminger M, Reindl M, Wahl A, Traupe T, Seiler C, Metzler B, Gawaz M, Windecker S, Mahrholdt H. Time-Dependent Myocardial Necrosis in Patients With ST-Segment-Elevation Myocardial Infarction Without Angiographic Collateral Flow Visualized by Cardiac Magnetic Resonance Imaging: Results From the Multicenter STEMI-SCAR Project. J Am Heart Assoc 2019; 8:e012429. [PMID: 31181983 PMCID: PMC6645633 DOI: 10.1161/jaha.119.012429] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/13/2022]
Abstract
Background Acute complete occlusion of a coronary artery results in progressive ischemia, moving from the endocardium to the epicardium (ie, wavefront). Dependent on time to reperfusion and collateral flow, myocardial infarction (MI) will manifest, with transmural MI portending poor prognosis. Late gadolinium enhancement cardiac magnetic resonance imaging can detect MI with high diagnostic accuracy. Primary percutaneous coronary intervention is the preferred reperfusion strategy in patients with ST‐segment–elevation MI with <12 hours of symptom onset. We sought to visualize time‐dependent necrosis in a population with ST‐segment–elevation MI by using late gadolinium enhancement cardiac magnetic resonance imaging (STEMI‐SCAR project). Methods and Results ST‐segment–elevation MI patients with single‐vessel disease, complete occlusion with TIMI (Thrombolysis in Myocardial Infarction) score 0, absence of collateral flow (Rentrop score 0), and symptom onset <12 hours were consecutively enrolled. Using late gadolinium enhancement cardiac magnetic resonance imaging, the area at risk and infarct size, myocardial salvage index, transmurality index, and transmurality grade (0–50%, 51–75%, 76–100%) were determined. In total, 164 patients (aged 54±11 years, 80% male) were included. A receiver operating characteristic curve (area under the curve: 0.81) indicating transmural necrosis revealed the best diagnostic cutoff for a symptom‐to‐balloon time of 121 minutes: patients with >121 minutes demonstrated increased infarct size, transmurality index, and transmurality grade (all P<0.01) and decreased myocardial salvage index (P<0.001) versus patients with symptom‐to‐balloon times ≤121 minutes. Conclusions In MI with no residual antegrade and no collateral flow, immediate reperfusion is vital. A symptom‐to‐balloon time of >121 minutes causes a high grade of transmural necrosis. In this pure ST‐segment–elevation MI population, time to reperfusion to salvage myocardium was less than suggested by current guidelines.
Collapse
Affiliation(s)
- Simon Greulich
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Agnes Mayr
- 2 Department of Radiology University of Innsbruck Austria
| | - Steffen Gloekler
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland.,4 Department of Cardiology Schwarzwald-Baar Klinikum Villingen-Schwenningen Germany
| | - Andreas Seitz
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Stefan Birkmeier
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Tim Schäufele
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Raffi Bekeredjian
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | | | - Peter Seizer
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Tobias Geisler
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Karin A L Müller
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Patrick Krumm
- 7 Department of Radiology University of Tübingen Germany
| | | | - Gert Klug
- 8 Department of Cardiology University of Innsbruck Austria
| | | | | | - Martin Reindl
- 8 Department of Cardiology University of Innsbruck Austria
| | - Andreas Wahl
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | - Tobias Traupe
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | - Christian Seiler
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | | | - Meinrad Gawaz
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Stephan Windecker
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | - Heiko Mahrholdt
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| |
Collapse
|
20
|
Cruz-González I, González-Ferreiro R, Freixa X, Gafoor S, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Kanagaratnam P, Nietlispach F, Gloekler S, Aminian A, Danna P, Rezzaghi M, Stock F, Stolcova M, Paiva L, Costa M, Millán X, Ibrahim R, Tichelbäcker T, Schillinger W, Park JW, Sievert H, Meier B, Tzikas A. Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry. ACTA ACUST UNITED AC 2019; 73:28-34. [PMID: 31036510 DOI: 10.1016/j.rec.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite the efficacy of oral anticoagulant (OAC) therapy, some patients continue to have a high residual risk and develop a stroke on OAC therapy (resistant stroke [RS]), and there is a lack of evidence on the management of these patients. The aim of this study was to analyze the safety and efficacy of left atrial appendage occlusion (LAAO) as secondary prevention in patients with nonvalvular atrial fibrillation who have experienced a stroke/transient ischemic attack despite OAC treatment. METHODS We analyzed data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients with nonvalvular atrial fibrillation undergoing LAAO. Patientes with previous stroke on OAC therapy as indication for LAAO were identified and compared with patients with other indications. RESULTS A total of 115 patients (11%) with RS were identified. The CHA2DS2-VASc and the HAS-BLED score were significantly higher in the RS group (respectively 5.5±1.5 vs 4.3±1.6; P <.001; 3.9±1.3 vs 3.1±1.2; P <.001). No significant differences were observed in periprocedural major safety events (7.8 vs 4.5%; P=.1). With a mean clinical follow-up of 16.2±12.2 months, the observed annual stroke/transient ischemic attack rate for the RS group was 2.6% (65% risk reduction) and the observed annual major bleeding rate was 0% (100% risk reduction). CONCLUSIONS Patients with RS undergoing LAAO showed similar safety outcomes to patients without RS, with a significant reduction in stroke/transient ischemic attack and major bleeding events during follow-up. Adequately powered controlled trials are needed to further investigate the use of LAAO in RS patients.
Collapse
Affiliation(s)
- Ignacio Cruz-González
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain.
