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Lebek S, Wester M, Tafelmeier M, Fisser C, Hirt S, Schopka S, Schmid C, Maier L, Arzt M, Wagner S. Abnormal P-waves found in patients with sleep-disordered breathing are associated with triggered pro-arrhythmic activity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3685] [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: 11/14/2022] Open
Abstract
Abstract
Background
Sleep-disordered breathing (SDB) is frequently associated with atrial arrhythmias, but diagnostic markers that predict the propensity for atrial arrhythmias are missing. Abnormal P-wave terminal force in lead V1 (PTFV1) has been associated with atrial structural/electrical remodeling and arrhythmias.
Purpose
Here we investigate the association of triggered pro-arrhythmic activity with abnormal PTFV1 in human right atrial appendage biopsies of patients without and with SDB.
Methods
30 patients undergoing elective coronary artery bypass grafting were screened for SDB by polygraphy. An apnoea-hypopnea index (AHI) of ≥15/h defined SDB. PTFV1 was measured as product of negative P-wave amplitude and duration in lead V1 and was defined as abnormal if >4000 ms*μV. Ca/Calmodulin-dependent protein kinase II (CaMKII) activity was measured in human right atrial appendage biopsies by a specific HDAC4 pull-down assay. Premature atrial contractions (PACs) were triggered by exposure to 100 nM isoproterenol (at 3.5 mM [Ca]o) in human atrial trabeculae. PACs severity was classified by a score from 0 points (no arrhythmias) to 5 points (salve). In addition, atrial fibrosis was quantified by Masson's trichrome stain in cryo-sectioned atrial tissue. Multivariate linear regression analyses were performed accounting for age, sex, BMI, existing AF, heart failure, diabetes, and creatinine.
Results
Interestingly, the AHI was independently associated with the magnitude of PTFV1 (fig. A+B, B=57.47±21.03, R2=0.48, P=0.01). Importantly, patients with an abnormal PTFV1 had a significantly increased CaMKII activity (fig. C, P=0.04) and showed significantly more severe triggered PACs (fig. D, P=0.02). Moreover, the magnitude of PTFV1 correlated significantly and independently with PAC severity (fig. D, B=0.0005±0.0002, R2=0.50, P=0.03). Consistently, these arrhythmias could be significantly reduced by acute CaMKII inhibition (5 μM KN93, P<0.01), which abolished the correlation between PTFV1 and PAC severity (P=N.S.). Surprisingly, atrial fibrosis was significantly decreased in patients with an abnormal PTFV1 (fig. E, P=0.02), suggesting that abnormal PTFV1 is a marker of proarrhythmic atrial electrical remodeling of functional cardiomyocytes but not of fibrotic tissue.
Conclusion
The severity of sleep-disordered breathing (AHI) is independently associated with an abnormal PTFV1. Intriguingly, this abnormality is associated with an increased CaMKII activity and with CaMKII-dependent arrhythmias, suggesting PTFV1 to be a potential tool to evaluate the pro-arrhythmic risk of patients with SDB.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Part of this study was funded by Philips Respironics.
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Affiliation(s)
- S Lebek
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - M Wester
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - M Tafelmeier
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - C Fisser
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - S Hirt
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - S Schopka
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - C Schmid
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - L.S Maier
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - M Arzt
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
| | - S Wagner
- University Hospital Regensburg, University Heart Centre Regensburg, Regensburg, Germany
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Trum M, Riechel J, Lebek S, Pabel S, Sossalla ST, Hirt S, Arzt M, Maier LS, Wagner S. Empagliflozin inhibits Na + /H + exchanger activity in human atrial cardiomyocytes. ESC Heart Fail 2020; 7:4429-4437. [PMID: 32946200 PMCID: PMC7755005 DOI: 10.1002/ehf2.13024] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Recent clinical trials have proven gliflozins to be cardioprotective in diabetic and non-diabetic patients. However, the underlying mechanisms are incompletely understood. A potential inhibition of cardiac Na+ /H+ exchanger 1 (NHE1) has been suggested in animal models. We investigated the effect of empagliflozin on NHE1 activity in human atrial cardiomyocytes. METHODS AND RESULTS Expression of NHE1 was assessed in human atrial and ventricular tissue via western blotting. NHE activity was measured as the maximal slope of pH recovery after NH4 + pulse in isolated carboxy-seminaphtarhodafluor 1 (SNARF1)-acetoxymethylester-loaded murine ventricular and human atrial cardiomyocytes. NHE1 is abundantly expressed in human atrial and ventricular tissue. Interestingly, compared with patients without heart failure (HF), atrial NHE1 expression was significantly increased in patients with HF with preserved ejection fraction and atrial fibrillation. The largest increase in atrial and ventricular NHE1 expression, however, was observed in patients with end-stage HF undergoing heart transplantation. Importantly, acute exposure to empagliflozin (1 μmol/L, 10 min) significantly inhibited NHE activity to a similar extent in human atrial myocytes and mouse ventricular myocytes. This inhibition was also achieved by incubation with the well-described selective NHE inhibitor cariporide (10 μmol/L, 10 min). CONCLUSIONS This is the first study systematically analysing NHE1 expression in human atrial and ventricular myocardium of HF patients. We show that empagliflozin inhibits NHE in human cardiomyocytes. The extent of NHE inhibition was comparable with cariporide and may potentially contribute to the improved outcome of patients in clinical trials.