| | - Rocío González-Ferreiro
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | - Xavier Freixa
- Servicio de Cardiologia, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain
| | - Sameer Gafoor
- Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Samera Shakir
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Heyder Omran
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Sergio Berti
- Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Gennaro Santoro
- Department of Cardiology, Ospedale Careggi di Firenze, Florence, Italy
| | - Joelle Kefer
- Department of Cardiology, St-Luc University Hospital, Brussels, Belgium
| | - Ulf Landmesser
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Prapa Kanagaratnam
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland; Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Paolo Danna
- Department of Cardiology Ospedale Luigi Sacco, Milan, Italy
| | - Marco Rezzaghi
- Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Friederike Stock
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | | | - Luis Paiva
- Department of Cardiology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Marco Costa
- Department of Cardiology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Montreal, Canada
| | - Tobias Tichelbäcker
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Heart Center Cologne, Cologne, Germany
| | - Wolfgang Schillinger
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Heart Center Cologne, Cologne, Germany
| | - Jai-Wun Park
- Department of Cardiology, Coburg Hospital, Coburg, Germany
| | - Horst Sievert
- Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Apostolos Tzikas
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|
21
|
Traupe T, Stoller M, Gloekler S, Meier P, Seiler C. The effect of pegylated granulocyte colony-stimulating factor on collateral function and myocardial ischaemia in chronic coronary artery disease: A randomized controlled trial. Eur J Clin Invest 2019; 49:e13035. [PMID: 30316200 DOI: 10.1111/eci.13035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/09/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the effect of long-term pegfilgrastim on collateral function and myocardial ischaemia in patients with chronic stable coronary artery disease (CAD). METHODS This was a prospective clinical trial with randomized 2:1 allocation to pegfilgrastim or placebo for 6 months. The primary study endpoint was collateral flow index (CFI) as obtained during a 1-minute ostial coronary artery balloon occlusion. CFI is the ratio of mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure (mm Hg/mm Hg). Secondary endpoints were signs of myocardial ischaemia determined during the same coronary occlusion, that is quantitative intracoronary (i.c.) ECG ST-segment shift (mV) and the occurrence of angina pectoris. Endpoints were obtained at baseline before and at follow-up after three subcutaneous study drug injections. RESULTS Collateral flow index in the pegfilgrastim group changed from 0.096 ± 0.076 at baseline to 0.126 ± 0.070 at follow-up (P = 0.0039), while in the placebo group CFI changed from 0.157 ± 0.146 to 0.122 ± 0.043, respectively (P = 0.29); the CFI increment at follow-up was +0.030 ± 0.075 in the pegfilgrastim group and -0.034 ± 0.148 in the placebo group (P = 0.0172). In the pegfilgrastim group, i.c. ECG ST-segment shift changed from +1.23 ± 1.01 mV at baseline to +0.93 ± 0.97 mV at follow-up (P = 0.0049), and in the placebo group, it changed from +0.98 ± 1.02 mV to +1.43 ± 1.09 mV, respectively (P = 0.05). At follow-up, the fraction of patients free from angina pectoris during coronary occlusion had increased in the pegfilgrastim but not in the placebo group. CONCLUSION Pegfilgrastim given over the course of 6 months improves collateral function in chronic stable CAD, which is reflected by reduced myocardial ischaemia during a controlled coronary occlusion.
Collapse
Affiliation(s)
- Tobias Traupe
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Michael Stoller
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Pascal Meier
- University Hospital Geneva, Geneva, Switzerland.,University College London UCL, London, UK
| | - Christian Seiler
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
22
|
Kaski JC, Gloekler S, Ferrari R, Fox K, Lévy BI, Komajda M, Vardas P, Camici PG. Role of ivabradine in management of stable angina in patients with different clinical profiles. Open Heart 2018; 5:e000725. [PMID: 29632676 PMCID: PMC5888443 DOI: 10.1136/openhrt-2017-000725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/29/2017] [Accepted: 02/14/2018] [Indexed: 12/12/2022] Open
Abstract
In chronic stable angina, elevated heart rate contributes to the development of symptoms and signs of myocardial ischaemia by increasing myocardial oxygen demand and reducing diastolic perfusion time. Accordingly, heart rate reduction is a well-known strategy for improving both symptoms of myocardial ischaemia and quality of life (QOL). The heart rate-reducing agent ivabradine, a direct and selective inhibitor of the If current, decreases myocardial oxygen consumption while increasing diastolic time, without affecting myocardial contractility or coronary vasomotor tone. Ivabradine is indicated for treatment of stable angina and chronic heart failure (HF). This review examines available evidence regarding the efficacy and safety of ivabradine in stable angina, when used as monotherapy or in combination with beta-blockers, in particular angina subgroups and in patients with stable angina with left ventricular systolic dysfunction (LVSD) or HF. Trials involving more than 45 000 patients receiving treatment with ivabradine have shown that this agent has antianginal and anti-ischaemic effects, regardless of age, sex, severity of angina, revascularisation status or comorbidities. This heart rate-lowering agent might also improve prognosis, reduce hospitalisation rates and improve QOL in angina patients with chronic HF and LVSD.
Collapse
Affiliation(s)
- Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Steffen Gloekler
- Department of Cardiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany.,Cardiology, Cardiovascular Department, Bern University Hospital, Bern, Switzerland
| | - Roberto Ferrari
- Centro Cardiologico Universitario di Ferrara, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Kim Fox
- National Heart and Lung Institute, Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London, UK
| | - Bernard I Lévy
- PARCC, INSERM U970, Vessels and Blood Institute, Hôpital Lariboisière, Paris, France
| | - Michel Komajda
- Department of Cardiology, Université Pierre et Marie Curie Paris VI, La Pitié-Salpêtrière Hospital, Paris, France
| | - Panos Vardas
- Cardiology Department, University Hospital of Heraklion, Heraklion, Greece
| | - Paolo G Camici
- Cardiology Department, Vita Salute University and San Raffaele Hospital, Milan, Italy
| |
Collapse
|
23
|
Angelillis M, Gargiulo G, Moschovitis A, Fürholz M, Shakir S, Piazza N, Räber L, Meier B, Gloekler S, Windecker S, Valgimigli M. Computed tomography detection and quantification of left atrial appendage residual patency as collateral finding after percutaneous closure. Int J Cardiol 2018; 260:42-46. [PMID: 29506938 DOI: 10.1016/j.ijcard.2018.02.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 02/21/2018] [Accepted: 02/26/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Marco Angelillis
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland; Cardiac Thoracic and Vascular Department, University of Pisa, Italy
| | - Giuseppe Gargiulo
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland; Department of Advanced Biomedical Sciences, University Federico II of Naples, Italy
| | - Aris Moschovitis
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Monika Fürholz
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Samera Shakir
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Nicolo Piazza
- McGill University Health Center, Montreal, Quebec, Canada
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland; Cardiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland.
| |
Collapse
|
24
|
Dar T, Yarlagadda B, Tzikas A, Veerapaneni V, Parikh V, Reddy M, Sheldon S, Meier B, Gloekler S, Jung-Sun K, Gabriels J, Lakkireddy DR. LEFT ATRIAL APPENDAGE OCCLUSION DEVICE EMBOLIZATION (LAAODE): UNDERSTANDING THE TIMING, MECHANISM AND OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30943-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
25
|
Gloekler S, Hajredini B, Rycerz S, Jäckle S, Jung W. [Left atrial appendage clusure in nonvalvular atrial fibrillation : Clinical evidence 2017]. Herzschrittmacherther Elektrophysiol 2017; 28:366-380. [PMID: 29143099 DOI: 10.1007/s00399-017-0536-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/05/2017] [Indexed: 06/07/2023]
Abstract
Nonvalvular atrial fibrillation (AF) is the most common arrhythmia with a prevalence of 1-2% and affects approximately 15-20% of all octogenarians. Patients are at increased risk of thromboembolic stroke, with an overall risk of 5% per year. Thrombi form almost exclusively in the left atrial appendage (LAA), a blind sac-like heterogeneous structure trabeculated by pectinate muscles. In the past five decades, life-long oral anticoagulation (OAC) with vitamin K antagonists (VKA) has been the state-of-the art treatment to prevent stroke and systemic embolism from thrombi in AF. In the last decade, nonvitamin K dependent oral anticoagulants (NOAC) have been shown to be superior to VKA. Given the safety issues of indefinite OAC with either VKA or NOAC, it is plausible to consider left atrial appendage closure (LAAC) as an alternative strategy to prevent death, stroke or other systemic embolization, and bleeding. In recent years, LAAC has been compared to VKA in prospective randomized trials, yielding superior results regarding efficacy and noninferiority regarding safety in the mid-term. This review provides an update on the current state of LAAC in the field of prevention of death, stroke, and bleedings in patients suffering from nonvalvular AF. We elucidate the evidence and limitations of anticoagulation as the classical treatment paradigm, and review devices and techniques for LAAC. Most importantly, the current clinical evidence on efficacy and safety is outlined.