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Affiliation(s)
- Maximilian Trum
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Johannes Riechel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Simon Lebek
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Steffen Pabel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Samuel T Sossalla
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Messmann R, Dietl A, Wagner S, Domenig O, Jungbauer C, Luchner A, Maier LS, Schopka S, Hirt S, Schmid C, Birner C. Alterations of the renin angiotensin system in human end-stage heart failure before and after mechanical cardiac unloading by LVAD support. Mol Cell Biochem 2020; 472:79-94. [PMID: 32564294 PMCID: PMC7431447 DOI: 10.1007/s11010-020-03787-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
Heart transplantation is often an unrealizable therapeutic option for end-stage heart failure, which is why mechanical left ventricular assist devices (LVADs) become an increasingly important therapeutic alternative. Currently, there is a lack of information about molecular mechanisms which are influenced by LVADs, particularly regarding the pathophysiologically critical renin angiotensin system (RAS). We, therefore, determined regulation patterns of key components of the RAS and the β-arrestin signaling pathways in left ventricular (LV) tissue specimens from 8 patients with end-stage ischemic cardiomyopathy (ICM) and 12 patients with terminal dilated cardiomyopathy (DCM) before and after LVAD implantation and compared them with non-failing (NF) left ventricular tissue samples: AT1R, AT2R, ACE, ACE2, MasR, and ADAM17 were analyzed by polymerase chain reaction. ERK, phosphorylated ERK, p38, phosphorylated p38, JNK, phosphorylated JNK, GRK2, β-arrestin 2, PI3K, Akt, and phosphorylated Akt were determined by Western blot analysis. Angiotensin I and Angiotensin II were quantified by mass spectrometry. Patients were predominantly middle-aged (53 ± 10 years) men with severely impaired LV function (LVEF 19 ± 8%), when receiving LVAD therapy for a mean duration of 331 ± 317 days. Baseline characteristics did not differ significantly between ICM and DCM patients. By comparing failing with non-failing left ventricles, i.e., before LVAD implantation, a downregulation of AT1R, AT2R, and MasR and an upregulation of ACE, ACE2, GRK, β-arrestin, ERK, PI3K, and Akt were seen. Following LVAD support, then angiotensin I, ACE2, GRK, and β-arrestin were downregulated and AT2R, JNK, and p38 were upregulated. ACE, angiotensin II, AT1R, ADAM17, MasR, ERK, PI3K, and Akt remained unchanged. Some regulation patterns were influenced by the underlying etiology of heart failure, the severity of LV dysfunction at baseline, and the duration of LVAD therapy. Key components of the RAS and β-arrestin signaling pathways were divergently altered in failing left ventricles both before and after LVAD implantation, whereas a remarkable fraction remained unchanged. This indicates a rather incomplete molecular reverse remodeling, whose functional relevance has to be further evaluated.
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Affiliation(s)
- Rebecca Messmann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Carsten Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Clinic Barmherzige Brüder, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany.
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Schweiger M, Zuckermann A, Beiras-Fernandez A, Berchtolld-Herz M, Boeken U, Garbade J, Hirt S, Richter M, Ruhpawar A, Schmitto JD, Schönrath F, Schramm R, Schulz U, Wilhelm MJ, Barten MJ. A Review of Induction with Rabbit Antithymocyte Globulin in Pediatric Heart Transplant Recipients. Ann Transplant 2018; 23:322-333. [PMID: 29760372 PMCID: PMC6248300 DOI: 10.12659/aot.908243] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pediatric heart transplantation (pHTx) represents only a small proportion of cardiac transplants. Due to these low numbers, clinical data relating to induction therapy in this special population are far less extensive than for adults. Induction is used more widely in pHTx than in adults, mainly because of early steroid withdrawal or complete steroid avoidance. Antithymocyte globulin (ATG) is the most frequent choice for induction in pHTx, and rabbit antithymocyte globulin (rATG, Thymoglobulin®) (Sanofi Genzyme) is the most widely-used ATG preparation. In the absence of large, prospective, blinded trials, we aimed to review the current literature and databases for evidence regarding the use, complications, and dosages of rATG. Analyses from registry databases suggest that, overall, ATG preparations are associated with improved graft survival compared to interleukin-2 receptor antagonists. Advantages for the use of rATG have been shown in low-risk patients given tacrolimus and mycophenolate mofetil in a steroid-free regimen, in sensitized patients with pre-formed alloantibodies and/or a positive donor-specific crossmatch, and in ABO-incompatible pHTx. Registry and clinical data have indicated no increased risk of infection or post-transplant lymphoproliferative disorder in children given rATG after pHTx. A total rATG dose in the range 3.5–7.5 mg/kg is advisable.