Collapse
Affiliation(s)
- Steffen Gloekler
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland.
| | - Bajram Hajredini
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| | - Simon Rycerz
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| | - Sebastian Jäckle
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| | - Werner Jung
- Klinik für Innere Medizin III, Kardiologie, Schwarzwald-Baar-Klinikum, 78052, Villingen-Schwenningen, Deutschland
| |
Collapse
|
26
|
Gloekler S, Saw J, Koskinas KC, Kleinecke C, Jung W, Nietlispach F, Meier B. Left atrial appendage closure for prevention of death, stroke, and bleeding in patients with nonvalvular atrial fibrillation. Int J Cardiol 2017; 249:234-246. [DOI: 10.1016/j.ijcard.2017.08.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 01/06/2023]
|
27
|
Gloekler S, Shakir S, Meier B. Transseptal Puncture Through Amplatzer Atrial Septal Occluder for Left Atrial Appendage Closure. JACC Cardiovasc Interv 2017; 10:2222-2223. [DOI: 10.1016/j.jcin.2017.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
|
28
|
Pecoraro F, Gloekler S, Mader CE, Roos M, Chaykovska L, Veith FJ, Cayne NS, Mangialardi N, Neff T, Lachat M. Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era. Updates Surg 2017; 70:129-136. [PMID: 28913787 DOI: 10.1007/s13304-017-0488-y] [Citation(s) in RCA: 7] [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: 03/20/2017] [Accepted: 08/15/2017] [Indexed: 12/17/2022]
Abstract
The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality. Significant mortality-related risk factor identification was the secondary endpoint. Open repair trend and its related perioperative mortality with a per-year analysis and a correlation subanalysis to identify predictive mortality factor were performed. Mean follow-up time was 23 (SD 23) months. Overall, 30-day mortality was 30%. Significant mortality-related risk factors were the use of computed tomography (CT) as a preoperative diagnostic tool, AAA rupture, preoperative shock, intraoperative cardiopulmonary resuscitation (CPR), use of aortic balloon occlusion, intraoperative massive blood transfusion (MBT), and development of abdominal compartment syndrome (ACS). Previous abdominal surgery was identified as a protective risk factor. The mortality rate at 90 days was 44%. Significant mortality-related risk factors were AAA rupture, aortocaval fistula, peripheral artery disease (PAD), preoperative shock, CPR, MBT, and ACS. The mortality rate at follow-up was 45%. Correlation analysis showed that MBT, shock, and ACS are the most relevant predictive mortality factor at 30 and 90 days. During the transition period from open to endovascular repair, open repair mortality outcomes remained comparable with other contemporary data despite a selection bias for higher risk patients. MBT, shock, and ACS are the most pronounced predictive mortality risk factors.
Collapse
Affiliation(s)
- Felice Pecoraro
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. .,Vascluar Surgery Unit, University Hospital "P. Giaccone", Via Liborio Giuffrè, 5, 90100, Palermo, Italy.
| | - Steffen Gloekler
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Caecilia E Mader
- Department of Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Malgorzata Roos
- Institute for Social- and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Lyubov Chaykovska
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Frank J Veith
- Division of Vascular Surgery, New York University Medical Center, New York, NY, USA
| | - Neal S Cayne
- Division of Vascular Surgery, New York University Medical Center, New York, NY, USA
| | | | - Thomas Neff
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital of Muensterlingen, Muensterlingen, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
29
|
Lempereur M, Aminian A, Freixa X, Gafoor S, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Cruz-Gonzalez I, Kanagaratnam P, Nietlispach F, Ibrahim R, Sievert H, Schillinger W, Park JW, Gloekler S, Tzikas A. Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Previous Major Gastrointestinal Bleeding (from the Amplatzer Cardiac Plug Multicenter Registry). Am J Cardiol 2017; 120:414-420. [PMID: 28595859 DOI: 10.1016/j.amjcard.2017.04.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 12/19/2022]
Abstract
History of major gastrointestinal (GI) bleeding may represent a frequent clinical indication for left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (AF). This study aims to investigate the procedural safety and long-term outcome of patients with previous major GI bleeding (MGIB) who underwent LAAO. Data from the Amplatzer Cardiac Plug multicenter registry on 1,047 patients were analyzed. Patients with previous MGIB as indication for LAAO were compared with patients without previous MGIB. A total of 151 patients (14.4%) with previous MGIB were identified. Periprocedural major bleeding events were more frequent in patients with previous MGIB (4.0% vs 0.8%, p = 0.001). With an average follow-up of 1.3 years, the observed annual rate of stroke/transient ischemic attack and major bleeding for patients with previous MGIB were 2.1% (61.4% relative reduction according to the Congestive Heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65-74, and Sex (female) [CHA2DS2-VASc] score) and 4.6% (20.1% relative reduction according to the expected rate based on the Hypertension, Abnormal renal/liver function (1 point each), Stroke, Bleeding history or predisposition, Labile INR, Elderly (>65 years), Drugs/alcohol concomitantly (1 point each) [HAS-BLED] score), respectively. In conclusion, in patients with non-valvular atrial fibrillation and previous MGIB, LAAO was associated with a low annual rate of stroke/transient ischemic attack. Periprocedural major bleeding events were more frequent in this specific population although the annual major bleeding rate showed a 20.1% relative risk reduction according to the HAS-BLED score.