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Affiliation(s)
- Martin Schweiger
- Department of Cardiac Surgery, Children's Hospital, Zürich, Switzerland
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Udo Boeken
- Department of Cardiovascular Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Stephan Hirt
- Department of Cardiac and Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | | | - Arjang Ruhpawar
- Cardiac Surgery Clinic, University of Heidelberg, Heidelberg, Germany
| | - Jan Dieter Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Schönrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, and DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Rene Schramm
- Clinic of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Uwe Schulz
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Markus J Wilhelm
- Clinic for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Markus J Barten
- University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Persoon S, Paulus M, Hirt S, Jungbauer C, Dietl A, Luchner A, Schmid C, Maier LS, Birner C. Cardiac unloading by LVAD support differentially influences components of the cGMP-PKG signaling pathway in ischemic and dilated cardiomyopathy. Heart Vessels 2018; 33:948-957. [PMID: 29546540 DOI: 10.1007/s00380-018-1149-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Abstract
Implantation of left ventricular assist devices (LVADs) as bridge to transplant in end-stage heart failure allows for analyzing reverse remodeling processes of the supported heart. Whether this therapy influences the cGMP-PKG signaling pathway, which is currently under thorough investigation for developing new heart failure therapeutics, is unknown. In fourteen end-stage heart failure patients (8 with dilated cardiomyopathy, DCM; 6 with ischemic cardiomyopathy, ICM) tissue specimens of left ventricles were collected at LVAD implantation and afterwards at receiver heart explantation, respectively. Then the expressions of key components of the cGMP-PKG signaling pathway were determined by polymerase chain reaction (ANP; BNP; natriuretic peptide receptor A, NPR-A; natriuretic peptide receptor C, NPR-C; neprilysin; NOS3; soluble guanylyl cyclase, sGC; PDE5; cGMP-dependent protein kinase G, PKG) and enzyme-linked immunosorbent assay (cGMP), respectively. Patients were predominantly male, 52 ± 10 years old, were receiving recommended heart failure therapy, and had their donor organ implanted after 351 ± 317 days of LVAD support. Except for more DCM patients with ICD therapy, no significant differences were detected between ICM and DCM, which also applies to the expression of cGMP-PKG pathway components at baseline. After LVAD support, ANP, NPR-C, and cGMP were significantly down-regulated and neprilysin, PDE5, and PKG I expressions were reduced with borderline significance in DCM, but not in ICM patients. Multiple significant correlations were found for expression differences (i.e., expression at LVAD implantation minus expression at heart transplantation) both in DCM and ICM, even though there was a closer connection between the NO and NP side of the cGMP-PKG pathway in DCM patients. Furthermore, duration of LVAD support negatively correlated with expression differences of PKG I, PDE5, and sGC in ICM, but not in DCM. Originating from the same activation level at LVAD implantation, cardiac unloading significantly alters key components of the cGMP-PKG pathway in DCM, but not in ICM patients. This etiology-specific regulation should be considered when analyzing therapeutic interventions with effects on this signaling pathway.
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Affiliation(s)
- Sven Persoon
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Christof Schmid
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
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Freundt M, Lunz D, Philipp A, Panholzer B, Lubnow M, Friedrich C, Rupprecht L, Hirt S, Haneya A. Impact of dynamic changes of elevated bilirubin on survival in patients on veno-arterial extracorporeal life support for acute circulatory failure. PLoS One 2017; 12:e0184995. [PMID: 29049294 PMCID: PMC5648125 DOI: 10.1371/journal.pone.0184995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022] Open
Abstract
Aims Veno-arterial extracorporeal life support (ECLS) is an established method to stabilize acute circulatory failure. Parameters and data on when to ideally wean circulatory support are limited. Bilirubin is a marker of end-organ damage. Therefore, the purpose of this large study was to evaluate the impact of dynamic changes of elevated bilirubin levels on survival in patients on ECLS. Methods and results We reviewed 502 consecutive cases of ECLS from 2007 to 2015. Bilirubin levels were recorded before implantation and until six days after explantation. Dynamic bilirubin changes, and hemodynamic and laboratory outcome parameters were compared in survivors and nonsurvivors. Reason for ECLS implantation was cardiac arrest with ongoing resuscitation in 230 (45.8%), low cardiac output in 174 (34.7%) and inability to wean off cardiopulmonary bypass in 98 (19.5%) patients. 307 (61.2%) patients were weaned off ECLS, however, 206 (41.0%) survived. Mean duration of ECLS was 3 (2–6) days, and survivors received significantly longer ECLS (5 vs 3 days, p < 0.001). Survivors had significantly lower baseline bilirubin levels (p = 0.003). Bilirubin started to rise from day 2 in all patients. In survivors, bilirubin levels had trended down on the day of ECLS explantation and stayed at an acceptable level. However, in weaned patients who did not survive and patients who died on ECLS bilirubin levels continued to rise during the recorded period. Conclusion ECLS support improves survival in patients with acute circulatory failure. Down trending bilirubin levels on veno-arterial ECLS indicate improved chances of successful weaning and survival in hemodynamically stable patients.
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Affiliation(s)
- Miriam Freundt
- Dept. of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Dirk Lunz
- Dept. of Anesthesiology and Critical Care, University Medical Center of Regensburg, Regensburg, Germany
| | - Alois Philipp
- Dept. of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Bernd Panholzer
- Dept. of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Lubnow
- Dept. of Internal Medicine II, University Medical Center of Regensburg, Regensburg, Germany
| | - Christine Friedrich
- Dept. of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Leopold Rupprecht
- Dept. of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Dept. of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
| | - Assad Haneya
- Dept. of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany
- Dept. of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
- * E-mail:
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Camboni D, Zerdzitzki M, Hirt S, Tandler R, Weyand M, Schmid C. Reduction of INCOR® driveline infection rate with silicone at the driveline exit site. Interact Cardiovasc Thorac Surg 2017; 24:222-228. [PMID: 27702831 DOI: 10.1093/icvts/ivw336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/04/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives A silicone interface at skin level of left ventricular assist device (LVAD) may reduce the risk of driveline (DL) exit site infections when compared with other materials (e.g. velour). The purpose of this study was to evaluate the rate of DL exit site infection according to the presence of silicone or velour at the exit site with the redesigned INCOR, facilitating the positioning of silicone at the exit site. Methods The rate of DL exit site infection and overall survival were compared between the two groups (silicone group, n = 16/velour group, n = 24) with 1-year follow-up postimplantation. Results Risk factors for infection were more prevalent in the silicone group (obesity P = 0.33, prevalence of renal dysfunction P = 0.007, higher CRP levels P = 0.001). During the observation period, 6 patients developed a DL infection (25%) in the velour group, whereas 1 patient developed a DL infection in (6%) in the silicone group (P = 0.19). The event-per-patient year (EPPY) rates were 0.34 and 0.10 for velour group and silicone group, respectively (P = 0.30). All DL infections could be treated successfully by the antibiotic treatment, surgical debridement and ultimately high urgency heart transplantation, resulting in no direct DL infection-related mortality in this cohort. One-year survival was similar in both the groups (silicone 69 vs 75% in the velour group; P = 0.67). Conclusions Fewer infections were observed at the exit site in case of a silicone-covered DL, without reaching statistical significance. More patients and longer observation periods are needed to demonstrate a statistical difference.
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Affiliation(s)
- Daniele Camboni
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthaeus Zerdzitzki
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - René Tandler
- Department of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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8
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Deuse T, Bara C, Barten M, Hirt S, Doesch A, Knosalla C, Grinninger C, Stypmann J, Porstner M, Wimmer P, Schulz U. A Multi-Center, Randomized, Open-Label, Parallel Group Phase IV Trial Investigating the Outcome on Renal Function, Efficacy and Safety of CNI-Reduction or Elimination With Everolimus in De Novo Heart Transplant: Recipients: The MANDELA Study Design. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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9
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Camboni D, Hirt S, Tandler R, Weyand M, Schmid C. INCOR® INVASTOP - Reduction of Driveline Infection Rate: Observational Prospective Study of Silicone at the Driveline Exit Site. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Freundt M, Haneya A, Philipp A, Kolat P, Rupprecht L, Hirt S, Schmid C. Impact of Cardiac Troponin I as a Predictor of Graft Failure in Selection of Heart Donors. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Freundt M, Haneya A, Ried M, Philipp A, Diez C, Kobuch R, Zausig Y, Hirt S, Schmid C. Improving Outcome of Coronary Artery Bypass Grafting in the Elderly by Using Minimized Extracorporeal Circulation. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Zuckermann A, Schulz U, Deuse T, Ruhpawar A, Schmitto JD, Beiras-Fernandez A, Hirt S, Schweiger M, Kopp-Fernandes L, Barten MJ. Thymoglobulin induction in heart transplantation: patient selection and implications for maintenance immunosuppression. Transpl Int 2014; 28:259-69. [PMID: 25363471 PMCID: PMC4359038 DOI: 10.1111/tri.12480] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/18/2014] [Accepted: 10/24/2014] [Indexed: 01/12/2023]
Abstract
Clinical data relating to rabbit antithymocyte globulin (rATG) induction in heart transplantation are far less extensive than for other immunosuppressants, or indeed for rATG in other indications. This was highlighted by the low grade of evidence and the lack of detailed recommendations for prescribing rATG in the International Society for Heart and Lung Transplantation (ISHLT) guidelines. The heart transplant population includes an increasing frequency of patients on mechanical circulatory support (MCS), often with ongoing infection and/or presensitization, who are at high immunological risk but also vulnerable to infectious complications. The number of patients with renal impairment is also growing due to lengthening waiting times, intensifying the need for strategies that minimize calcineurin inhibitor (CNI) toxicity. Additionally, the importance of donor-specific antibodies (DSA) in predicting graft failure is influencing immunosuppressive regimens. In light of these developments, and in view of the lack of evidence-based prescribing criteria, experts from Germany, Austria, and Switzerland convened to identify indications for rATG induction in heart transplantation and to develop an algorithm for its use based on patient characteristics.
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Affiliation(s)
- Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Freundt M, Haneya A, Schmid C, Hirt S. Dangerous surgical scavenger hunt: the complicated course of a patient with left ventricular assist device and end-stage renal disease undergoing reconstructive flap surgery. Perfusion 2014; 30:469-71. [PMID: 25378418 DOI: 10.1177/0267659114560043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with left ventricular assist devices (LVADs) who develop stage IV sacral pressure sores (SPS) have an increased procedural risk. We present the complications, including severe intra- and postoperative bleeding, diarrhea with metabolic acidosis, volume loss and acute on chronic renal failure, flap dehiscence and late LVAD outflow cannula thrombosis, in a 54-year-old male who underwent diverting ileostomy (DI) and subsequent fasciocutaneous flap (FCF) surgery for stage IV SPS while supported with an LVAD. Our experience suggests that, despite continuous heparinization, life-threatening thrombotic complications, such as device clotting, can occur. Therefore, the benefit of intervention has to outweigh the risk of bleeding, which should be managed with meticulous surgical technique and substitution of red blood cells rather than the reversal of heparinization or the substitution of clotting factors. Continuation of double anti-platelet therapy should also be considered.