Collapse
|
30
|
Haener J, Fuerholz M, Cherni T, Koskinas K, Piccolo R, Streit S, Praz F, Shakir S, Attinger-Toller A, Nietlispach F, Valgimigli M, Meier B, Windecker S, Gloekler S. P4891Procedural safety and long-term clinical outcome of left atrial appendage closure according to predefined stroke risk. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4891] [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: 11/12/2022] Open
|
31
|
Wenaweser P, Stortecky S, Schütz T, Praz F, Gloekler S, Windecker S, Elsässer A. Transcatheter aortic valve implantation with the NVT Allegra transcatheter heart valve system: first-in-human experience with a novel self-expanding transcatheter heart valve. EUROINTERVENTION 2017; 12:71-7. [PMID: 27173865 DOI: 10.4244/eijv12i1a13] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Indexed: 11/23/2022]
Abstract
AIMS We aimed to demonstrate the feasibility and investigate the safety of a novel, self-expanding trans-catheter heart valve in a selected patient population with severe aortic stenosis. METHODS AND RESULTS Between January and September 2013, a total of 21 patients with symptomatic severe aortic stenosis were eligible for transcatheter aortic valve implantation (TAVI) with the self-expanding NVT Allegra bioprosthesis (New Valve Technology, Hechingen, Germany) at two cardiovascular centres. Patients were elderly (age 83.8±4 years), predominantly female (95.2%), and all were considered to be at prohibitive risk for surgical aortic valve replacement (logistic EuroSCORE 30.4±11%). Procedural and device success was achieved in 95.2% and 85.7%, respectively. Echocardiographic assessment at discharge showed favourable haemodynamic results with a reduction of the mean transvalvular aortic gradient from 48.0±21 mmHg to 8.9±3 mmHg. In the majority of patients (90.5%), none or trace aortic regurgitation was recorded. Permanent pacemaker implantation was required in 23.8% of patients within the first 30 days of follow-up. Apart from one procedural death, no other serious adverse events were observed during the periprocedural period. TAVI with the NVT Allegra system was highly effective in alleviating symptoms and reducing NYHA functional class at 30-day follow-up. CONCLUSIONS The first-in-human experience with the NVT Allegra transcatheter heart valve prosthesis was associated with a high rate of procedural success. Furthermore, the NVT Allegra bioprosthesis was able to achieve favourable haemodynamic results and effectively alleviate symptoms at 30-day follow-up. The larger, multicentre NAUTILUS study will provide further information on the safety and efficacy of this novel, second-generation transcatheter aortic bioprosthesis.
Collapse
Affiliation(s)
- Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | | | | | | | | |
Collapse
|
32
|
Saw J, Tzikas A, Shakir S, Gafoor S, Omran H, Nielsen-Kudsk JE, Kefer J, Aminian A, Berti S, Santoro G, Nietlispach F, Moschovitis A, Cruz-Gonzalez I, Stammen F, Tichelbäcker T, Freixa X, Ibrahim R, Schillinger W, Meier B, Sievert H, Gloekler S. Incidence and Clinical Impact of Device-Associated Thrombus and Peri-Device Leak Following Left Atrial Appendage Closure With the Amplatzer Cardiac Plug. JACC Cardiovasc Interv 2017; 10:391-399. [PMID: 28231907 DOI: 10.1016/j.jcin.2016.11.029] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [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: 10/12/2016] [Revised: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Routine device surveillance after successful left atrial appendage closure is recommended to evaluate for intermediate to late complications. The aim of this study was to assess the incidence and clinical impact of these complications on cardiovascular events. METHODS Centers participating in the Amplatzer Cardiac Plug multicenter study were requested to submit their post-procedural transesophageal echocardiograms for independent adjudication. Thirteen of 22 centers contributed all their post-procedural echocardiograms, which included 344 from 605 consecutive patients. These images were submitted to a core laboratory and reviewed by 2 independent experts for peri-device leak, device-associated thrombus, device embolization, device migration, left atrial appendage thrombus, and left atrial thrombus. Clinical events were prospectively collected by each center. RESULTS Of the 344 transesophageal echocardiograms, 339 were deemed analyzable. Patients' mean age was 74.4 ± 7.5 years, and 67.3% were men. The mean CHADS2 score was 2.7 ± 1.3, the mean CHA2DS2-VASc score was 4.3 ± 1.5, and the mean HAS-BLED score was 3.0 ± 1.2. Amplatzer Cardiac Plug implantation was successful in all patients. Periprocedural major adverse events occurred in 2.4%. Median clinical follow-up duration was 355 days (range 179 to 622 days). Follow-up transesophageal echocardiography was performed after a median of 134 days (range 88 to 227 days). Device-associated thrombus was observed in 3.2% and peri-device leak in 12.5% (5.5% minimal, 5.8% mild, 0.6% moderate, 0.6% severe). Neither device-associated thrombus nor peri-device leak was associated with an increased risk for cardiovascular events. Independent predictors of device-associated thrombus were smoking (odds ratio: 5.79; p = 0.017) and female sex (odds ratio: 4.22; p = 0.027). CONCLUSIONS Following successful left atrial appendage closure with the Amplatzer Cardiac Plug, the presence of peri-device leak was relatively low, and device-associated thrombus was infrequent. Neither was associated with increased risk for thromboembolism.
Collapse
Affiliation(s)
- Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada.
| | - Apostolos Tzikas
- AHEPA University Hospital, Thessaloniki, Greece; Interbalkan European Medical Center, Thessaloniki, Greece
| | | | | | | | | | | | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Sergio Berti
- Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | | | | | | | | | | | | | - Xavier Freixa
- Hospital Clinic of University of Barcelona, Barcelona, Spain
| | - Reda Ibrahim
- Montreal Heart Institute, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
33
|
Freixa X, Llull L, Gafoor S, Cruz-Gonzalez I, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Kanagaratnam P, Nietlispach F, Gloekler S, Aminian A, Danna P, Rezzaghi M, Stock F, Stolcova M, Paiva L, Costa M, Millán X, Ibrahim R, Tichelbäcker T, Schillinger W, Park JW, Sievert H, Meier B, Tzikas A. Characterization of Cerebrovascular Events After Left Atrial Appendage Occlusion. Am J Cardiol 2016; 118:1836-1841. [PMID: 27745964 DOI: 10.1016/j.amjcard.2016.08.075] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 02/02/2023]
Abstract
Cardioembolic strokes are generally more lethal and disabling than other source of strokes. Data from PROTECT AF (Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation) suggest that strokes after left atrial appendage occlusion (LAAO) with the Watchman device are less disabling than those in the warfarin group. No data assessing the severity of strokes after LAAO with the AMPLATZER Cardiac Plug (ACP) are available. The objective of the study was to evaluate the severity of cerebrovascular events after LAAO with the ACP in a population mostly characterized by an absolute or relative contraindication to oral anticoagulation. Data from the ACP multicenter registry were analyzed. Disabling strokes were defined as those with a modified Rankin score of 3 to 6 at 90 days after the event. A total of 1,047 subjects were included. The mean age and CHADS2 score were 75 ± 8 years and 2.8 ± 1.3, respectively. Procedural success was achieved in 97.3% and 4.9% of the patients presented procedural major adverse events. Clinical follow-up was complete in 98.2% of patients with a median of 13 months. There were 9 strokes (0.9%), 9 transient ischemic attacks (0.9%), and no intracranial hemorrhages (0%) at follow-up. After excluding 2 patients with pre-LAAO disability, functional assessment showed disabling events in 3 (19%) of the remaining 16 patients. The median time of presentation was 420 days (interquartile range 234 to 671) after LAAO, and 17 patients (94%) were on single-antiplatelet therapy when the event occurred. According to our results, cerebrovascular events after LAAO with the ACP system were infrequent and mostly nondisabling.
Collapse
|
34
|
Greulich S, Kitterer D, Kurmann R, Henes J, Latus J, Gloekler S, Wahl A, Buss SJ, Katus HA, Bobbo M, Lombardi M, Backes M, Steubing H, Schepat P, Braun N, Alscher MD, Sechtem U, Mahrholdt H. Cardiac involvement in patients with rheumatic disorders: Data of the RHEU-M(A)R study. Int J Cardiol 2016; 224:37-49. [DOI: 10.1016/j.ijcard.2016.08.298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/19/2016] [Indexed: 01/08/2023]
|
35
|
Wolfrum M, Attinger-Toller A, Shakir S, Gloekler S, Seifert B, Moschovitis A, Khattab A, Maisano F, Meier B, Nietlispach F. Percutaneous left atrial appendage occlusion: Effect of device positioning on outcome. Catheter Cardiovasc Interv 2016; 88:656-664. [DOI: 10.1002/ccd.26646] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 11/15/2015] [Accepted: 06/04/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Mathias Wolfrum
- University Heart Center; University Hospital Zurich; Zurich Switzerland
| | | | - Samera Shakir
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Steffen Gloekler
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology; Biostatistics and Prevention Institute, University of Zurich; Zurich Switzerland
| | - Aris Moschovitis
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Ahmed Khattab
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Francesco Maisano
- University Heart Center; University Hospital Zurich; Zurich Switzerland
| | - Bernhard Meier
- Department of Cardiology; Bern University Hospital; Bern Switzerland
| | | |
Collapse
|
36
|
Attinger-Toller A, Maisano F, Senn O, Taramasso M, Shakir S, Possner M, Gloekler S, Windecker S, Stortecky S, Lüscher TF, Meier B, Nietlispach F. “One-Stop Shop”. JACC Cardiovasc Interv 2016; 9:1487-95. [DOI: 10.1016/j.jcin.2016.04.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
|
37
|
Rimoldi SF, Messerli FH, Cerny D, Gloekler S, Traupe T, Laurent S, Seiler C. Selective Heart Rate Reduction With Ivabradine Increases Central Blood Pressure in Stable Coronary Artery Disease. Hypertension 2016; 67:1205-10. [DOI: 10.1161/hypertensionaha.116.07250] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/15/2016] [Indexed: 01/27/2023]
Abstract
Abstract—
Heart rate (HR) lowering by β-blockade was shown to be beneficial after myocardial infarction. In contrast, HR lowering with ivabradine was found to confer no benefits in 2 prospective randomized trials in patients with coronary artery disease. We hypothesized that this inefficacy could be in part related to ivabradine’s effect on central (aortic) pressure. Our study included 46 patients with chronic stable coronary artery disease who were randomly allocated to placebo (n=23) or ivabradine (n=23) in a single-blinded fashion for 6 months. Concomitant baseline medication was continued unchanged throughout the study except for β-blockers, which were stopped during the study period. Central blood pressure and stroke volume were measured directly by left heart catheterization at baseline and after 6 months. For the determination of resting HR at baseline and at follow-up, 24-hour ECG monitoring was performed. Patients on ivabradine showed an increase of 11 mm Hg in central systolic pressure from 129±22 mm Hg to 140±26 mm Hg (
P
=0.02) and in stroke volume by 86±21.8 to 107.2±30.0 mL (
P
=0.002). In the placebo group, central systolic pressure and stroke volume remained unchanged. Estimates of myocardial oxygen consumption (HR×systolic pressure and time-tension index) remained unchanged with ivabradine.The decrease in HR from baseline to follow-up correlated with the concomitant increase in central systolic pressure (
r
=−0.41,
P
=0.009) and in stroke volume (
r
=−0.61,
P
<0.001). In conclusion, the decrease in HR with ivabradine was associated with an increase in central systolic pressure, which may have antagonized possible benefits of HR lowering in coronary artery disease patients.
Clinical Trials—URL:
http://www.clinicaltrials.gov
. Unique identifier NCT01039389.
Collapse
Affiliation(s)
- Stefano F. Rimoldi
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| | - Franz H. Messerli
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| | - David Cerny
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| | - Steffen Gloekler
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| | - Tobias Traupe
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| | - Stéphane Laurent
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| | - Christian Seiler
- From the Department of Cardiology and Clinical Research, Inselspital, University of Bern Hospital, Bern, Switzerland (S.F.R., F.H.M., D.C., S.G., T.T., C.S.); and Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France (S.L.)
| |
Collapse
|
38
|
Abstract
Atrial fibrillation (AF) is the most common atrial arrhythmia, with a prevalence of 1-2% in the general population. It increases with age, affecting approximately 7% of individuals age >65 years and 15-20% of octogenarians. The human left atrium has a blind sac-like remnant, called left atrial appendage (LAA). It originates from a primordial pulmonary vein. Due to its complicated structure, blind end and inner surface trabeculated by pectinate muscles, thrombi in nonvalvular AF form almost exclusively in the LAA and not in the smooth-walled left atrium. For the last 50 years, oral anticoagulation (OAC) with vitamin K antagonists (VKAs) has been the only treatment option to prevent stroke and systemic embolism from thrombi in AF. More recently, non-vitamin K-dependant oral anticoagulants (NOACs) have been shown to be noninferior or even superior to VKA with respect to efficacy and safety. In light of the limitations of indefinite OAC, particularly among patients at increased risk for bleeding and because thrombi arise predominantly from the LAA among AF patients, exclusion of the LAA with closure devices (LAAC) provides a novel treatment strategy for prevention of stroke and bleeding. Recently, LAAC has been compared with VKA therapy in prospective randomised trials with promising results. Today, the decision to provide the most appropriate treatment for a patient with AF (OAC, NOAC or LAAC) is complex and needs to be individualised. This review provides an update on the current state of LAAC in the field of stroke prevention in patients suffering from nonvalvular AF. We describe the pathophysiology of the LAA with regard to stroke. Aside from the evidence and limitations of anticoagulation as the classical treatment paradigm for stroke prevention, devices and techniques for LAAC are outlined and the current clinical evidence with regard to efficacy and safety is reviewed. Finally, contemporary recommendations for patient selection are provided.