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Affiliation(s)
- M Freundt
- Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany Exempla Saint Joseph Hospital, Internal Medicine Residency Program, Denver, CO, USA
| | - A Haneya
- Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Schmid
- Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany
| | - S Hirt
- Dept. Cardiothoracic Surgery, University Hospital Regensburg, Germany
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Diez C, Kolat P, Suesskind-Schwendi M, Ried M, Schmid C, Hirt S, Haneya A. Re-Exploration for Bleeding or Tamponade after Cardiac Surgery: Impact of Timing and Indication on Outcome. Thorac Cardiovasc Surg 2014; 63:51-7. [DOI: 10.1055/s-0034-1390154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Claudius Diez
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Philipp Kolat
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | - Michael Ried
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Assad Haneya
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Kolat P, Ried M, Haneya A, Philipp A, Kobuch R, Hirt S, Hilker M, Schmid C, Diez C. Impact of age on early outcome after coronary bypass graft surgery using minimized versus conventional extracorporeal circulation. J Cardiothorac Surg 2014; 9:143. [PMID: 25185963 PMCID: PMC4243947 DOI: 10.1186/s13019-014-0143-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/04/2014] [Indexed: 02/04/2023] Open
Abstract
Background Objective of this study was to evaluate the impact of age on comparative early outcomes after coronary artery bypass graft surgery (CABG) with minimized (MECC) and conventional extracorporeal circulation (CECC). Methods A retrospective age-, gender- and operation-matched cohort analysis between January 2005 and December 2010 with a total of 2274 patients undergoing CABG with MECC (n = 1137; 50%) or CECC was performed. Patients were stratified into 4 groups according to age: <59 years, 60–69 years, 70–79 years, and 80 years of age or older. Outcomes were compared within each age group. Patients with preoperative dialysis were excluded from analysis. Primary endpoint was 30-day mortality. Results Patients treated with CECC had a significantly higher mean logistic EuroSCORE (6.3% vs. 5.0%; p < 0.001), a slightly lower rate of preoperative myocardial infarction (46% vs. 51%; p = 0.01) and a higher rate of impaired renal function (eGFR < 60 mL/min/1.73 m2: 24% vs. 20%; p = 0.01) compared to MECC-patients. Left internal mammary artery was significantly used more often in MECC patients (93% vs. 86%; p < 0.001). Cardiopulmonary bypass and aortic-cross clamping time were significantly lower in the MECC group (p < 0.001). Overall 30-day mortality was significantly higher in patients treated with CECC (4.4% vs. 2.2%; p = 0.002). Within the different age groups mortality rates were not significantly different except for patients aged 60–69 years (4.5% vs. 1.8%; p = 0.03). Postoperative requirement of renal replacement therapy (4% vs. 2.2%; p = 0.01), respiratory insufficiency (9.9% vs. 6.6%; P = 0.004) and incidence of low cardiac output syndrome (3% vs. 1.2%; p = 0.003) were significantly increased in patients with CECC. Multivariate analysis identified age (p = 0.005; 95% CI 1.01 to 1.08; OR 1.05) among other parameters as an independent risk factor, whereas conventional extracorporeal circulation itself did not present as an independent risk factor for 30-day mortality. Conclusions In this matched study sample early outcome was significantly better in patients with MECC compared to CECC, irrespective of age. Prior myocardial infarction estimated GFR < 60 mL and waiving the use of LIMA were independent risk factors for 30-day mortality, which were more present in the CECC group.
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Camboni D, Lange TJ, Ganslmeier P, Hirt S, Flörchinger B, Zausig Y, Rupprecht L, Hilker M, Schmid C. Left ventricular support adjustment to aortic valve opening with analysis of exercise capacity. J Cardiothorac Surg 2014; 9:93. [PMID: 24884921 PMCID: PMC4099013 DOI: 10.1186/1749-8090-9-93] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/12/2014] [Indexed: 11/21/2022] Open
Abstract
Background LVAD speed adjustment according to a functioning aortic valve has hypothetic advantages but could lead to submaximal support. The consequences of an open aortic valve policy on exercise capacity and hemodynamics have not yet been investigated systematically. Methods Ambulatory patients under LVAD support (INCOR®, Berlin Heart, mean support time 465 ± 257 days, average flow 4.0 ± 0.3 L/min) adjusted to maintain a near normal aortic valve function underwent maximal cardiopulmonary exercise testing (CPET) and right heart catheterization (RHC) at rest and during constant work rate exercise (20 Watt). Results Although patients (n = 8, mean age 45 ± 13 years) were in NYHA class 2, maximum work-load and peak oxygen uptake on CPET were markedly reduced with 69 ± 13 Watts (35% predicted) and 12 ± 2 mL/min/kg (38% predicted), respectively. All patients showed a typical cardiac limitation pattern and severe ventilatory inefficiency with a slope of ventilation to carbon dioxide output of 42 ± 12. On RHC, patients showed an exercise-induced increase of mean pulmonary artery pressure (from 16 ± 2.4 to 27 ± 2.8 mmHg, p < 0.001), pulmonary artery wedge pressure (from 9 ± 3.3 to 17 ± 5.3 mmHg, p = 0.01), and cardiac output (from 4.7 ± 0.5 to 6.2 ± 1.0 L/min, p = 0.008) with a corresponding slight increase of pulmonary vascular resistance (from 117 ± 35.4 to 125 ± 35.1 dyn*sec*cm−5, p = 0.58) and a decrease of mixed venous oxygen saturation (from 58 ± 6 to 32 ± 9%, p < 0.001). Conclusion An open aortic valve strategy leads to impaired exercise capacity and hemodynamics, which is not reflected by NYHA-class. Unknown compensatory mechanisms can be suspected. Further studies comparing higher vs. lower support are needed for optimization of LVAD adjustment strategies.