Collapse
Affiliation(s)
- Steffen Gloekler
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| | - Stephan Windecker
- Cardiology, Cardiovascular Department, University Hospital of Bern, Bern, Switzerland
| |
Collapse
|
39
|
Greulich S, Meloni A, Nazir SA, Stefan Biesbroek P, Arenja N, Kammerlander AA, Sayeed A, Ricci F, Bernhardt P, Meierhofer C, Devos DG, Ruecker B, Burkhardt B, Kamphuis VP, De Lazzari M, Nederend I, Dux-Santoy L, Cavalcante JL, Rosmini S, Liu B, Fent G, Claessen G, Behar J, Oebel S, Baritussio A, Ranjit Arnold J, Kitterer D, Latus J, Henes J, Kurmann R, Gloekler S, Wahl A, Buss S, Katus H, Bobbo M, Lombardi M, Braun N, Alscher M, Sechtem U, Mahrholdt H, Neri M, Preziosi P, Grassedonio E, Schicchi N, Keilberg P, Pulini S, Facchini E, Positano V, Pepe A, Shetye A, Khan JN, Singh A, Kanagala P, Swarbrick D, Gulsin G, Graham-Brown M, Squire I, Gershlick A, McCann GP, Amier RP, Teunissen PF, Robbers LF, Beek AM, van Rossum AC, Hofman MB, van Royen N, Nijveldt R, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Thomas Z, Korosoglou G, Katus HA, Buss SJ, Schwaiger ML, Duca F, Aschauer S, Marzluf BA, Zotter-Tufaro C, Dalos D, Pfaffenberger S, Bonderman D, Mascherbauer J, Fridman Y, Hackman B, Kadakkal A, Maanja M, Daya HA, Wong TC, Schelbert EB, Barison A, Todiere G, Gaeta R, Galllina S, Emdin M, De Caterina R, Aquaro G, Buckert D, Dyckmanns N, Rottbauer W, Kühn A, Shehu N, Müller J, Stern H, Ewert P, Fratz S, Vogt M, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E, Geiger J, Makki M, Burkhardt B, Kellenberger CJ, Buechel ERV, Kellenberger C, Geiger J, Ruecker B, Buechel EV, Elbaz MS, Kroft LJ, van der Geest RJ, de Roos A, Blom NA, Westenberg JJ, Roest AA, Cipriani A, Susana A, Rizzo S, Giorgi B, Carmelo L, Bertaglia E, Bauce B, Corrado D, Thiene G, Marra MP, Basso C, Iliceto S, Roest A, van den Boogaard P, ten Harkel A, de Geus J, Kroft L, de Roos A, Westenberg J, Kale R, Teixido-Tura G, Maldonado G, Huguet M, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares J, Rijal S, Schindler JT, Gleason TG, Lee JS, Schelbert EB, Bulluck H, Treibel TA, Bhuva A, Abdel-Gadir A, Culotta V, Merghani A, Maestrini V, Herrey AS, Kellman P, Manisty C, Moon JC, Hayer M, Baig S, Shah T, Rooney S, Edwards N, Steeds R, Garg P, Swoboda P, Dobson L, Musa T, Foley J, Haaf P, Greenwood J, Plein S, Schnell F, Bogaert J, Dymarkowski S, Pattyn N, Claus P, Van Cleemput J, Gerche AL, Heidbuchel H, Toth D, Reiml S, Panayiotou M, Claridge S, Jackson T, Sohal M, Webb J, O'Neill M, Brost A, Mountney P, Razavi R, Rhode K, Rinaldi CA, Arya A, Hilbert S, Bollmann A, Hindricks G, Jahnke C, Paetsch I, Dinov B, Perazzolo Marra M, Ghosh Dastidar A, Rodrigues J, Zorzi A, Susana A, Scatteia A, De Garate E, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C, Jerosch-Herold M, Karamitsos TD, Francis JM, Bhamra-Ariza P, Sarwar R, Choudhury R, Selvanayagam JB, Neubauer S. ORAL AB AGORA1362Cardiac Involvement in Patients With Different Rheumatic Disorders1366Gender differences in the development of cardiac complications: a multicentric prospective study in a large cohort of thalassemia major patients1646Comparison of T1-mapping, T2-weighted and contrast-enhanced cine imaging at 3.0T CMR for diagnostic oedema assessment in ST-segment elevation myocardial infarction1375Evaluation of Tissue Changes in Remote Noninfarcted Myocardium after Acute Myocardial Infarction using T1-mapping1377Right ventricular long axis strain – The prognostic value of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging1389The role of the right ventricular insertion point in heart failure patients with preserved ejection fraction: Insights from a cardiovascular magnetic resonance study1398Myocardial fibrosis associates with B-type natriuretic peptide levels and outcomes more than wall stress1478Prognostic Value of Pulmonary Blood Volume by Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure Outpatients – The PROVE-HF Study1370Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary1509Influence of non-invasive hemodynamic CMR parameters on maximal exercise capacity in surgically untreated patients with Ebstein's anomaly1356Proximal aortic stiffening in Turner patients is more pronounced in the presence of a bicuspid valve. A segmental functional MRI study1503Flow pattern and vascular distensibility of the pulmonary arteries in patients after repair of tetralogy of Fallot. Insights from 4D flow CMR1516Myocardial deformation characteristics of the systemic right ventricle after atrial switch operation for transposition of the great arteries1633Three-dimensional vortex formation in patients with a Fontan circulation: evaluation with 4D flow CMR1483Mitral valve prolapse: arrhythmogenic substrates by cardiac magnetic imaging1596Increased local wall shear stress after coarctation repair is associated with descending aorta pulse wave velocity: evaluation with CMR and 4D flow1636Three-dimensional wall shear stress assessed by 4Dflow CMR in bicuspid aortic valve disease1464Cardiac Amyloidosis and Aortic Stenosis – The Convergence of Two Aging Processes1630Blood T1 variability explained in healthy volunteers: an analysis on MOLLI, ShMOLLI and SASHA1408Myocardial deformation on CMR predicts adverse outcomes in carcinoid heart disease - a new marker of risk1492Myocardial Perfusion Reserve and Global Longitudinal Strain in Early Rheumatoid Arthritis1500Exercise CMR to differentiate athlete's heart from patients with early dilated cardiomyopathy1559Real-Time, x-mri guidance to optimise left ventricular lead placement for delivery of cardiac resynchronisation therapy1560The role of Cardiac magnetic resonance imaging in patients undergoing ablation for ventricular tachycardia- Defining the substrate and visualizing the outcome1590Impact of cardiovascular magnetic resonance on clinical management and decision-making of out of hospital cardiac arrest survivors with inconclusive coronary angiogram1561Detection of coronary stenosis at rest using Oxygenation-Sensitive Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew181] [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: 11/14/2022] Open
|
40
|
O'Sullivan CJ, Englberger L, Hosek N, Heg D, Cao D, Stefanini GG, Stortecky S, Gloekler S, Spitzer E, Tüller D, Huber C, Pilgrim T, Praz F, Buellesfeld L, Khattab AA, Carrel T, Meier B, Windecker S, Wenaweser P. Clinical outcomes and revascularization strategies in patients with low-flow, low-gradient severe aortic valve stenosis according to the assigned treatment modality. JACC Cardiovasc Interv 2016; 8:704-17. [PMID: 25946444 DOI: 10.1016/j.jcin.2014.11.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study compared clinical outcomes and revascularization strategies among patients presenting with low ejection fraction, low-gradient (LEF-LG) severe aortic stenosis (AS) according to the assigned treatment modality. BACKGROUND The optimal treatment modality for patients with LEF-LG severe AS and concomitant coronary artery disease (CAD) requiring revascularization is unknown. METHODS Of 1,551 patients, 204 with LEF-LG severe AS (aortic valve area <1.0 cm(2), ejection fraction <50%, and mean gradient <40 mm Hg) were allocated to medical therapy (MT) (n = 44), surgical aortic valve replacement (SAVR) (n = 52), or transcatheter aortic valve replacement (TAVR) (n = 108). CAD complexity was assessed using the SYNTAX score (SS) in 187 of 204 patients (92%). The primary endpoint was mortality at 1 year. RESULTS LEF-LG severe AS patients undergoing SAVR were more likely to undergo complete revascularization (17 of 52, 35%) compared with TAVR (8 of 108, 8%) and MT (0 of 44, 0%) patients (p < 0.001). Compared with MT, both SAVR (adjusted hazard ratio [adj HR]: 0.16; 95% confidence interval [CI]: 0.07 to 0.38; p < 0.001) and TAVR (adj HR: 0.30; 95% CI: 0.18 to 0.52; p < 0.001) improved survival at 1 year. In TAVR and SAVR patients, CAD severity was associated with higher rates of cardiovascular death (no CAD: 12.2% vs. low SS [0 to 22], 15.3% vs. high SS [>22], 31.5%; p = 0.037) at 1 year. Compared with no CAD/complete revascularization, TAVR and SAVR patients undergoing incomplete revascularization had significantly higher 1-year cardiovascular death rates (adj HR: 2.80; 95% CI: 1.07 to 7.36; p = 0.037). CONCLUSIONS Among LEF-LG severe AS patients, SAVR and TAVR improved survival compared with MT. CAD severity was associated with worse outcomes and incomplete revascularization predicted 1-year cardiovascular mortality among TAVR and SAVR patients.