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Affiliation(s)
- Daniele Camboni
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
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Freundt M, Kolat P, Haneya S, Rupprecht L, Kellner E, Hirt S, Schmid C. CALCINEURIN INHIBITOR-FREE IMMUNOSUPPRESSION AFTER HEART TRANSPLANTATION: TRADING IMPROVING RENAL FUNCTION FOR RISK OF ACUTE AND CHRONIC REJECTION IN FOLLOW-UP? J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60876-7] [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: 11/25/2022]
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Eisen HJ, Kobashigawa J, Starling RC, Pauly DF, Kfoury A, Ross H, Wang SS, Cantin B, Van Bakel A, Ewald G, Hirt S, Lehmkuhl H, Keogh A, Rinaldi M, Potena L, Zuckermann A, Dong G, Cornu-Artis C, Lopez P. Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial. Am J Transplant 2013; 13:1203-16. [PMID: 23433101 DOI: 10.1111/ajt.12181] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 01/25/2023]
Abstract
In an open-label, 24-month trial, 721 de novo heart transplant recipients were randomized to everolimus 1.5 mg or 3.0 mg with reduced-dose cyclosporine, or mycophenolate mofetil (MMF) 3 g/day with standard-dose cyclosporine (plus corticosteroids ± induction). Primary efficacy endpoint was the 12-month composite incidence of biopsy-proven acute rejection, acute rejection associated with hemodynamic compromise, graft loss/retransplant, death or loss to follow-up. Everolimus 1.5 mg was noninferior to MMF for this endpoint at month 12 (35.1% vs. 33.6%; difference 1.5% [97.5% CI: -7.5%, 10.6%]) and month 24. Mortality to month 3 was higher with everolimus 1.5 mg versus MMF in patients receiving rabbit antithymocyte globulin (rATG) induction, mainly due to infection, but 24-month mortality was similar (everolimus 1.5 mg 10.6% [30/282], MMF 9.2% [25/271]). Everolimus 3.0 mg was terminated prematurely due to higher mortality. The mean (SD) 12-month increase in maximal intimal thickness was 0.03 (0.05) mm with everolimus 1.5 mg versus 0.07 (0.11) mm with MMF (p < 0.001). Everolimus 1.5 mg was inferior to MMF for renal function but comparable in patients achieving predefined reduced cyclosporine trough concentrations. Nonfatal serious adverse events were more frequent with everolimus 1.5 mg versus MMF. Everolimus 1.5 mg with reduced-dose cyclosporine offers similar efficacy to MMF with standard-dose cyclosporine and reduces intimal proliferation at 12 months in de novo heart transplant recipients.
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Affiliation(s)
- H J Eisen
- Division of Cardiology, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA.
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Camboni D, Lange T, Lunz D, Rupprecht L, Hilker M, Hirt S, Schmid C. Slight Exercise in Ambulatory LVAD Patients Leads to a Severe Compromise of Hemodynamic Parameters. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Ried M, Kolat P, Haneya A, Rupprecht L, Kobuch R, Hirt S, Hilker M, Diez C, Schmid C. Emergency coronary artery bypass surgery using minimized extracorporeal circulation compared to conventional extracorporeal circulation. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Haneya A, Kobuch R, Kolat P, Ried M, Zausig Y, Lunz D, Hirt S, Schmid C. Impact of re-exploration for bleeding or tamponade on outcome after cardiac surgery. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Camboni D, Lange T, Ganslmeier P, Flörchinger B, Amann M, Rupprecht L, Hirt S, Hilker M, Schmid C. Slight exercise in ambulatory LVAD patients leads to a severe compromise of hemodynamic parameters. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kobuch R, Hilker M, Rupprecht L, Hirt S, Keyser A, Puehler T, Amman M, Zink W, Schmid C. Late reoperations after repaired acute type A aortic dissection. J Thorac Cardiovasc Surg 2012; 144:300-7. [PMID: 22078710 DOI: 10.1016/j.jtcvs.2011.08.052] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 07/15/2011] [Accepted: 08/25/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Reinhard Kobuch
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany
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Hoenicka M, Hirt S. YC-1 induced constrictions: no dependency on other vasoconstrictor. Ann Thorac Surg 2012; 93:1762; author reply 1762. [PMID: 22541226 DOI: 10.1016/j.athoracsur.2011.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 11/29/2022]
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Kobashigawa J, Pauly D, Kfoury A, Ross H, Wang SS, Cantin B, van Bakel A, Starling R, Hirt S, Dong G, Panis C, Lopez P, Eisen H. 201 Multicenter Randomized Trial of Everolimus vs. Mycophenolate Mofetil in Heart Transplantation: Final 24 Month Analysis of Efficacy and Safety. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ganslmeier P, Schneider HJ, Monika G, Foltan M, Diez C, Camboni D, Hilker M, Hirt S, Schmid C. 556 Benefits of Physical Training on Exercise Capacity and Ventricular Pump Function in Patients with Ventricular Assist Devices Long-Term Post Implantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lehmkuhl H, Bara C, Zuckermann A, Lopez P, Dong G, Hirt S. 667 Development of Serum Lipids in Everolimus Treated Heart Recipients. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kobuch R, Schelker E, Hirt S, Amann M, Diez C, Schmid C. Quality of Life Following Surgery of Ascending Aorta and Aortic Arch with Selective Antegrade Cerebral Perfusion. Thorac Cardiovasc Surg 2012; 60:496-500. [DOI: 10.1055/s-0031-1299583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Reinhard Kobuch
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Erich Schelker
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Matthias Amann
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Claudius Diez