Collapse
Affiliation(s)
- Crochan J O'Sullivan
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland
| | - Lars Englberger
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Nicola Hosek
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Davide Cao
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Ernest Spitzer
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - David Tüller
- Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland
| | - Christoph Huber
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Lutz Buellesfeld
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Ahmed A Khattab
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Bern University Hospital, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland; Clinical Trials Unit, Bern University Hospital, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
| |
Collapse
|
41
|
Freixa X, Gafoor S, Regueiro A, Cruz-Gonzalez I, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Sievert H, Kanagaratnam P, Nietlispach F, Gloekler S, Aminian A, Danna P, Rezzaghi M, Stock F, Stolcova M, Costa M, Ibrahim R, Schillinger W, Park JW, Meier B, Tzikas A. Comparison of Efficacy and Safety of Left Atrial Appendage Occlusion in Patients Aged <75 to ≥ 75 Years. Am J Cardiol 2016; 117:84-90. [PMID: 26552507 DOI: 10.1016/j.amjcard.2015.10.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/26/2022]
Abstract
Left atrial appendage occlusion (LAAO) is emerging as a promising alternative to oral anticoagulation. Because aged patients present a greater risk of not only cardioembolic events but also major bleeding, LAAO might represent a valid alternative as this would allow oral anticoagulation cessation while keeping cardioembolic protection. The objective of the study was to explore the safety and efficacy of LAAO in elderly patients. Data from the AMPLATZER Cardiac Plug multicenter registry were analyzed. The cohort was categorized in 2 groups (<75 vs ≥ 75 years). A total of 1,053 subjects were included in the registry. Of them, 219 were excluded because of combined procedures. As a result, 828 subjects were included (54.6% ≥ 75 years). Procedural success was high and similar in both groups (97.3%). Acute procedural major adverse events were not statistically different among groups (3.2% in <75 years vs 5.1%; p = 0.17) although stratified analysis showed a higher incidence of cardiac tamponade in elderly patients (0.5% vs 2.2%; p = 0.04). With a median follow-up of 16.8 months, no significant differences in stroke/TIA (1.9% vs 2.3%; p = 0.89) and major bleeding (1.7% vs 2.6%; p = 0.54) were observed. In conclusion, LAAO was associated with similar procedural success in patients aged <75 and ≥ 75 years although older patients had a higher incidence of cardiac tamponade. At follow-up, stroke and major bleeding rates were similar among groups.
Collapse
|
42
|
Affiliation(s)
- Steffen Gloekler
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern 3010, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern 3010, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern 3010, Switzerland
| | - Michael Stoller
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern 3010, Switzerland
| |
Collapse
|
43
|
|
44
|
Stortecky S, Heg D, Gloekler S, Wenaweser P, Windecker S, Buellesfeld L. Accuracy and reproducibility of aortic annulus sizing using a dedicated three-dimensional computed tomography reconstruction tool in patients evaluated for transcatheter aortic valve replacement. EUROINTERVENTION 2015; 10:339-46. [PMID: 24273249 DOI: 10.4244/eijv10i3a59] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate the accuracy and reproducibility of aortic annulus sizing using a multislice computed tomography (MSCT) based aortic root reconstruction tool compared with conventional imaging among patients evaluated for transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS Patients referred for TAVR underwent standard preprocedural assessment of aortic annulus parameters using MSCT, angiography and transoesophageal echocardiography (TEE). Three-dimensional (3D) reconstruction of MSCT images of the aortic root was performed using 3mensio (3mensio Medical Imaging BV, Bilthoven, The Netherlands), allowing for semi-automated delineation of the annular plane and assessment of annulus perimeter, area, maximum, minimum and virtual diameters derived from area and perimeter (aVD and pVD). A total of 177 patients were enrolled. We observed a good inter-observer variability of 3D reconstruction assessments with concordance coefficients for agreement of 0.91 (95% CI: 0.87-0.93) and 0.91 (0.88-0.94) for annulus perimeter and area assessments, respectively. 3D derived pVD and aVD correlated very closely with a concordance coefficient of 0.97 (0.96-0.98) with a mean difference of 0.5±0.3 mm (pVD-aVD). 3D derived pVD showed the best, but moderate concordance with diameters obtained from coronal MSCT (0.67, 0.56-0.75; 0.3±1.8 mm), and the lowest concordance with diameters obtained from TEE (0.42, 0.31-0.52; 1.9±1.9 mm). CONCLUSIONS MSCT-based 3D reconstruction of the aortic annulus using the 3mensio software enables accurate and reproducible assessment of aortic annulus dimensions.