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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Haneya A, Philipp A, Foltan M, Camboni D, Kobuch R, Hirt S, Ried M, Diez C, Puehler T, Schmid C. Successful coronary artery bypass grafting with the aid of a new portable, minimized extracorporeal life support system. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ganslmeier P, Schneider HJ, Keyser A, Michl M, Foltan M, Hirt S, Hilker M, Schmid C. Hemodynamic effects of pump flow reduction in patients with axial flow pumps during exercise training. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hoenicka M, Keyser A, Rupprecht L, Puehler T, Hirt S, Schmid C. Endothelium-dependent vasoconstriction in isolated vessel grafts: a novel mechanism of vasospasm? Ann Thorac Surg 2011; 92:1299-306. [PMID: 21958775 DOI: 10.1016/j.athoracsur.2011.05.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Received: 02/10/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND YC-1 (3-(5'-hydroxymethyl-2'furyl)-1-benzyl-indazole) is an allosteric activator of soluble guanylyl cyclase (sGC) and a vasodilator. This study describes a paradoxical action of YC-1 in isolated vessels of patients with coronary artery disease (CAD) that appears to trigger an endothelium-dependent vasoconstrictor pathway present in vessels with endothelial dysfunction. METHODS Effects of YC-1 on the tensions of isolated vessels were investigated in an organ bath. Vasoconstrictors released from the vessels were quantified through enzyme-linked immunosorbent assay. RESULTS YC-1 elicited long-lasting constriction in saphenous veins and radial arteries from patients with CAD, but not in human umbilical veins. The half-maximal effective dose was 1.0 μmol/L. Constriction was attenuated by nifedipine (an L-type Ca(2+)-channel blocker), bosentan (an endothelin [ET](A)/ET(B) inhibitor), BQ-788 (N-[(cis-2,6-Dimethyl-1-piperidinyl)carbonyl]-4-methyl-L-leucyl-1-(methoxycarbonyl)-D-tryptophyl-D-norleucine; an ET(B) inhibitor), and by denuding, but not by ODQ (1H-(1,2,4)oxadiazolo[4,3-a]quinoxalin-1-one; an inhibitor of sGC), BQ-123 (cyclo(-D-Trp-D-Asp-Pro-D-Val-Leu); an ET(A) inhibitor), or phosphoramidon (an endothelin converting enzyme inhibitor). Indomethacin (an inhibitor of cyclooxygenase-1 and -2) and SQ29,548 ([1S-[1α,2α(Z),3α,4α]]-7-[3-[[2-[(phenylamino)carbonyl]hydrazino]methyl]-7-oxabicyclo[2.2.1]hept-2-yl]-5-heptenoic acid; a thromboxane receptor antagonist) suppressed YC-1-induced constriction, whereas DFU (5,5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulfonyl)phenyl-2(5H)-furanone; a cyclooxygenase-2 inhibitor) had no effect. Rings of saphenous vein released significantly more endothelin-1 in the presence than in the absence of YC-1. CONCLUSIONS YC-1-induced vasoconstriction demonstrates the existence of an endothelium-dependent vasoconstrictor pathway in the blood vessels of patients with CAD that to date has been described only in animal models of hypertension. Patients with CAD who have elevated plasma levels of endothelin-1 are thus prone to endothelium-dependent vasoconstriction, which may also play a role in vasospasm in vascular grafts.
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Affiliation(s)
- Markus Hoenicka
- Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Regensburg, Germany.
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Ried M, Hirt S, Schmid C. Over 2-year disease-free survival after multimodality therapy of a primary cardiac lymphoma. J Heart Lung Transplant 2011; 31:334. [PMID: 22014449 DOI: 10.1016/j.healun.2011.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/12/2011] [Accepted: 09/28/2011] [Indexed: 11/25/2022] Open
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Benck U, Hoeger S, Brinkkoetter PT, Gottmann U, Doenmez D, Boesebeck D, Lauchart W, Gummert J, Karck M, Lehmkuhl HB, Bittner HB, Zuckermann A, Wagner F, Schulz U, Koch A, Bigdeli AK, Bara C, Hirt S, Berchtold-Herz M, Brose S, Herold U, Boehm J, Welp H, Strecker T, Doesch A, Birck R, Krämer BK, Yard BA, Schnuelle P. Effects of Donor Pre-Treatment With Dopamine on Survival After Heart Transplantation. J Am Coll Cardiol 2011; 58:1768-77. [DOI: 10.1016/j.jacc.2011.05.060] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/14/2011] [Accepted: 05/10/2011] [Indexed: 12/17/2022]
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Pauly D, Starling R, Kobashigawa J, Wang S, Cantin B, Keogh A, Lehmkuhl H, Hirt S, Lopez P, Dong G, Cines M, Jiang H, Eisen H. 57 Heart Transplant Recipients Treated with Everolimus Have Less Increase in Intimal Thickness vs MMF, Irrespective of Lipid Values. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Haneya A, Haake N, Diez C, Puehler T, Cremer J, Schmid C, Hirt S. Impact of the Eurotransplant High-Urgency Heart Allocation System on the Outcome of Transplant Candidates in Germany. Thorac Cardiovasc Surg 2011; 59:93-7. [DOI: 10.1055/s-0030-1250482] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kolat P, Kobuch R, Hirt S, Janotta M, Kasprzak P, Schmid C. Total aortic replacement for extensive aneurysmal disease by staged hybrid procedure using E-vita open followed by percutaneous endovascular interventions. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hoenicka M, Keyser A, Klose A, Huber G, Hirt S, Puehler T, Schmid C. Endothelium-dependent contractions in bypass grafts: A novel mechanism of vasospasms? Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ganslmeier P, Schneider H, Rupprecht L, Zausig Y, Hirt S, Hilker M, Schmid C. Effects of exercise training in patients with axial flow pumps. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haneya A, Philipp A, Zausig Y, Rupprecht L, Hirt S, Schmid C. First use of the Cardiohelp system in the ECMO-LVAD concept. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ried M, Haneya A, Zausig Y, Rupprecht L, Hirt S, Hilker M, Schmid C. Over 1-year disease-free survival after sequential therapy of a primary cardiac lymphoma. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haneya A, Philipp A, Puehler T, Diez C, Ried M, Hirt S, Rupprecht L, Zausig Y, Schmid C, Lehle K. Minimized versus conventional cardiopulmonary bypass: outcome of diabetic patients after coronary artery bypass grafting. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schopka S, Hilker M, Haneya A, Hirt S, Arlt M, Zink W, Schmid C. Temporary circulatory assist for right heart failure. A new approach. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Haneya A, Philipp A, Mueller T, Lubnow M, Pfeifer M, Zink W, Hilker M, Schmid C, Hirt S. Extracorporeal Circulatory Systems as a Bridge to Lung Transplantation at Remote Transplant Centers. Ann Thorac Surg 2011; 91:250-5. [DOI: 10.1016/j.athoracsur.2010.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 09/01/2010] [Accepted: 09/03/2010] [Indexed: 11/27/2022]