Collapse
Affiliation(s)
- Stefan Stortecky
- Department of Cardiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland
| | | | | | | | | | | |
Collapse
|
45
|
Huber C, Praz F, O'Sullivan CJ, Langhammer B, Gloekler S, Stortecky S, von Allmen RS, Meier B, Carrel T, Englberger L, Windecker S, Wenaweser P. Transcarotid aortic valve-in-valve implantation for degenerated stentless aortic root conduits with severe regurgitation: a case series. Interact Cardiovasc Thorac Surg 2015; 20:694-700. [DOI: 10.1093/icvts/ivv053] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/24/2015] [Indexed: 11/14/2022] Open
|
46
|
Gloekler S, Shakir S, Doblies J, Khattab AA, Praz F, Guerios Ê, Koermendy D, Stortecky S, Pilgrim T, Buellesfeld L, Wenaweser P, Windecker S, Moschovitis A, Jaguszewski M, Landmesser U, Nietlispach F, Meier B. Early results of first versus second generation Amplatzer occluders for left atrial appendage closure in patients with atrial fibrillation. Clin Res Cardiol 2015; 104:656-65. [PMID: 25736061 DOI: 10.1007/s00392-015-0828-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [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: 12/01/2014] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transcatheter left atrial appendage (LAA) occlusion has been proven to be an effective treatment for stroke prophylaxis in patients with atrial fibrillation. For this purpose, the Amplatzer cardiac plug (ACP) was introduced. Its second generation, the Amulet, was developed for easier delivery, better coverage, and reduction of complications. AIM To investigate the safety and efficacy of first generation versus second generation Amplatzer occluders for LAA occlusion. METHODS Retrospective analysis of prospectively collected data from the LAA occlusion registries of the Bern and Zurich university hospitals. Comparison of the last consecutive 50 ACP cases versus the first consecutive 50 Amulet cases in patients with non-valvular atrial fibrillation. For safety, a periprocedural combined endpoint, which is composed of death, stroke, cardiac tamponade, and bailout by surgery was predefined. For efficacy, the endpoint was procedural success. RESULTS There were no differences between the two groups in baseline characteristics. The percentage of associated interventions during LAA occlusion was high in (78% with ACP vs. 70% with Amulet p = ns). Procedural success was similar in both groups (98 vs. 94%, p = 0.61). The combined safety endpoint for severe adverse events was reached by a similar rate of patients in both groups (6 vs. 8%, p = 0.7). Overall complication rate was insignificantly higher in the ACP group, which was mainly driven by clinically irrelevant pericardial effusions (24 vs. 14%, p = 0.31). Death, stroke, or tamponade were similar between the groups (0 vs. 2%, 0 vs. 0%, or 6 vs. 6%, p = ns). CONCLUSION Transcatheter LAA occlusion for stroke prophylaxis in patients with atrial fibrillation can be performed with similarly high success rates with first and second generations of Amplatzer occluders. According to this early experience, the Amulet has failed to improve results of LAA occlusion. The risk for major procedural adverse events is acceptable but has to be taken into account when selecting patients for LAA occlusion, a preventive procedure.
Collapse
Affiliation(s)
- Steffen Gloekler
- Cardiology, Cardiovascular Department, Bern University Hospital, Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Khattab AA, Gloekler S, Sprecher B, Shakir S, Guerios E, Stortecky S, O'Sullivan CJ, Nietlispach F, Moschovitis A, Pilgrim T, Buellesfeld L, Wenaweser P, Windecker S, Meier B. Feasibility and outcomes of combined transcatheter aortic valve replacement with other structural heart interventions in a single session: a matched cohort study. Open Heart 2014; 1:e000014. [PMID: 25332781 PMCID: PMC4195934 DOI: 10.1136/openhrt-2013-000014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/08/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022] Open
Abstract
Background Concurrent cardiac diseases are frequent among elderly patients and invite simultaneous treatment to ensure an overall favourable patient outcome. Aim To investigate the feasibility of combined single-session percutaneous cardiac interventions in the era of transcatheter aortic valve implantation (TAVI). Methods This prospective, case–control study included 10 consecutive patients treated with TAVI, left atrial appendage occlusion and percutaneous coronary interventions. Some in addition had patent foramen ovale or atrial septal defect closure in the same session. The patients were matched in a 1:10 manner with TAVI-only cases treated within the same time period at the same institution regarding their baseline factors. The outcome was validated according to the Valve Academic Research Consortium (VARC) criteria. Results Procedural time (126±42 vs 83±40 min, p=0.0016), radiation time (34±8 vs 22±12 min, p=0.0001) and contrast dye (397±89 vs 250±105 mL, p<0.0001) were higher in the combined intervention group than in the TAVI-only group. Despite these drawbacks, no difference in the VARC endpoints was evident during the in-hospital period and after 30 days (VARC combined safety endpoint 32% for TAVI only and 20% for combined intervention, p=1.0). Conclusions Transcatheter treatment of combined cardiac diseases is feasible even in a single session in a high-volume centre with experienced operators.
Collapse
Affiliation(s)
- Ahmed A Khattab
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Steffen Gloekler
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Beate Sprecher
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Samera Shakir
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Enio Guerios
- Centro de Cardiopatias Congênitas e Estruturais do Paraná , Curitiba, Paraná , Brazil
| | - Stefan Stortecky
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Crochan J O'Sullivan
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Fabian Nietlispach
- Department of Cardiology , Zurich University Hospital , Zürich , Switzerland
| | - Aris Moschovitis
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Thomas Pilgrim
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Lutz Buellesfeld
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Peter Wenaweser
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Stephan Windecker
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| | - Bernhard Meier
- Cardiology, Cardiovascular Department , Bern University Hospital , Bern , Switzerland
| |
Collapse
|
48
|
Buellesfeld L, Stortecky S, Heg D, Gloekler S, Meier B, Wenaweser P, Windecker S. Extent and distribution of calcification of both the aortic annulus and the left ventricular outflow tract predict aortic regurgitation after transcatheter aortic valve replacement. EUROINTERVENTION 2014; 10:732-8. [DOI: 10.4244/eijv10i6a126] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
49
|
Brill AK, Gloekler S, Aubert JD, Wenaweser PM, Geiser T. Transcatheter aortic valve implantation in a lung transplant recipient. Ann Thorac Surg 2014; 97:e159-60. [PMID: 24882332 DOI: 10.1016/j.athoracsur.2014.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/20/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022]
Abstract
Transcatheter aortic valve implantation is a feasible therapeutic option for selected patients with severe aortic stenosis and high or prohibitive risk for standard surgery. Lung transplant recipients are often considered high-risk patients for heart surgery because of their specific transplant-associated characteristics and comorbidities. We report a case of successful transfemoral transcatheter aortic valve replacement in a lung transplant recipient with a symptomatic severe aortic stenosis, severe left ventricular dysfunction, and end-stage renal failure 9 years after bilateral lung transplantation.
Collapse
Affiliation(s)
- Anne-Kathrin Brill
- Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland; Academic Department of Sleep and Breathing, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
| | - Steffen Gloekler
- Cardiology, Cardiovascular Department, University Hospital and University of Bern, Bern, Switzerland
| | - John-David Aubert
- Service de Pneumologie et Centre Transplantation, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter M Wenaweser
- Cardiology, Cardiovascular Department, University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
50
|
Affiliation(s)
- Bernhard Meier
- Cardiovascular Department, Bern University Hospital, 3010 Bern, Switzerland
| | - Steffen Gloekler
- Cardiovascular Department, Bern University Hospital, 3010 Bern, Switzerland
| | | | - Aris Moschovitis
- Cardiovascular Department, Bern University Hospital, 3010 Bern, Switzerland
| |
Collapse
|