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Hoenicka M, Wiedemann L, Puehler T, Hirt S, Birnbaum DE, Schmid C. Effects of Shear Forces and Pressure on Blood Vessel Function and Metabolism in a Perfusion Bioreactor. Ann Biomed Eng 2010; 38:3706-23. [DOI: 10.1007/s10439-010-0116-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
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Puehler T, Haneya A, Philipp A, Camboni D, Hirt S, Zink W, Lehle K, Rupprecht L, Kobuch R, Diez C, Schmid C. Minimized extracorporeal circulation in coronary artery bypass surgery is equivalent to standard extracorporeal circulation in patients with reduced left ventricular function. Thorac Cardiovasc Surg 2010; 58:204-9. [PMID: 20514574 DOI: 10.1055/s-0029-1241028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Minimized extracorporeal circulation (MECC) is a promising alternative to standard extracorporeal circulation (ECC) and its use is increasing in routine coronary bypass surgery. We analyzed the clinical outcome of patients with reduced left ventricular function who underwent coronary artery bypass surgery with MECC or with standard ECC. METHODS From January 2003 to September 2008, 238 patients with a left ventricular function < 30 % underwent bypass surgery with ECC or MECC. The primary end point of our retrospective observational study was 30-day mortality. Secondary endpoints were the transfusion requirements, as well as intensive care and the in-hospital course. RESULTS Demographic data, comorbidities and left ventricular function were similar in the study groups. MECC patients had a tendency towards a lower 30-day mortality rate, a better postoperative renal function and reduced ventilation times. Extracorporeal circulation time and postoperative high-dose inotropic support were significantly lower in the MECC group, while the stays in the intensive care unit and in hospital were comparable between the two groups. In our study, age in the ECC group, and previous infarction and New York Heart Association grade IV in the MECC group were preoperative risk factors associated with a higher mortality. CONCLUSION Coronary bypass surgery using MECC is feasible and safe for patients with severely impaired left ventricular function. It is a promising alternative to ECC with a low mortality rate and a more favorable postoperative course.
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Affiliation(s)
- T Puehler
- Department of Cardiothoracic Surgery, Medical Center University Regensburg, Regensburg, Germany.
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Puehler T, Gleich O, Schopka S, Rupprecht L, Hirt S, Schmid C, Lehle K. Impact of normothermic perfusion and protein supplementation on human endothelial cell function during organ preservation. Ann Thorac Surg 2010; 89:512-20. [PMID: 20103334 DOI: 10.1016/j.athoracsur.2009.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Received: 02/27/2009] [Revised: 10/13/2009] [Accepted: 10/14/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hypothermia-induced changes in endothelial cell (EC) morphology and function after organ storage may influence the initial outcome and development of transplant-associated coronary artery disease. METHODS Human saphenous vein ECs were incubated with saline (NaCl), University of Wisconsin (UW), and histidine-tryptophan-ketoglutarate (HTK) solution, with and without protein additives, at 4 degrees C and 37 degrees C. After 6 hours, ECs were recultivated for 24 and 48 hours with culture medium (reperfusion). Mitochondrial activity, adenosine triphosphate concentration, cell count, and inflammatory responses were analyzed. RESULTS Cold preservation did not affect the mitochondrial activity of ECs and allowed a complete regeneration of the metabolic turnover after reperfusion. However, under normothermic conditions the metabolism of the cells was influenced by time and type of preservation solution. While both the mitochondrial activity and cell count did not change after treatment with NaCl and culture medium, the metabolic turnover of cells treated with HTK and UW solution significantly increased (twofold) and decreased (twofold, p < 0.05), respectively, after reperfusion. The endothelial reactivity remained unchanged after treatment with NaCl and HTK. The addition of serum proteins significantly improved mitochondrial activity of cells treated with warm NaCl and HTK (p < 0.05). The UW-treated cells burned out through a significant up-regulation of the ATP concentration resulting in a complete metabolic regression after reperfusion and induction of apoptosis. CONCLUSIONS Normothermic preservation in UW prevented regeneration of ECs, while treatment with HKT solution did not irreversibly affect mitochondrial activity of ECs and allowed complete regeneration of metabolism and function. Serum proteins improved the preservation effect of HTK and NaCl.
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Affiliation(s)
- Thomas Puehler
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
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Suesskind-Schwendi MV, Brunner E, Lehle K, Puehler T, Schmid C, Hirt S. Everolimus in the treatment of chronic lung rejection. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kobuch R, Hirt S, Rupprecht L, Hilker M, Schmid C. Reoperations after repaired acute type A dissection. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Haneya A, Camboni D, Philipp A, Mueller T, Lubnow M, Hilker M, Arlt M, Zink W, Schmid C, Hirt S. Extracorporeal circulatory systems as a bridge to lung transplantation at remote transplant centers. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ried M, Rupprecht L, Hirt S, Zausig Y, Grube M, Hilker M, Hofstädter F, Schmid C. Cardiac T-cell lymphoma treated by total artificial heart, heart transplantation and chemotherapy. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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